There are things you cannot learn from articles or emedicine. In the case of stroke syndromes, the one and only bible is Bogousslavsky’s The Stroke Syndromes, which served as the reference for today’s case of a severly abulic ACA stroke patient. Apart from the clinical pictures, there is a lot to take home:
- Most of ACA strokes are embolic, nowadays a lot of them are due to endovascular procedures.
- Proximal A1 emboli can occlude Heubner’s perforating arteries, more distal ones don’t bother the patient if the anterior communicating artery is patent.
- The corpus callosum is often supplied by both sides, so that you have to occlude either A2 to result in corpus callosum strokes (or have a unilateral supply of both ACAs). In this case one of the famous callotomized patients can result.