Anterior cerebral artery and Heubner's artery territory infarction.

Anterior cerebral artery (ACA) territory strokes account for 0.5-3% of all ischemic strokes. The etiological mechanisms of ACA territory strokes vary by race; ACA dissection is a frequent cause in Japan. The most prevalent symptom of such strokes is contralateral hemiparesis or monoparesis, usually affecting the leg predominantly. Predominant leg weakness is attributed to damage in the paracentral lobule, and weakness of the arm and face is associated with involvement of Heubner's artery and the medial striate arteries. Hypobulia, typically 'akinetic mutism', is also common. Several behavioral disorders, including the grasp reflex and the alien hand sign, can present as callosal disconnection signs. Transcortical aphasia and urinary incontinence are other frequent symptoms. A non-throbbing headache is common at stroke onset in patients with ACA dissection.