Anterior Cerebral Artery (ACA) Territory Infarction

Anatomical Localization and Clinical Presentation

The American College of Neurology suggests that the ACA supplies the medial motor cortex, which contains the motor representation for the contralateral lower extremity, and the MCA supplies the lateral motor cortex, which contains motor representation for the contralateral face and upper extremity, as indicated by the pattern of weakness in ACA and MCA strokes 1
The American Heart Association recommends recognizing that MCA strokes typically present with contralateral hemiparesis affecting the face and arm more than the leg, with sensory deficits following a similar distribution, whereas ACA strokes characteristically cause contralateral weakness that is most prominent in the lower extremity 2, 1

The American College of Radiology suggests obtaining CT or MRI with vascular imaging (CTA/MRA) to confirm ACA territory infarction and identify the mechanism, looking specifically for infarction in the medial frontal lobe and paracentral lobule, and vascular occlusion or stenosis of the ACA 3