Left leg sensory and motor loss with frontal dysfunction (apathy, stimulus bound, jocularity, hypomania). Which stroke territory?

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Multiple Choice

Left leg sensory and motor loss with frontal dysfunction (apathy, stimulus bound, jocularity, hypomania). Which stroke territory?

Right ACA territory. The anterior cerebral artery supplies the medial surface of the frontal lobe, including the leg area of the primary motor and sensory cortices and the medial prefrontal regions involved in executive function and behavior. An infarct on the right produces contralateral (left) leg weakness and sensory loss, matching the leg-predominant sensory/motor loss. At the same time, damage to the medial frontal circuits often yields a frontal syndrome with apathy and disinhibition. The specific signs described—stimulus-bound behavior, jocularity, and hypomania—are characteristic of right frontal pathology and reflect a lack of appropriate social restraint and initiative. Left ACA would cause similar leg findings but with different language/behavioral patterns if the dominant hemisphere were affected; MCA lesions would typically present with more arm/face involvement or higher-order language/neglect signs, not a pure leg-predominant and frontal syndrome pattern.

Right ACA territory. The anterior cerebral artery supplies the medial surface of the frontal lobe, including the leg area of the primary motor and sensory cortices and the medial prefrontal regions involved in executive function and behavior. An infarct on the right produces contralateral (left) leg weakness and sensory loss, matching the leg-predominant sensory/motor loss. At the same time, damage to the medial frontal circuits often yields a frontal syndrome with apathy and disinhibition. The specific signs described—stimulus-bound behavior, jocularity, and hypomania—are characteristic of right frontal pathology and reflect a lack of appropriate social restraint and initiative. Left ACA would cause similar leg findings but with different language/behavioral patterns if the dominant hemisphere were affected; MCA lesions would typically present with more arm/face involvement or higher-order language/neglect signs, not a pure leg-predominant and frontal syndrome pattern.

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