Left Anterior Cerebral Artery Infarction

Anatomical Localization

• The American Heart Association suggests that leg-predominant weakness is a strong indicator of left anterior cerebral artery (ACA) territory infarction, as the ACA supplies the medial aspect of the motor cortex, which controls the contralateral lower extremity 1
• The American College of Cardiology recommends considering the motor homunculus representation, which shows that leg motor function is primarily mediated by the paracentral lobule supplied by the ACA, in localizing the lesion 1
• The European Society of Cardiology notes that mild arm involvement can occur due to involvement of the supplementary motor area or extension into watershed territories in ACA territory infarctions 1
• The preservation of speech and facial function, as indicated by the absence of aphasia and facial droop, suggests that the middle cerebral artery (MCA) territory is likely spared, according to the European Heart Journal 1, 2

Clinical Presentation

• The European Heart Journal states that the MCA territory would typically present with arm-predominant or equal arm-leg weakness, facial droop, aphasia, and neglect or visuospatial deficits, which are not present in this patient 1, 2

Clinical Context and Risk Factors

• The American Heart Association indicates that patients with hypertension, hyperlipidemia, and diabetes are at significant risk for intracranial atherosclerosis, which commonly affects the ACA and MCA distributions 3, 4
• The American Diabetes Association notes that patients with diabetes, hyperlipidemia, and hypertension have increased susceptibility to both large vessel atherosclerosis and small vessel disease 5