Anterior cerebral artery (ACA) stroke

1. Where can the ACA be occluded without having any deficits?
2. What occurs when both ACAs arise from one stem and there is an occlusion?
3. What symptoms occur when there is occlusion of one ACA, distal to the anterior comm artery?
4. If the dominant side is affected, what sort of aphasia results?

Answers:
1. At the stem of the ACA, just proximal to its connection with the anterior communicating artery, due to collateral circulation.
2. Major disturbances in both hemispheres --> aphasia, paraplegia, incontinence, frontal lobe dysfunction.
3. Contralateral weakness and sensory loss, affecting mainly distal leg, little UE involvement, head and eyes deviating toward side of lesion, urinary incontinence, gait apraxia.
4. Transcortical motor aphasia.