Acute Isolated Anterior Cerebral Artery Infarcts: A Clinical-Radiological Study

Background: The anterior cerebral artery (ACA) supplies many eloquent areas and can have anatomical variations making ACA strokes clinically and radiologically challenging. This study looks at the clinical and radiological features of isolated acute ACA strokes from a stroke centre in Oman. Methods: A retrospective study conducted over a 2 year period on ACA strokes presenting within 12 hours of symptom onset. TOAST classification was used for aetiology. National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to assess stroke severity. Fischer's classification was used for assessing the arterial segments with CT angiogram. Heidelberg Bleeding Classification was used for haemorrhagic conversion. Results: Isolated ACA strokes constituted 25/1180 (2.1 %) of ischemic strokes. Males 15/25 (60%) Mean age was 68.4 years (Range 42 -97 years). Twenty eight percent of patients had earlier strokes. Hemiparesis (68%) was the commonest clinical presentation. Twenty percent had only lower limb weakness. Hypertension 22/25 (88%) followed by diabetes mellitus 12/25 (48%) was the commonest risk factor. The mean NIHSS was 9 (range 3 to 13). In 36% of patients there was progression of stroke. Plain CT Picked the infarct only in 6/24 (25%). Left side involvement in 18/25 (72%) Artery of Hubner was involved in 6/25 (24%); 44% had an embolic aetiology. There was no mortality and at discharge, 11/25 (44%) had mRS3 or less. Conclusions: In acute ACA infarcts a CT scan can miss the diagnosis in 74%. An embolic aetiology has to be considered in any Isolated ACA stroke and the outcome appears to be good.