1Post Graduate, Department of Radio-Diagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044. Email: muthujournal1@gmail.com; Phone: 8667486031
2Head of Department, Department of Radio-Diagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044. Email: dr.gmurugan@yahoo.com
3*Senior Resident, Department of Radio-Diagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044. Email: drmaniksmc@gmail.com
*Corresponding Author: Dr. Manikandan S, Senior Resident, Department of Radio-Diagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, 600044. Email: drmaniksmc@gmail.com
Background: Ischemic stroke in the posterior circulation accounts for a significant portion of all cerebrovascular events and often presents diagnostic challenges due to variable clinical manifestations and complex vascular anatomy. We report a case of a 61-year-old female patient with acute-onset neurological symptoms, who underwent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain.
Imaging Findings: The imaging revealed an acute/subacute infarct in the left posterior cerebral artery (PCA) territory, characterized by gyriform T2/FLAIR hyperintensities with diffusion restriction. This acute event was superimposed on chronic infarcts in the left gangliocapsular region and thalamus, with associated chronic small vessel ischemic changes in the bilateral frontoparietal white matter. Time-of-flight (TOF) MRA demonstrated a complex arrangement of posterior circulation variants, including a non-fusion of the vertebral arteries (VA) where the left VA continued as the basilar artery and the right VA terminated as the anterior inferior cerebellar artery (AICA), a fetal origin of the right PCA, and a hypoplastic left PCA.
Conclusion: This case highlights the crucial role of advanced neuroimaging in characterizing both the parenchymal consequences and the underlying vascular anomalies in stroke. It underscores how anatomical variants can create hemodynamic vulnerabilities, predisposing individuals to ischemic events, particularly in the context of chronic microvascular disease. The findings emphasize the need for a comprehensive vascular evaluation to understand stroke etiology and guide secondary prevention strategies.
Keywords: Posterior Cerebral Artery, Ischemic Stroke, Magnetic Resonance Angiography, Vertebral Artery Anomaly, Fetal Posterior Cerebral Artery
How to cite this article: Manickam M, Murugan G, Manikandan S. A Case of Acute-on-Chronic Ischemic Stroke in the Posterior Cerebral Artery Territory Associated with Complex Posterior Circulation Variants. Int J Drug Deliv Technol. 2026;16(12s): 821-824. DOI: 10.25258/ijddt.16.12s.97
Source of support: Nil.
Conflict of interest: None