Anterior cerebral artery (ACA) territory infarctions are relatively rare, accounting for 0.3 % to 4.4 % of stroke cases, with bilateral occurrences being even rarer. These infarctions can lead to quadriplegia/paresis. Bilateral ACA territory infarctions are possibly caused by vasospasm due to subarachnoid haemorrhage (SAH) from ruptured anterior communicating artery (ACoA) aneurysms or thrombosis in the presence of a rudimentary contralateral artery. ACoA aneurysm with quadriparesis is extremely unusual, with this being only the second recorded occurrence and the youngest reported. Overall, understanding the mechanisms and consequences of ACA territory infarctions, especially bilateral occurrences, remains crucial for effective diagnosis and management of such rare but serious neurological events.

A 35-year-old male, previously healthy, presented with quadriparesis and an ACoA aneurysm. Initially experiencing a headache and brief loss of consciousness, he later developed right foot drop and progressive right-sided weakness, leading to altered consciousness. Subsequent imaging revealed SAH consistent with the aneurysm and also bilateral ACA territory infractions. Upon referral for further management, he presented with intact higher mental functions but motor deficits in the upper and lower limbs. Imaging and assessments confirmed the diagnosis, prompting a decision for craniotomy and clipping. Postoperatively, the patient showed improvement, with enhanced power in both upper limbs at one-month follow-up.

Bilateral ACA territory infarction is unusual, and the symptoms are not yet well understood. ACoA aneurysm with quadriparesis is extremely unusual. Understanding the mechanics and clinical consequences of bilateral ACA territory infarctions is critical for early detection and management.

An anterior communicating artery (ACoA) aneurysm causing unilateral pupil sparing oculomotor nerve paresis is highly unusual. This is, to the best of our knowledge, the second case report of its sort. Compression, ischemia, or haemorrhage affecting the anterior visual pathway are common neuro-ophthalmic manifestations of ACoA aneurysm but when there is partial paresis it only affects the superior division of the third cranial nerve's fibres which is an extremely rare occurrence.

A 45-year-old man came in as an outpatient with complaints of severe headache and right eyelid drooping for the previous 6 days. He had GCS 15 (E4,V5,M6), and right eyelid partial ptosis with normal reactive pupils. The other cranial nerves and neurological examination came out normal. A non-contrast enhanced computed tomography (CT) scan of the brain revealed a hyperdense area around the ACoA region and SAH. During CT angiography, an ACoA aneurysm was found. The patient was clipped on the 24th post-bleeding day. On the three-week follow-up appointment, the ptosis had improved somewhat.

Although unilateral pupil sparing oculomotor nerve paresis has little localising utility, it does help to comprehend acute microvascular spasm, which may have therapeutic implications.

To appraise the overall outcomes of microsurgical resection of low-grade arteriovenous malformations (AVMs) in a low-middle-income country.

Data was collected prospectively from three different neurosurgical centres in Pakistan for this study and it lasted for two years. According to the Spetzler-Martin (S-M) grading system, patients diagnosed with cerebral AVMs were divided into three classes A, B, and C. AVMs of grade 1 and 2 were included in Class A. Class B contained grade 3 AVMs, while Class C contained grade 4 and 5 AVMs. All male and female patients in Class A were eligible for this study. Patients were evaluated postoperatively for seizures, haemorrhage, focal neurological deficits, and AVM cure rates. Morbidity, mortality, and functional recovery were used to evaluate the outcome. Functional recovery and cure rate were observed after 6 months of follow-up.

There were a total of 22 patients. Mean age was 36.41 ± 14.32 SD years. There were 12 (54.5 %) male patients and 10 (45.5 %) female patients. 13 patients (59.1 %) presented with spontaneous intracerebral haemorrhage, while 9 patients (40.9 %) presented with seizures. 14 patients (63.6 %) had S-M grade 1 and 8 patients (36.4 %) had S-M grade 2. All patients underwent microsurgical resection. We discovered 4.5 % morbidity in our study. There was no postoperative mortality. At 6 months, an excellent functional outcome of 95.5 % (according to the Glasgow outcome scale) and 100 % cure rate was observed.

Microsurgery is a safe and effective treatment for low-grade AVMs in terms of morbidity, mortality, functional outcome and cure rates in our country.