Anterior choroidal artery syndrome

Anterior choroidal artery syndrome is a rare entity characterisedcaused by the triad of:

• hemiplegia

• hemianaesthesia

• contralateral hemianopia

This occurs as a result of cerebral infarction in the anterior choroidal artery territory territory.

In its complete form, the syndrome is characterised by the triad of ⁷:

• contralateral hemiplegia

• contralateral hemisensory loss

• contralateral homonymous hemianopia

  • e.g. homonymous quadruple sectoranopia if the lateral geniculate body is involved

  • e.g. incongruent homonymous hemianopia if the optic tract is involved

Incomplete forms of the syndrome are more common than that of complete forms ⁷. The syndrome may also be associated with neuropsychological disorders, including left neglect syndrome in right-sided lesions and disorders of speechlanguage in left-sided lesions.

Incomplete forms of the syndrome are more common than that of complete forms. The incomplete forms include lacunar syndromes and ataxic hemiparesis ⁵⁷.

Pathology

Aetiology

The complete Complete anterior choroidal artery ichaemic strokes are usually associated with cardioembolic sources anddue to cardioembolism or internal carotid artery stenosis. Smaller strokes (i.e. lacunar strokes) that involve only parts of the territory are typically due to T2traditional cerebrovascular risk factors, such as type 2 diabetes mellitus, hypertension and hyperlipidaemia ⁵. The classic triad of symptoms isof a complete syndrome are rare to see because of the anastomosis with perforators from the middle cerebral, posterior cerebral and posterior communicating arteries.

DiagnosisDifferential diagnosis

The anterior choroidal artery has an extensive area of supply and large variations in its distributed territory ⁶. As a result of its extensive and strategic supply, anterior choroidal artery infarcts can often be confused with posterior cerebral artery or middle cerebral artery infarcts ⁶.