Anterior cerebral artery syndrome

1. Hemiparesis or hemiplegia contralaterally, involving primarily the lower limbs and pelvic floor musculature
2. Sensory deficits contralaterally, involving primarily the leg and perineum
3. Apraxia (due to branches to the supplementary motor area and corpus callosum)
4. Disconnection syndrome (due to callosal branches)
5. Anosmia (due to branches of the olfactory bulb and olfactory tract)
6. Urinary incontinence
7. Grasp reflex and or sucking reflex contralaterally (if circle of Willis compromised)

Smoking, diabetes mellitus, high blood pressure, high cholesterol, and cardiovascular disease are recognized risk factors that are commonly present in stroke patients.{{cite web | last1=Casano | first1=Harold A. Matos | last2=Tadi | first2=Prasanna | last3=Ciofoaia | first3=Gabriela A. | title=Anterior Cerebral Artery Stroke | publisher=StatPearls Publishing | date=August 14, 2023 | pmid=30726018 | url=https://www.ncbi.nlm.nih.gov/books/NBK537333/ | access-date=February 12, 2024}} An additional important risk factor is atrial fibrillation.{{cite journal | last1=Arboix | first1=Adrià | last2=García-Eroles | first2=Luis | last3=Sellarés | first3=Núria | last4=Raga | first4=Agnès | last5=Oliveres | first5=Montserrat | last6=Massons | first6=Joan | title=Infarction in the territory of the anterior cerebral artery: clinical study of 51 patients | journal=BMC Neurology | publisher=Springer Science and Business Media LLC | volume=9 | issue=1 | date=July 9, 2009 | issn=1471-2377 | doi=10.1186/1471-2377-9-30 | doi-access=free | page=30| pmid=19589132 | pmc=2714497 }}

An ischemic stroke's main cause is atherosclerosis.{{cite web | last1=Casano | first1=Harold A. Matos | last2=Tadi | first2=Prasanna | last3=Ciofoaia | first3=Gabriela A. | title=Anterior Cerebral Artery Stroke | publisher=StatPearls Publishing | date=August 14, 2023 | pmid=30726018 | url=https://www.ncbi.nlm.nih.gov/books/NBK537333/ | access-date=February 12, 2024}} Stroke is commonly caused by atherosclerotic large vessel disease and results from local branch occlusion by plaque, artery-to-artery embolism, or in situ thrombosis, with the latter being the most common cause of anterior cerebral artery infarction.{{cite journal | last1=Kumral | first1=E. | last2=Bayulkem | first2=G. | last3=Evyapan | first3=D. | last4=Yunten | first4=N. | title=Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings | journal=European Journal of Neurology | publisher=Wiley | volume=9 | issue=6 | year=2002 | issn=1351-5101 | doi=10.1046/j.1468-1331.2002.00452.x | pages=615–624| pmid=12453077 }} The most commonly reported etiology in studies involving patients with Asian ancestry is atherosclerosis.{{cite book | last=Toyoda | first=Kazunori | title=Frontiers of Neurology and Neuroscience | chapter=Anterior Cerebral Artery and Heubner's Artery Territory Infarction | publisher=S. Karger AG | year=2012 | volume=30 | issn=1660-4431 | doi=10.1159/000333607 | pages=120–122| pmid=22377877 | isbn=978-3-8055-9910-8 }}{{cite journal | last1=Kang | first1=Suk Y. | last2=Kim | first2=Jong S. | title=Anterior cerebral artery infarction | journal=Neurology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=70 | issue=24_part_2 | date=June 10, 2008 | issn=0028-3878 | doi=10.1212/01.wnl.0000314686.94007.d0 | pages=2386–2393| pmid=18541871 }}

Additional important causes of anterior cerebral artery infarction include cardiac embolism from various sources, such as tumors, intracardiac thrombus, atrial fibrillation, and valve disease. Arterial dissection is a significant additional mechanism of anterior cerebral artery stroke.{{cite journal | last1=Hensler | first1=Johannes | last2=Jensen-Kondering | first2=Ulf | last3=Ulmer | first3=Stephan | last4=Jansen | first4=Olav | title=Spontaneous dissections of the anterior cerebral artery: a meta-analysis of the literature and three recent cases | journal=Neuroradiology | publisher=Springer Science and Business Media LLC | volume=58 | issue=10 | date=August 11, 2016 | issn=0028-3940 | doi=10.1007/s00234-016-1731-9 | pages=997–1004| pmid=27516097 }}

Some less common mechanisms, such as coagulopathic states and vasculitis, have been described. Another cause is vasospasm. Pituitary apoplexy and subarachnoid hemorrhage have been identified as triggers.{{cite journal | last1=Mohindra | first1=Sandeep | last2=Kovai | first2=Priyamvada | last3=Chhabra | first3=Rajesh | title=Fatal Bilateral ACA Territory Infarcts after Pituitary Apoplexy: A Case Report and Literature Review | journal=Skull Base | publisher=Georg Thieme Verlag KG | volume=20 | issue=4 | date=March 1, 2010 | issn=1531-5010 | doi=10.1055/s-0030-1249243 | pages=285–288| pmid=21311623 | pmc=3023322 }}

When an acute ischemic stroke is suspected, routine assessments of the airway, breathing, and circulation are made; blood glucose is checked; a validated stroke severity scale assessment is conducted; and an accurate, focused history is obtained with respect to the time of symptom onset, last known well, or baseline.

To determine the type and characteristics of a stroke, brain imaging is an essential part of the stroke patient evaluation process. The preferred imaging modality in this case is non-contrast computed tomography (CT) of the head. Depending on where they are or how big they are, anterior cerebral artery strokes may be overlooked on imaging tests. Quick noncontrast head CT should be followed by head and neck CT angiography in order to identify intracranial large vessel occlusion as soon as possible.

Anterior cerebral artery syndrome accounts for 0.3% to 4.4% of stroke cases.

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{{Cerebrovascular diseases}}

{{Lesions of spinal cord, brainstem, and cortex}}

Category:Stroke

Category:Syndromes affecting the nervous system