Acute Bilateral Internal Carotid Artery Territory Infarction Associated with a Variant of Aortic Arch Branching

ABSTRACT

Acute bilateral internal carotid artery occlusion (ICAO) is a rare form of ischemic stroke. The possible role of variants of the aortic arch in bilateral ICAO has never been reported. Two patients presented with abrupt coma with quadriplegia. Magnetic resonance images revealed acute ischemic lesions on both hemispheres, except the area supplied by the vertebrobasilar artery. Both patients showed variation of the origin of the brachiocephalic trunk and left common carotid artery. This variation might explain simultaneous bilateral carotid territory infarctions.