A patient with frontal dysfunction such as apathy and hypomania accompanied by right leg weakness has which stroke territory?

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Multiple Choice

A patient with frontal dysfunction such as apathy and hypomania accompanied by right leg weakness has which stroke territory?

Frontal lobe signs with leg-dominant weakness point to the anterior cerebral artery territory. The medial portion of the frontal lobe includes the motor cortex area that controls the leg, so an ACA stroke classically produces contralateral leg weakness. In addition, the medial frontal circuits contribute to behavior and personality changes such as apathy, abulia, or disinhibition, which can manifest as hypomanic or frontal-dysexecutive features. Given the right leg weakness, the lesion must be in the left hemisphere’s ACA territory to produce the contralateral (right) weakness. A right ACA stroke would typically cause left leg weakness, not right, so it wouldn’t fit the bedside signs as cleanly. Other territories (MCA lesions) would produce face/arm weakness or aphasia (if left-dominant), and MCA stem lesions often produce more widespread deficits like gaze deviation or neglect. The combination of frontal behavioral changes with leg-dominant weakness best localizes to a left ACA stroke.

Frontal lobe signs with leg-dominant weakness point to the anterior cerebral artery territory. The medial portion of the frontal lobe includes the motor cortex area that controls the leg, so an ACA stroke classically produces contralateral leg weakness. In addition, the medial frontal circuits contribute to behavior and personality changes such as apathy, abulia, or disinhibition, which can manifest as hypomanic or frontal-dysexecutive features.

Given the right leg weakness, the lesion must be in the left hemisphere’s ACA territory to produce the contralateral (right) weakness. A right ACA stroke would typically cause left leg weakness, not right, so it wouldn’t fit the bedside signs as cleanly. Other territories (MCA lesions) would produce face/arm weakness or aphasia (if left-dominant), and MCA stem lesions often produce more widespread deficits like gaze deviation or neglect. The combination of frontal behavioral changes with leg-dominant weakness best localizes to a left ACA stroke.

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