Anterior cerebral artery (ACA) infarct
Disclosures
- updated 30 Aug 2022:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
Updates to Article Attributes
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was changed:
Anterior cerebral artery (ACA) territory infarcts are much less common than either middle or posterior cerebral artery territory infarcts.
Epidemiology
ACA territory infarcts are rare, comprising ~2% of ischaemic strokes 1,2.
Clinical presentation
ACA stroke syndrome presents as 1-3:
- 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
-<p><strong>Anterior cerebral artery (ACA) territory infarcts</strong> are much less common than either <a href="/articles/middle-cerebral-artery-mca-infarct">middle</a> or <a href="/articles/posterior-cerebral-artery-pca-infarct">posterior cerebral artery territory infarcts</a>.</p><h4>Epidemiology</h4><p><a href="/articles/anterior-cerebral-artery">ACA</a> territory infarcts are rare, comprising ~2% of <a href="/articles/ischaemic-stroke">ischaemic strokes</a> <sup>1,2</sup>.</p><h4>Clinical presentation</h4><p>ACA stroke syndrome presents as <sup>1-3</sup>:</p><ul>-<li>dysarthria, aphasia</li>-<li>unilateral contralateral motor weakness (leg/shoulder > arm/hand/face)</li>-<li>minimal sensory changes (two-point discrimination) in the same distribution as above</li>-<li>left limb <a title="Apraxia" href="/articles/apraxia">apraxia</a>-</li>-<li>urinary incontinence</li>-</ul><h4>Pathology</h4><p>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 <sup>2</sup>.</p><p>Embolic strokes (often with MCA involvement) are the most common cause <sup>3</sup>. Rarely, they are also seen as a complication of severe <a href="/articles/midline-shift">midline shift</a>, where the ACA is occluded by mass effect or severe <a href="/articles/cerebral-vasospasm-following-subarachnoid-haemorrhage">vasospasm</a>.</p><h4>Radiographic features</h4><p>The features are those of <a href="/articles/stroke">cerebral infarction</a> in the anterior cerebral artery <a href="/articles/cerebral-vascular-territories">vascular territory</a>:</p><ul>-<li>paramedian frontoparietal cerebral cortex</li>-<li>anterior <a href="/articles/corpus-callosum">corpus callosum</a>-</li>-<li>anterior limb of the <a href="/articles/internal-capsule">internal capsule</a>-</li>-<li>inferior portion of the <a href="/articles/caudate-nucleus">caudate</a> head</li>-</ul><h4>Differential diagnosis</h4><ul>-<li><a href="/articles/watershed-cerebral-infarction">watershed infarct</a></li>-<li><a href="/articles/cerebral-venous-infarction">cerebral venous infarct</a></li>- +<p><strong>Anterior cerebral artery (ACA) territory infarcts</strong> are much less common than either <a href="/articles/middle-cerebral-artery-mca-infarct">middle</a> or <a href="/articles/posterior-cerebral-artery-pca-infarct">posterior cerebral artery territory infarcts</a>.</p><h4>Epidemiology</h4><p><a href="/articles/anterior-cerebral-artery">ACA</a> territory infarcts are rare, comprising ~2% of <a href="/articles/ischaemic-stroke">ischaemic strokes</a> <sup>1,2</sup>.</p><h4>Clinical presentation</h4><p>ACA stroke syndrome presents as <sup>1-3</sup>:</p><ul>
- +<li>dysarthria, aphasia</li>
- +<li>unilateral contralateral motor weakness (leg/shoulder > arm/hand/face)</li>
- +<li>minimal sensory changes (two-point discrimination) in the same distribution as above</li>
- +<li>left limb <a title="Apraxia" href="/articles/apraxia-1">apraxia</a>
- +</li>
- +<li>urinary incontinence</li>
- +</ul><h4>Pathology</h4><p>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 <sup>2</sup>.</p><p>Embolic strokes (often with MCA involvement) are the most common cause <sup>3</sup>. Rarely, they are also seen as a complication of severe <a href="/articles/midline-shift">midline shift</a>, where the ACA is occluded by mass effect or severe <a href="/articles/cerebral-vasospasm-following-subarachnoid-haemorrhage">vasospasm</a>.</p><h4>Radiographic features</h4><p>The features are those of <a href="/articles/stroke">cerebral infarction</a> in the anterior cerebral artery <a href="/articles/brain-arterial-vascular-territories">vascular territory</a>:</p><ul>
- +<li>paramedian frontoparietal cerebral cortex</li>
- +<li>anterior <a href="/articles/corpus-callosum">corpus callosum</a>
- +</li>
- +<li>anterior limb of the <a href="/articles/internal-capsule">internal capsule</a>
- +</li>
- +<li>inferior portion of the <a href="/articles/caudate-nucleus">caudate</a> head</li>
- +</ul><h4>Differential diagnosis</h4><ul>
- +<li><a href="/articles/watershed-cerebral-infarction">watershed infarct</a></li>
- +<li><a href="/articles/cerebral-venous-infarction">cerebral venous infarct</a></li>
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