The anterior cerebral artery supplies the medial hemisphere including the primary motor and sensory cortex for the leg (and foot), the premotor cortex, and the anterior corpus callosum. ACA territory infarction produces the characteristic lower limb predominant contralateral weakness, in contrast to MCA strokes that predominantly affect the face and arm. The anterior communicating artery connecting the two ACAs is the most common site of intracranial aneurysm.
| Origin | Medial terminal branch of the internal carotid artery |
|---|
Anterior communicating artery (ACoA) aneurysm rupture produces subarachnoid haemorrhage that classically affects the genu of the corpus callosum, producing the abulia and personality changes of bifrontal dysfunction in addition to the typical SAH presentation. ACA territory infarction is less common than MCA or PCA and produces leg weakness often mistaken for a spinal cord lesion. Bilateral ACA infarction from vasospasm after ACoA aneurysm rupture produces akinetic mutism.
Anterior cerebral artery infarction producing contralateral leg predominant weakness from medial motor cortex involvement, distinguished from MCA stroke by the lower extremity predominance.
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