The anterior cerebral artery may be occluded by embolus or thrombus. The clinical picture depends on the site of occlusion (especially in relation to the anterior communicating artery) and anatomical variation, e.g. both anterior cerebral arteries may arise from one side by enlargement of the anterior communicating artery.
Occlusion proximal to the anterior communicating artery is normally well tolerated because of the cross flow.
- Distal occlusion results in weakness and cortical sensory loss in the contralateral lower limb with associated incontinence. Occasionally a contralateral grasp reflex is present.
- Proximal occlusion when both anterior cerebral vessels arise from the same side results in ‘cerebral’ paraplegia with lower limb weakness, sensory loss, incontinence and presence of grasp, snout and palmomental reflexes.
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