The anterior cerebral artery (ACA) is one of the main arteries responsible for supplying blood to the brain. Although strokes affecting this artery are less common than those involving the middle cerebral artery, they can cause significant impairments in mobility, behavior, and cognitive functions.
Understanding which areas of the brain are supplied by the anterior cerebral artery and the symptoms associated with injury to this artery can help provide a better understanding of the manifestations of certain strokes and the importance of early medical attention.
What is the anterior cerebral artery?
The anterior cerebral artery is one of the two terminal branches of the internal carotid artery. After branching from the internal carotid artery, the two anterior cerebral arteries are connected by the anterior communicating artery, forming part of the Circle of Willis, a structure that helps maintain blood flow to the brain.
Its main function is to supply oxygen-rich blood to the medial regions of the frontal and parietal lobes.
What areas does it supply?
The anterior cerebral artery supplies blood to several areas that are essential for movement, planning, and behavior, including:
- Medial surface of the frontal lobe.
- Medial surface of the parietal lobe.
- Motor area corresponding to the leg and foot.
- Sensory area of the lower limb.
- Cingulate gyrus.
- Part of the corpus callosum.
- Areas involved in motivation and executive functions.
Because of this distribution, an injury affecting this vascular territory can produce very characteristic symptoms.
What happens when it becomes blocked?
When the anterior cerebral artery becomes blocked by a thrombus or embolus, the oxygen supply to the regions it supplies is reduced. If blood flow is not restored quickly, neurons begin to sustain progressive damage that may become irreversible.
The extent of the damage will depend on factors such as:
- The time elapsed before receiving treatment.
- The size of the obstruction.
- The available collateral circulation.
- The patient’s pre-existing condition.
Symptoms of an anterior cerebral artery stroke
Symptoms may vary depending on the extent of the injury, although some manifestations are quite characteristic.
The most common include:
- Weakness predominantly affecting the contralateral leg.
- Loss of sensation in the leg.
- Difficulty walking.
- Balance problems.
- Difficulty initiating movements.
- Behavioral changes.
- Personality changes.
- Difficulty planning tasks.
- Urinary incontinence.
- Reduced initiative or apathy.
When the injury affects the dominant hemisphere, language impairments may also occur.
Why is the leg usually more affected?
A distinctive feature of anterior cerebral artery infarcts is that weakness usually affects the leg more than other parts of the body.
This occurs because the motor and sensory representations of the lower limb are located on the medial surface of the brain, precisely within the territory supplied by this artery.
In contrast, the face and arm usually retain greater strength, as they are primarily supplied by the middle cerebral artery.
Cognitive and behavioral changes
Injuries affecting the frontal region can cause symptoms that are not always as obvious as paralysis.
Some patients may experience:
- Lack of initiative.
- Difficulty concentrating.
- Loss of interest in usual activities.
- Disinhibited behavior.
- Difficulty dealing with everyday situations.
- Impaired judgment.
- Emotional changes.
These changes can significantly affect the patient’s independence and their interactions with others.
How is it diagnosed?
Diagnosis begins with a comprehensive neurological assessment and is confirmed through imaging tests.
The most commonly used are:
- Computed tomography (CT).
- Magnetic resonance imaging (MRI).
- CT angiography (CTA).
- Magnetic resonance angiography (MRA).
- Doppler ultrasound.
- Cardiac tests when an embolic origin is suspected.
These tests help identify the affected blood vessel and determine the extent of brain damage.
Treatment
Treatment will depend on the type of stroke and the time elapsed since its onset.
The main treatment options include:
- Intravenous thrombolysis in selected patients.
- Mechanical thrombectomy when indicated.
- Blood pressure management.
- Management of risk factors.
- Care in a specialized stroke unit.
Prompt treatment can significantly limit the extent of the cerebral infarction.
Possible long-term effects
The long-term effects vary considerably and depend on the extent of the injury and the time elapsed before treatment is initiated.
The most common include:
- Persistent leg weakness.
- Balance problems.
- Difficulty walking.
- Cognitive problems.
- Behavioral changes.
- Urinary incontinence.
- Reduced mental processing speed.
Not all patients experience the same limitations, and many people achieve partial or significant recovery over time.
Rehabilitation
Recovery usually requires a multidisciplinary approach tailored to the individual needs of the patient.
It may include:
- Physiotherapy to improve walking ability and muscle strength.
- Occupational therapy to improve independence.
- Neuropsychological rehabilitation to address memory, attention, and executive functions.
- Speech and language therapy when language impairments are present.
- Psychological support to help patients cope with functional changes.
The intensity and duration of rehabilitation will depend on the degree of neurological impairment.
Prevention
Preventing strokes affecting the anterior cerebral artery is similar to preventing other types of stroke.
The main recommendations include:
- Controlling high blood pressure.
- Maintaining good diabetes control.
- Treating high cholesterol.
- Avoiding smoking.
- Engaging in regular physical activity.
- Maintaining a healthy diet.
- Managing heart conditions such as atrial fibrillation.
- Following prescribed treatments correctly.
Conclusion
The anterior cerebral artery supplies blood to key areas of the brain involved in leg movement, executive functions, and behavior. Although strokes affecting this vascular territory are less common than those involving the middle cerebral artery, they can cause motor, cognitive, and behavioral impairments that significantly affect quality of life.
Early recognition of symptoms, urgent medical attention, and an individualized rehabilitation program are essential to support recovery and improve the patient’s functional independence.
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