Symptoms and signs of occlusion of the anterior cerebral artery

1. Big picture

The anterior cerebral artery (ACA) supplies mainly the medial frontal lobe, medial parietal lobe, paracentral lobule, supplementary motor area, cingulate cortex, and parts of the corpus callosum. Therefore, ACA occlusion produces a stroke syndrome that is very different from the more common middle cerebral artery stroke.

The examiner usually wants one key localization rule:

ACA stroke = contralateral lower limb weakness more than arm/face + frontal lobe behavioural signs + urinary/fecal incontinence.

ACA infarcts are relatively uncommon compared with middle cerebral artery infarcts, and their presentation depends strongly on whether the main ACA trunk, distal cortical branches, or deep perforating branches are involved. ACA infarcts classically involve the medial frontal and parietal territory, and reported series describe them as a small proportion of ischemic strokes.