Anterior cerebral artery syndrome

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Anterior cerebral artery syndrome
Gray's Anatomy plate 517 brain.png
Outer surface of cerebral hemisphere, showing areas supplied by cerebral arteries. (Blue is region supplied by anterior cerebral artery.)
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Anterior cerebral artery syndrome is a condition whereby the blood supply from the anterior cerebral artery (ACA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the medial aspects of the frontal and parietal lobes, basal ganglia, anterior fornix and anterior corpus callosum. [1]

Contents

Depending upon the area and severity of the occlusion, signs and symptoms may vary within the population affected with ACA syndrome. Blockages to the proximal (A1) segment of the vessel produce only minor deficits due to the collateral blood flow from the opposite hemisphere via the anterior communicating artery. Occlusions distal to this segment will result in more severe presentation of ACA syndrome. Contralateral hemiparesis and hemisensory loss of the lower extremity is the most common symptom associated with ACA syndrome. [1]

Signs and symptoms

  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) [1]
  4. Disconnection syndrome (due to callosal branches)
  5. Anosmia (due to branches of the olfactory bulb and olfactory tract)
  6. Urinary incontinence [1]
  7. Grasp reflex and or sucking reflex contralaterally (if circle of Willis compromised) [1]

Causes

Smoking, diabetes mellitus, high blood pressure, high cholesterol, and cardiovascular disease are recognized risk factors that are commonly present in stroke patients. [2] An additional important risk factor is atrial fibrillation. [3]

An ischemic stroke's main cause is atherosclerosis. [2] 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. [4] The most commonly reported etiology in studies involving patients with Asian ancestry is atherosclerosis. [5] [6]

Additional important causes of anterior cerebral artery infarction include cardiac embolism from various sources, such as tumors, intracardiac thrombus, atrial fibrillation, and valve disease. [3] Arterial dissection is a significant additional mechanism of anterior cerebral artery stroke. [7]

Some less common mechanisms, such as coagulopathic states and vasculitis, have been described. Another cause is vasospasm. [2] Pituitary apoplexy and subarachnoid hemorrhage have been identified as triggers. [8]

Diagnosis

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. [2]

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. [2]

Epidemiology

Anterior cerebral artery syndrome accounts for 0.3% to 4.4% of stroke cases. [2]

Related Research Articles

A transient ischemic attack (TIA), commonly known as a mini-stroke, is a minor stroke whose noticeable symptoms usually end in less than an hour. TIA causes the same symptoms associated with strokes, such as weakness or numbness on one side of the body, sudden dimming or loss of vision, difficulty speaking or understanding language, slurred speech, or confusion.

<span class="mw-page-title-main">Cerebrovascular disease</span> Condition that affects the arteries that supply the brain

Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders. The most common presentation of cerebrovascular disease is an ischemic stroke or mini-stroke and sometimes a hemorrhagic stroke. Hypertension is the most important contributing risk factor for stroke and cerebrovascular diseases as it can change the structure of blood vessels and result in atherosclerosis. Atherosclerosis narrows blood vessels in the brain, resulting in decreased cerebral perfusion. Other risk factors that contribute to stroke include smoking and diabetes. Narrowed cerebral arteries can lead to ischemic stroke, but continually elevated blood pressure can also cause tearing of vessels, leading to a hemorrhagic stroke.

<span class="mw-page-title-main">Stroke</span> Death of a region of brain cells due to poor blood flow

Stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functioning properly.

<span class="mw-page-title-main">Lateral medullary syndrome</span> Medical condition

Lateral medullary syndrome is a neurological disorder causing a range of symptoms due to ischemia in the lateral part of the medulla oblongata in the brainstem. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. Lateral medullary syndrome is also called Wallenberg's syndrome, posterior inferior cerebellar artery (PICA) syndrome and vertebral artery syndrome.

<span class="mw-page-title-main">Moyamoya disease</span> Disease characterized by constriction of brain arteries

Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by constriction and blood clots (thrombosis). A collateral circulation develops around the blocked vessels to compensate for the blockage, but the collateral vessels are small, weak, and prone to bleeding, aneurysm and thrombosis. On conventional angiography, these collateral vessels have the appearance of a "puff of smoke".

<span class="mw-page-title-main">Anterior cerebral artery</span> Artery supplying the brain

The anterior cerebral artery (ACA) is one of a pair of cerebral arteries that supplies oxygenated blood to most midline portions of the frontal lobes and superior medial parietal lobes of the brain. The two anterior cerebral arteries arise from the internal carotid artery and are part of the circle of Willis. The left and right anterior cerebral arteries are connected by the anterior communicating artery.

<span class="mw-page-title-main">Intraparenchymal hemorrhage</span> Medical condition

Intraparenchymal hemorrhage (IPH) is one form of intracerebral bleeding in which there is bleeding within brain parenchyma. The other form is intraventricular hemorrhage (IVH).

<span class="mw-page-title-main">Posterior cerebral artery</span> Artery which supplies blood to the occipital lobe of the brain

The posterior cerebral artery (PCA) is one of a pair of cerebral arteries that supply oxygenated blood to the occipital lobe, part of the back of the human brain. The two arteries originate from the distal end of the basilar artery, where it bifurcates into the left and right posterior cerebral arteries. These anastomose with the middle cerebral arteries and internal carotid arteries via the posterior communicating arteries.

<span class="mw-page-title-main">Cerebral infarction</span> Stroke resulting from lack of blood flow

Cerebral infarction, also known as an ischemic stroke, is the pathologic process that results in an area of necrotic tissue in the brain. In mid to high income countries, a stroke is the main reason for disability among people and the 2nd cause of death. It is caused by disrupted blood supply (ischemia) and restricted oxygen supply (hypoxia). This is most commonly due to a thrombotic occlusion, or an embolic occlusion of major vessels which leads to a cerebral infarct. In response to ischemia, the brain degenerates by the process of liquefactive necrosis.

<span class="mw-page-title-main">Anterior inferior cerebellar artery</span> Major blood supply to the cerebellum

The anterior inferior cerebellar artery (AICA) is one of three pairs of arteries that supplies blood to the cerebellum.

<span class="mw-page-title-main">Watershed stroke</span> Medical condition

A watershed stroke is defined as a brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral arteries. The actual blood stream blockage/restriction site can be located far away from the infarcts. Watershed locations are those border-zone regions in the brain supplied by the major cerebral arteries where blood supply is decreased. Watershed strokes are a concern because they comprise approximately 10% of all ischemic stroke cases. The watershed zones themselves are particularly susceptible to infarction from global ischemia as the distal nature of the vasculature predisposes these areas to be most sensitive to profound hypoperfusion.

<span class="mw-page-title-main">Weber's syndrome</span> Medical condition

Weber's syndrome, also known as midbrain stroke syndrome or superior alternating hemiplegia, is a form of stroke that affects the medial portion of the midbrain. It involves oculomotor fascicles in the interpeduncular cisterns and cerebral peduncle so it characterizes the presence of an ipsilateral lower motor neuron type oculomotor nerve palsy and contralateral hemiparesis or hemiplegia.

<span class="mw-page-title-main">Lacunar stroke</span> Medical condition

Lacunar stroke or lacunar cerebral infarct (LACI) is the most common type of ischemic stroke, resulting from the occlusion of small penetrating arteries that provide blood to the brain's deep structures. Patients who present with symptoms of a lacunar stroke, but who have not yet had diagnostic imaging performed, may be described as having lacunar stroke syndrome (LACS).

<span class="mw-page-title-main">Posterior cerebral artery syndrome</span> Medical condition

Posterior cerebral artery syndrome is a condition whereby the blood supply from the posterior cerebral artery (PCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the occipital lobe, the inferomedial temporal lobe, a large portion of the thalamus, and the upper brainstem and midbrain.

<span class="mw-page-title-main">Middle cerebral artery syndrome</span> Medical condition

Middle cerebral artery syndrome is a condition whereby the blood supply from the middle cerebral artery (MCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, caudate and putamen. The MCA is the most common site for the occurrence of ischemic stroke.

<span class="mw-page-title-main">Leptomeningeal collateral circulation</span>

The leptomeningeal collateral circulation is a network of small blood vessels in the brain that connects branches of the middle, anterior and posterior cerebral arteries, with variation in its precise anatomy between individuals. During a stroke, leptomeningeal collateral vessels allow limited blood flow when other, larger blood vessels provide inadequate blood supply to a part of the brain.

Benedikt syndrome, also called Benedikt's syndrome or paramedian midbrain syndrome, is a rare type of posterior circulation stroke of the brain, with a range of neurological symptoms affecting the midbrain, cerebellum and other related structures.

Claude's syndrome is a form of brainstem stroke syndrome characterized by the presence of an ipsilateral oculomotor nerve palsy, contralateral hemiparesis, contralateral ataxia, and contralateral hemiplegia of the lower face, tongue, and shoulder. Claude's syndrome affects oculomotor nerve, red nucleus and brachium conjunctivum.

A silent stroke is a stroke that does not have any outward symptoms associated with stroke, and the patient is typically unaware they have suffered a stroke. Despite not causing identifiable symptoms, a silent stroke still causes damage to the brain and places the patient at increased risk for both transient ischemic attack and major stroke in the future. In a broad study in 1998, more than 11 million people were estimated to have experienced a stroke in the United States. Approximately 770,000 of these strokes were symptomatic and 11 million were first-ever silent MRI infarcts or hemorrhages. Silent strokes typically cause lesions which are detected via the use of neuroimaging such as MRI. The risk of silent stroke increases with age but may also affect younger adults. Women appear to be at increased risk for silent stroke, with hypertension and current cigarette smoking being amongst the predisposing factors.

A migrainous infarction is a rare type of ischaemic stroke which occurs in correspondence with migraine aura symptoms. Symptoms include headaches, visual disturbances, strange sensations and dysphasia, all of which gradually worsen causing neurological changes which ultimately increase the risk of an ischaemic stroke. Typically, women under the age of 45 who experience migraine with aura (MA) are at the greatest risk for developing migrainous infarction, especially when combined with smoking and use of oral contraceptives.

References

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  2. 1 2 3 4 5 6 Casano, Harold A. Matos; Tadi, Prasanna; Ciofoaia, Gabriela A. (August 14, 2023). "Anterior Cerebral Artery Stroke". StatPearls Publishing. PMID   30726018 . Retrieved February 12, 2024.
  3. 1 2 Arboix, Adrià; García-Eroles, Luis; Sellarés, Núria; Raga, Agnès; Oliveres, Montserrat; Massons, Joan (July 9, 2009). "Infarction in the territory of the anterior cerebral artery: clinical study of 51 patients". BMC Neurology. 9 (1). Springer Science and Business Media LLC: 30. doi: 10.1186/1471-2377-9-30 . ISSN   1471-2377. PMC   2714497 . PMID   19589132.
  4. Kumral, E.; Bayulkem, G.; Evyapan, D.; Yunten, N. (2002). "Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings". European Journal of Neurology. 9 (6). Wiley: 615–624. doi:10.1046/j.1468-1331.2002.00452.x. ISSN   1351-5101. PMID   12453077.
  5. Toyoda, Kazunori (2012). "Anterior Cerebral Artery and Heubner's Artery Territory Infarction". Frontiers of Neurology and Neuroscience. Vol. 30. S. Karger AG. pp. 120–122. doi:10.1159/000333607. ISBN   978-3-8055-9910-8. ISSN   1660-4431. PMID   22377877.
  6. Kang, Suk Y.; Kim, Jong S. (June 10, 2008). "Anterior cerebral artery infarction". Neurology. 70 (24_part_2). Ovid Technologies (Wolters Kluwer Health): 2386–2393. doi:10.1212/01.wnl.0000314686.94007.d0. ISSN   0028-3878. PMID   18541871.
  7. Hensler, Johannes; Jensen-Kondering, Ulf; Ulmer, Stephan; Jansen, Olav (August 11, 2016). "Spontaneous dissections of the anterior cerebral artery: a meta-analysis of the literature and three recent cases". Neuroradiology. 58 (10). Springer Science and Business Media LLC: 997–1004. doi:10.1007/s00234-016-1731-9. ISSN   0028-3940. PMID   27516097.
  8. Mohindra, Sandeep; Kovai, Priyamvada; Chhabra, Rajesh (March 1, 2010). "Fatal Bilateral ACA Territory Infarcts after Pituitary Apoplexy: A Case Report and Literature Review". Skull Base. 20 (4). Georg Thieme Verlag KG: 285–288. doi:10.1055/s-0030-1249243. ISSN   1531-5010. PMC   3023322 . PMID   21311623.