Friday 23 March 2012

Anterior Choroidal Artery Infarct

AChA, the anterior choroidal artery originates from the supra clinoid portion of internal carotid artery just after giving off PCom.
Supply choroid plexus of the lateral ventricle and third ventricle, optic chiasm and optic tract, internal capsule,lateral geniculate body, globus pallidus, tail of the caudate nucleus, hippocampus, amygdala, substantia nigra red nucleus and crus cerebri. 
AChA constitutes a special vascular territory have etiology and prognosis different from that of typical hemispheric or deep infarcts.

Vasular terriotory of AchA confined to posterior para ventricular corona radiata region extending caudally along posterior limb of internal capsule and adjacent part of medial temporal lobe. 
Anterior Choroidal Artery territory infarct.
AChA syndrome, was first described by Foix et al, consist of contra lateral hemiplegia, contra lateral hemi hypoesthesia, and homonymous hemianopsia.
Hemi plegia or paresis is due to involvement of the posterior limb of the internal capsule, the most constant finding.
Hemi hypoesthesia or hemisensory loss is due to involvement of the ventral postero lateral nucleus of the thalamus and 
Hemianopsia secondary to involvement of the lateral geniculate body.
A syndrome of acute pseudo bulbar mutism has been described in patients with bilateral AChA infarctions.

Principal cause or etiology of AChA infarct varies from lesion to lesion. Smaller lesions are associated with small-vessel disease with chronic hypertension being the single most important risk factor. Large AChA infarcts shows association with an embolic source. Other causes include carotid artery stenosis. Associated with relatively younger age groups, male and diabetic. Cause of AchA infarct is evaluated and individualized in every case, so that treatment is directed towards the risk factors like small-vessel disease, embolism etc. 

"Artery, anterior choroidal." Stedman's Medical Dictionary, 27th ed. (2000). ISBN 0-683-40007-X 
Victor, Maurice and Allan H. Ropper. Adams and Victor's Principles of Neurology. (2001). ISBN 0-07-067497-3
Helgason C, Caplan LR. Anterior choroidal artery-territory infarction: Report of cases and review. Arch Neurol 1986;43:681-686.
Infarcts in the anterior choroidal artery territory, Anatomical distribution, clinical syndromes, presumed pathogenesis and early outcome, R. M. M. Hupperts1,0, J. Lodder1, E. P. M. Heuts-van Raak1 and F. Kessels. 
Anterior Choroidal Artery Territory Infarction: A Small Vessel Disease. Askiel Bruno, MD, Neill R. Graff-Radford, MBBCh, MRCP, Jos6 Biller, MD, and Harold P. Adams Jr., MD
Acute ischemic stroke in anterior choroidal artery territory, Angel Ois

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