Teaching NeuroImage: Atypical Anterior Cerebral Artery Syndrome From Pericallosal Artery Infarct

A 76-year-old right-handed woman presented with sudden right-sided weakness and mutism. Examination revealed transcortical motor aphasia, right arm apraxia and spasticity, and right leg hemiplegia. She demonstrated abulia, anosognosia, and emotional lability. CT angiogram demonstrated a left pericallosal artery occlusion (Figure 1). The patient received tPA. MRI demonstrated an infarct spanning the left supplementary motor area (SMA) and anterior cingulate cortex (Figure 2).1

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