Anterior choroidal artery syndrome

Anterior choroidal artery (AchA) syndrome is a rare entity characterized by the triad of hemiplegia, hemianaesthesia and contralateral hemianopia as a result of cerebral infarction in the anterior choroidal artery territory.

The syndrome may also be associated with neuropsychological disorders, including left neglect syndrome in right-sided lesions and disorders of speech 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 ⁵.

Etiology

The complete AchA strokes are usually associated with cardioembolic sources and carotid stenosis. Smaller AchA strokes usually cause lacunar strokes and are typically due to T2 diabetes mellitus, hypertension and hyperlipidemia ⁵. The triad of symptoms is rare to see because of the anastomosis with the MCA, PCA and posterior communicating artery.

Diagnosis

The AchA has an extensive area of supply due to large variations in its distributed territory ⁶. This means that its territory cannot be seen on isolated coronal or axial images ⁶. As a result of its extensive and strategic supply, AchA infarcts can often be confused with PCA or MCA infarcts ⁶.