Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings

Abstract

To evaluate and review the clinical spectrum of anterior cerebral artery (ACA) territory infarction, we studied 48 consecutive patients who admitted to our stroke unit over a 6-year period. We performed magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in all patients, and diffusion magnetic resonance imaging (DWI) in 21. In our stroke registry, patients with ACA infarction represented 1.3% of 3705 patients with ischemic stroke. The main risk factors of ACA infarcts was hypertension in 58% of patients, diabetes mellitus in 29%, hypercholesterolemia in 25%, cigarette smoking in 19%, atrial fibrillation in 19%, and myocardial infarct in 6%. Presumed causes of ACA infarct were large-artery disease and cardioembolism in 13 patients each, small-artery disease (SAD) in the territory of Heubner's artery in two and atherosclerosis of large-arteries (<50% stenosis) in 16. On clinico-radiologic analysis there were three main clinical patterns depending on lesion side; left-side infarction (30 patients) consisting of mutism, transcortical motor aphasia, and hemiparesis with lower limb predominance; right side infarction (16 patients) accompanied by acute confusional state, motor hemineglect and hemiparesis; bilateral infarction (two patients) presented with akinetic mutism, severe sphincter dysfunction, and dependent functional outcome. Our findings suggest that clinical and etiologic spectrum of ACA infarction may present similar features as that of middle cerebral artery infarction, but frontal dysfunctions and callosal syndromes can help to make a clinical differential diagnosis. Moreover, at the early phase of stroke, DWI is useful imaging method to locate and delineate the boundary of lesion in the territory of ACA.

Akinetic Mutism Following Bilateral Anterior Cerebral Artery Territory Infarction Due to Aneurysm: A Case Report

“…Especially on her 8th day of admisson she started to talk and move with no induced. Abulia and akinetic mutizm to be 44% after either unilateral or bilateral ACA distribution infarcts [4]. A similar proportion was found in a larger series with these symptoms being most Turkish Journal of Cerebrovascular Diseases 2014; 20 (1): 32-35 frequent after bilateral lesions (67%) but was not uncommon after left-or right-sided strokes (51% and 25% respectively) [3].…”

The Relationship between Age and Affected Cerebral Vessels in Ischemic Stroke Patients

“…In several studies, the mean value of stroke patients' ages was analyzed. It was found to be 70±11 years by Yoneda et al (7) Although according to a study made by Kumral et al (12) in 2002, the MCA-affected group were two-thirds of all analyzed patients, and it is responsible for 90% of anterior circulation infarcts; in our study, MCA-affected patients were only 41.5% of all ischemic stroke patients. Unlike this particular study, the ACA-affected group had the highest mean value of age with 71.3±13.2 years.…”

Neurobiology of apathy in Alzheimer's disease

“…The third, "auto-activation" processing, is observed in the most severe forms of apathy, characterized by difficulties in selfinitiating actions or thoughts, contrasting with relatively spared, externally driven response. This pattern, called the "auto-activation deficit" may be observed after bilateral lesions in the internal portions of the pallidum 44,45 , or after extensive damage to the medial wall of the PFc 46 . The latter topography of lesion, however, may not represent a good framework to understand apathy in as far as its great extension makes it difficult to draw specific functional conclusions.…”