ABSTRACT
The middle cerebral artery (MCA) tends to be the preferential end point for emboli originating from the internal carotid artery, but the anterior cerebral artery (ACA) or both the MCA and ACA can be occluded if the embolus is large. The presenting symptoms at that time, localizing to the right frontal area, suggest that there was a transient disturbance of flow in a branch of the right MCA probably due to a small embolus originating in the right internal carotid artery. In Etienne's case, it is unlikely that a hemiplegic migraine attack would occur for the first time at age 57; the disorder is primarily seen in children and young adults. In Etienne's case, the first embolus probably formed over complex plaque at the origin of the right internal carotid artery and travelled to the MCA, where it transiently blocked a small branch artery serving the motor strip on the right.
