Anterior cerebral artery (ACA) territory infarctions are rare causes of ischemic strokes and often present atypically. We report an isolated distal A2 segment ACA occlusion presenting with global aphasia and right hemiparesis, features typical of a left middle cerebral artery (MCA) syndrome. CT angiography revealed a patent MCA, with a distal left ACA thrombus in A2. Perfusion imaging confirmed a viable mismatch. The patient underwent successful thrombectomy with complete recovery. This case illustrates how distal ACA occlusions can mimic MCA strokes, especially when involving the supplementary motor area or anterior cingulate. While data remain limited, this case contributes to a growing body of literature, and emerging evidence that supports the safety and efficacy of thrombectomy in selected distal ACA occlusions with disabling deficits and viable penumbra. Early recognition and intervention in such atypical cases can lead to excellent outcomes.
Ezzeldin et al. (Sat,) studied this question.
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