—We agree that the mechanism of bilateral pallidal necrosis as seen in hypoxic-ischemic brain injury is probably not related to anterior choroidal artery (AchA) compression, but rather metabolically mediated and due to selective vulnerability. Computed tomographic scans in our cases1 and those of Decroix et al2 of AchA infarcts always included involvement of the posterior limb of the internal capsule as do all necropsy cases.3-7 Furthermore, hypoxic ischemic injury also involves the thalamus and other structures distant from the AchA, and many patients have no evidence of brain swelling.
Helgason CM, Caplan LR, Goodwin JA, Hedges T. Bilateral Basal Ganglia Necrosis Following Diffuse Hypoxic-lschemic Injury-Reply. Arch Neurol. 1987;44(9):897. doi:10.1001/archneur.1987.00520210005004
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