Clinical Syndromes Large Vessel Occlusion

The anterior cerebral artery is a branch of the internal carotid and runs above the optic nerve to follow the curve of the corpus callosum. Soon after its origin the vessel is joined by the anterior communicating artery. Deep branches pass to the anterior part of the internal capsule and basal nuclei.

Cortical branches supply the medial surface of the hemisphere:

1. Orbital

2. Frontal

3. Parietal

Clinical features

The anterior cerebral artery may be occluded by embolus or thrombus. The clinical picture depends on the site of occlusion (especially in relation to the anterior communicating artery) and anatomical variation, e.g. both anterior cerebral arteries may arise from one side by enlargement of the anterior communicating artery.

communicating artery is normally well tolerated because of the cross flow.

Distal occlusion results in weakness and cortical • sensory loss in the contralateral lower limb with associated incontinence. Occasionally a contralateral grasp reflex is present.

Proximal occlusion when both anterior cerebral vessels arise from the same side results in 'cerebral' paraplegia with lower limb weakness, sensory loss, incontinence and presence of grasp, snout and palmomental reflexes.

Bilateral frontal lobe infarction may result in akinetic mutism (page 107) or deterioration in Occlusion conscious level.


Motor + Urinary bladder Sensory


Motor + Urinary bladder Sensory

Medial surface of right cerebral hemisphere


Broca's speech, area

Wernicke's speech area

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