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Anterior cerebral artery (ACA) infarct

Dr Yair Glick ◉ and Dr Henry Knipe ◉ ◈ et al.

Anterior cerebral artery (ACA) territory infarcts are much less common than either middle or posterior cerebral artery territory infarcts.

On this page:

Article:

Epidemiology
Clinical presentation
Pathology
Radiographic features
Differential diagnosis
Related articles
References

Images:

Cases and figures

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

References

Stroke and intracranial haemorrhage

stroke and intracranial hemorrhage
- ischemic stroke
  - general discussions
  - scoring and classification systems
  - signs
    - hyperdense MCA sign
    - MCA dot sign
  - by region
    - hemispheric infarcts
      - frontal lobe infarct
      - parietal lobe infarct
        Gerstmann syndrome
      - 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
      - lacunar stroke syndromes
    - thalamic infarct
      - Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
      - top of the basilar syndrome
    - striatocapsular infarct
    - cerebellar infarct
    - 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)
    - acute spinal cord ischemia syndrome
  - by vascular territory
  - treatment options
    - mechanical thrombectomy
  - complications
    - crossed cerebellar diaschisis
    - hemorrhagic transformation of an ischemic infarct
      - cerebral intraparenchymal hyperattenuations post thrombectomy
- intracranial hemorrhage
  - intra-axial hemorrhage
    - signs
      - CTA spot sign
    - by region or type
  - extra-axial hemorrhage

Article information

rID: 39171

System: Vascular, Central Nervous System

Synonyms or Alternate Spellings:

ACA infarct
Anterior cerebral artery infarct
Anterior cerebral artery (ACA) territory infarcts

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Cases and figures

Figure 1: ACA territory (yellow) Figure 1: ACA territory (yellow)

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Figure 2: ACA territory (yellow) Figure 2: ACA territory (yellow)

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Figure 3: vascular territories Figure 3: vascular territories

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Case 1: as complication of MCA infarctCase 1: as complication of MCA infarct

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Case 2: cardio-embolicCase 2: cardio-embolic

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Case 3Case 3

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Case 4Case 4

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