1420 - Same Symptoms, Different Times: An Exceedingly Rare Case of Bilateral Symmetric MCA Strokes, Resulting in Identical Contralateral Symptoms, 20 Years Later
Physician Penn State Health Hershey, Pennsylvania, United States
Case Diagnosis: We describe a rare case of bilateral, symmetric, distal hand sensation loss secondary to first a left-sided MCA stroke in 2001, followed by right-sided middle cerebral artery (MCA) stroke in 2021, in the same, but contralateral, distribution as prior, resulting again in isolated distal hand sensation loss in a 53-year-old male. To our knowledge, such a case of identical strokes, in contralateral distribution separated temporally by such a time frame has not yet been described.
Case Description: A 53-year-old male with history of previous left M2 MCA stroke with residual right-sided hemianesthesia isolated to all digits distal to his metacarpophalangeal joints initially presented to the ER with symptoms of dysarthria, left hemiparesis and hemisensory loss, and neglect. CTA was concerning for right distal M2 occlusion and tenecteplase was given. Subsequent MRI revealed acute right frontoparietal lobe infarct within right MCA distribution and evidence of chronic encephalomalacia of left frontoparietal lobe at site of previous stroke. Cardioembolic and hypercoagulable workup were unremarkable, thus etiology undetermined, however patient was placed on dual anti-platelet therapy with aspirin and clopidogrel. The patient’s only residual deficit upon rehabilitation completion was hemianesthesia distal to his MCP joints now on his left-side, mirroring previous right-sided symptoms.
Discussions: Anatomical variation of cerebral vasculature or focal narrowing may predispose certain regions of the brain to ischemia however, in the presence of normal cerebral vasculature, it is exceedingly unlikely that a patient might not only experience the same sub-distribution stroke resulting in the exact same symptoms so many years apart. A case of bilateral symmetric strokes in a cocaine user has been described, yet these strokes were co-occurring, and symptoms were asymmetric.
Conclusions: This report details a rare case not only of stroke symmetry in normal cerebral vasculature, but that of isolated symptoms to the distal hand, separated by 20 years.
