Anterior cerebral artery (ACA) infarct
Anterior cerebral artery (ACA) territory infarcts are much less common than either middle or posterior cerebral artery territory infarcts.
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Epidemiology
ACA territory infarcts are rare, comprising ~2% of ischemic strokes 1,2.
Clinical presentation
ACA stroke syndrome presents as 1,2,3:
- dysarthria, aphasia
- unilateral contralateral motor weakness (leg/shoulder > arm/hand/face)
- minimal sensory changes (two-point discrimination) in the same distribution as above
- left limb apraxia
- urinary incontinence
Pathology
ACA territory infarcts are less common because if the A1 segment is occluded there is generally enough collateral flow via the contralateral A1 segment to supply the distal ACA territory 2.
Embolic strokes (often with MCA involvement) are the most common cause 3. Rarely, they are also seen as a complication of severe midline shift, where the ACA is occluded by mass effect or severe vasospasm.
Radiographic features
The features are those of cerebral infarction in the anterior cerebral artery vascular territory:
- paramedian frontoparietal cerebral cortex
- anterior corpus callosum
- anterior limb of the internal capsule
- inferior portion of the caudate head
Differential diagnosis
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stroke and intracranial hemorrhage
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ischemic stroke
- general discussions
- scoring and classification systems
- signs
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- alexia without agraphia syndrome: PCA
- cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
- Balint syndrome: bilateral PCA
- internal capsule infarct
- ataxic hemiparesis syndrome: MCA perforators or basilar artery perforators
- lacunar infarct
- thalamic infarct
- Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
- top of the basilar syndrome
- striatocapsular infarct
- cerebellar infarct
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brainstem infarct
- midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Nothnagel syndrome: PCA
- Weber syndrome: PCA
- pontine infarct
- Brissaud-Sicard syndrome
- facial colliculus syndrome
- Gasperini syndrome: basilar artery or AICA
- inferior medial pontine syndrome (Foville syndrome): basilar artery
- lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
- locked-in syndrome: basilar artery
- Millard-Gubler syndrome: basilar artery
- Raymond syndrome: basilar artery
- medullary infarct
- Babinski-Nageotte syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- treatment options
- complications
-
intracranial hemorrhage
-
intra-axial hemorrhage
- signs
- by region or type
- extra-axial hemorrhage
-
intra-axial hemorrhage
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ischemic stroke
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