Clinical effects of anterior cerebral artery infarction.

Anterior cerebral artery infarction is uncommon. We studied the topographical distribution of the lesions and the resulting clinical effects for a better understanding of their relationship and the functional outcome. There were 17 patients; the mean age of the cohort was 71 years. There were 10 men and 7 women. Two clinical syndromes were identified in accordance to the two anatomic areas of distribution. The paracentral lobule syndrome (group 1) was characterized by contralateral motor weakness, the leg more than the arm. The second group involved mainly the motor and supplementary motor areas. Beside contralateral weakness, they had a clinical picture of extrapyramidal symptomatology, which was designated as pseudoparkinsonian syndrome (group 2). Sixty percent of the patients in group 2 had bilateral occlusive carotid artery disease compared with 14% in the group 1, and it is likely that the mechanism was artery-to-artery embolism or cardioembolism in this group. In group 1, the lesions were smaller but superficial and it is possible that small emboli from the heart or parent large artery caused the obstruction. The location of the occlusion may be indicative of the stroke mechanism. The pseudoparkinsonian group with extrapyramidal features attributable to involvement of the supplementary motor area had an unfavorable outcome. There was poor correlation between size of the infarct and functional outcome (P=.12) in both groups.