—I agree with Dr Ward's suggestion that the patient described by Dr Kertesz and me may have an infarct of the right anterior choroidal artery (ACA) territory, especially since the posterior and retrolental parts of the posterior limb of the internal capsule were damaged. However, since angiograms were not performed we cannot be sure that he "... actually has an occlusion of the [ACA]." The posterior limb of the internal capsule also receives some blood supply from the penetrating (lenticulostriate) branches of the middle cerebral artery and from the posterior choroidal artery.1 It is difficult to distinguish between infarct on the ACA territory and "watershed" infarct occurring on the boundaries of these deep vessels. In fact, although "the ACA has been extensively studied... by many investigators... all have found great inconsistency in its origin and distribution."2 Moreover, the ACA can be ligated without harmful effects.3The lesion location
Ferro JM. Anterior Choroidal Artery Syndrome-Reply. Arch Neurol. 1985;42(5):424. doi:10.1001/archneur.1985.04060050018006
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