Anterior cerebral artery (ACA) infarct
Citation, DOI, disclosures and article data
Citation:
Knipe H, Hacking C, Sheikh Y, et al. Anterior cerebral artery (ACA) infarct. Reference article, Radiopaedia.org (Accessed on 25 Jan 2025) https://doi.org/10.53347/rID-39171
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rID:
39171
Article created:
Disclosures:
At the time the article was created Henry Knipe had no recorded disclosures.
View Henry Knipe's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.
View Craig Hacking's current disclosures
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Systems:
Synonyms:
- ACA infarct
- Anterior cerebral artery infarct
- Anterior cerebral artery (ACA) territory infarcts
Anterior cerebral artery (ACA) territory infarcts are much less common than either middle or posterior cerebral artery territory infarcts.
On this page:
Epidemiology
ACA territory infarcts are rare, comprising ~2% of ischemic 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
Quiz questions
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References
- 1. Stein J, Harvey RL, Macko RF et-al. Stroke Recovery and Rehabilitation. Demos Medical. ISBN:1933864125. Read it at Google Books - Find it at Amazon
- 2. Stroke syndromes. Cambridge University Press. ISBN:052180258X. Read it at Google Books - Find it at Amazon
- 3. Arboix A, García-Eroles L, Sellarés N et-al. Infarction in the territory of the anterior cerebral artery: clinical study of 51 patients. BMC Neurol. 2009;9 (1): 30. doi:10.1186/1471-2377-9-30 - Free text at pubmed - Pubmed citation
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Cases:
- Azygos anterior cerebral artery
- Middle and anterior cerebral artery infarction with haemorrhagic transformation
- Pericallosal ACA infarction
- Bilateral ACA infarction due to azygos ACA embolism
- Bilateral ACA infarction
- Recurrent artery of Heubner acute infarct
- Ruptured ACom aneurysm
- Acute A3 occlusion with ACA ischaemic penumbra (CT perfusion)
- Recurrent artery of Heubner infarct
- Acute left anterior cerebral artery territory infarction
- Anterior cerebral artery infarction
- Bilateral anterior cerebral artery territory infarction due to ruptured anterior communicating artery aneurysm
- Anterior cerebral artery infarct
- Anterior cerebral artery territory infarct
Multiple choice questions:
Related articles: Stroke and intracranial haemorrhage
-
stroke and intracranial hemorrhage
- general articles
-
ischemic stroke
- general discussions
- scoring and classification systems
- Alberta stroke program early CT score (ASPECTS)
- ASCOD classification
- Canadian Neurological Scale
- Heidelberg bleeding classification
- NIH Stroke Scale
- Mathew stroke scale
- modified Rankin scale
- Orgogozo Stroke Scale
- Scandinavian Stroke Scale
- thrombolysis in cerebral infarction (TICI) scale
- TOAST classification
- collateral vessel scores
- 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
- lacunar infarct
-
thalamic infarct
- artery of Percheron infarct
- Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
- top of the basilar syndrome
- striatocapsular infarct
- choroid plexus infarct
- cerebellar infarct
-
brainstem infarct
- midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Nothnagel syndrome: PCA
- Weber syndrome: PCA
- Wernekink commissure syndrome
- 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
- Cestan-Chenais syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
- Opalski syndrome
- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- by vessel size
- treatment options
- complications
-
intracranial hemorrhage
-
intra-axial hemorrhage
- signs and formulas
- ABC/2 (volume estimation)
- black hole sign
- blend sign
- cashew nut sign
- CTA spot sign
- island sign
- satellite sign
- swirl sign
- zebra sign
- by type
- by location
- signs and formulas
- extra-axial hemorrhage
- extradural hemorrhage (EDH)
- intralaminar dural hemorrhage
- subdural hemorrhage (SDH)
-
subarachnoid hemorrhage (SAH)
- types
- complications
- grading systems
- subpial hemorrhage
-
intra-axial hemorrhage
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