Partial anterior circulation syndrome

Subcortical white matter infarcts may mimic a superficial MCA infarct causing a partial anterior circulation syndrome or present as a lacunar syndrome (pure motor, ataxic hemiparesis or sensori motor stroke). Superficial perforating artery infarcts (medullary branches) are often accompanied by cortical spotty lesions. Borderzone and white matter medullary branches infarctions are usually caused by hypoperfusion due lo large vessel occlusion or stenosis (Bogousslavsky 1993 Donnan and Yasaka 1998), but white matter medullary branches infarction can also be caused by cardioembolism (Lee et al. 2003). 

It may be difficult to distinguish between some partial anterior circulation syndromes and a lacunar stroke. 

Some anterior circulation syndromes, usually classified as partial anterior circulation syndromes, are caused by boundary zone infarcts. The rare anterior choroidal artery distribution infarcts, which can be defined only by the CT or MRI pattern, are probably caused by microvascular disease as well as embolism, and they can lead to a partial anterior circulation syndrome or lacunar syndrome (Hupperts et al. 1994). 

Using only a few neurological findings the Oxfordshire Community Stroke Project (OCSP) classification allocates strokes to four subgroups, locating them either in the territory of the anterior (total anterior circulation infarct, TACI partial anterior circulation infarct, PACI lacunar infarct, LACI) and the posterior circulation, (posterior circulation infarct, POCI) (Bamford et al. 1991). The OCSP is a clinical syndromic classification, which... 

Lacunar syndromes are defined clinically. They are highly predictive of small, deep lesions affecting the motor and/or sensory pathways in the corona radiata, internal capsule, thalamus, cerebral peduncle or pons. Although a few patients have a partial anterior circulation infarct (Bamford et al. 1987 Anzalone and Landi 1989 Arboix et al. 2007), the great majority have small iirfarcts, which are sometimes visible on CT, more often on MRI. These are caused by presumed occlusion of a small perforating artery affected by intracranial small vessel disease (see Fig. 10.2). There is no visual field defect, no new cortical... 

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