ACA is an abbreviation for “anterior cerebral artery”. It can be translated into Turkish as the forebrain artery. It is often referred to as the anterior cerebral artery. Available as a left and right pair. It supplies most of the superior-medial part of the parietal lobes and part of the frontal lobes of the brain . The brain constantly needs oxygen and nutrients, so blood circulation is vital. ACA infarction refers to the occlusion of this vessel due to a clot and impaired circulation. If an artery feeding the brain is blocked by a clot, circulation is impaired and nerve cells begin to die within a few minutes. The resulting brain damage can lead to symptoms such as paralysis, slurred speech, and loss of consciousness.

The main risk factors for clot formation in the ACA vessel are hypertension, high cholesterol (dyslipidemia), diabetes, smoking, calcification of the arteries (atherosclerosis), arrhythmia in the heart (atrial fibrillation) and heart valve diseases.

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Anatomy

The ACA originates from the internal carotid artery, also known as the carotid artery. It joins the structure of the Willis polygon formed by the arteries at the base of the brain. The right and left ACA are connected to each other by the anterior communicating artery. Areas that ACAs feed on in the brain include:

  • Septal area: A region of the brain involved in fear and pleasure responses.
  • Corpus callosum: nerve fibers connecting the two hemispheres of the brain
  • Primary somatosensory cortices for the foot and leg: Interprets the sense of touch of the foot and leg.
  • Movement planning areas in the frontal lobes.
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The anterior cerebral arteries carry blood to the anterior surfaces of the frontal lobes. This region is responsible for higher cognitive activities such as judgment and logic. Occlusion of the ACA vessels can cause dementia (dementia), speech difficulties, gait disturbance and impaired arm movements. The person may experience problems such as taking wide steps while walking, hitting his feet hard on the ground.

ACA Infarct Findings

A stroke is a brain injury that develops as a result of a sudden deterioration in the blood circulation of the brain. ACA occlusion accounts for a relatively small percentage (0.3-4.4%) of all strokes. Although the ratio is small, the number of people affected in terms of absolute numbers is not small. If the ACA vein becomes blocked as a result of clot formation, the following symptoms may occur:

  • The ability to repeat words may be impaired.
  • Primitive reflexes (grabbing, sucking reflex, etc.) appear.
  • clouding of consciousness
  • Impaired decision making, personality change
  • Weakness in the opposite body half of the injured side of the brain. Loss of strength is greater in the leg than in the arm. Again, depending on the damage to the brain, sensory disturbances may occur on the opposite side.
  • Gait disturbances (apraxia)
  • urinary incontinence

Symptoms may vary depending on whether the ACA itself or one of its branches is affected. In addition, the passage of blood (anastomosis) between different vessels may alleviate the effect of the clot. Swelling of damaged brain tissue can lead to the development of cerebral edema. In this case, additional problems may occur. Another possible complication is epilepsy.

Diagnosis

When a stroke is suspected, 112 should be called immediately. Imaging methods such as computed tomography (CT), diffusion MR, CT angiography are used for diagnosis.

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Treatment

Oxygen level and blood pressure are checked. In the first 4.5 hours after the onset of complaints, clot-busting treatment can be given. Certain conditions are observed while applying the treatment because there is a risk of bleeding in the brain of the clot-melting treatment. Intravascular intervention method called mechanical thrombectomy in large vessel occlusions can be applied by a team experienced in this field. Preventive treatments are started to reduce the risk of having a second stroke after the life-threatening situation is over. Physical therapy and rehabilitation process is important in improving functional losses .

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