Anterior cerebral artery occlusion mimicking MCA syndrome: A rare case of supplementary motor area syndrome due to thromboembolism

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Abstract
Infarcts within the anterior cerebral artery (ACA) territory are uncommon, representing only 3-5% of all ischemic strokes. Infarcts within this area may closely mimic middle cerebral artery (MCA) syndromes due to overlapping clinical presentations such as contralateral hemiparesis and language impairment, leading to diagnosis uncertainty and delays in recognition of ACA involvement. Accurate and prompt identification of the correct clinical syndrome and vascular territories is essential for guiding timely reperfusion therapy. In this report, we present a 73-year-old right-handed male presenting with non-fluent aphasia and dense right-sided hemiparesis in the setting of mechanical rescue thrombectomy. This case illustrates the diagnostic challenges of atypical stroke presentations involving the ACA territory and highlights the precise clinical-radiographic correlation in identifying the affected vascular territory.

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