Is it true that pure motor strokes are associated with lenticulostriate arteries from the Middle Cerebral Artery (MCA) and pure sensory strokes with the Anterior Choroidal Artery (AChA) from the MCA?

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Vascular Territories and Lacunar Stroke Syndromes

Your understanding is partially correct but oversimplified: pure motor strokes are typically caused by lenticulostriate artery occlusions from the MCA, while pure sensory strokes are classically thalamic (not AChA territory), though the anterior choroidal artery (AChA) more commonly causes mixed sensorimotor deficits rather than pure sensory presentations.

Pure Motor Stroke: Lenticulostriate Territory

Pure motor hemiplegia is most commonly associated with occlusion of the lateral lenticulostriate arteries arising from the MCA, causing infarction in the posterior limb of the internal capsule. 1, 2

Anatomic Correlates

  • The lenticulostriate arteries (also called perforating arteries) arise from the MCA main trunk, terminal trunks, bifurcation site, or leptomeningeal branches 3
  • These vessels number between 2-12 per MCA and range from 80 to 1,400 micrometers in diameter 3
  • They supply the basal ganglia, genu, anterior limb of the internal capsule, and the rostral portion of the superior part of the posterior limb of the capsule 3

Clinical Presentation

  • Pure motor deficits occur in more than 50% of patients with lenticulostriate territory infarcts 1
  • CT studies demonstrate three varieties of ischemic capsular lesions causing pure motor hemiplegia: capsulo-putamino-caudate infarct (Type I, most common at 15/27 cases), capsulo-pallidal infarct (Type II), and anterior capsulo-caudate infarct (Type III) 2
  • Type I lesions correspond to the lateral lenticulostriate branches of the MCA 2
  • Sensorimotor deficits occur in 30% of lenticulostriate infarcts, while ataxic hemiparesis occurs in 20% 1

Critical Caveat

No patients with pure lenticulostriate territory infarcts presented with pure sensory stroke in the largest clinical series 1

Anterior Choroidal Artery (AChA): Not Pure Sensory

The anterior choroidal artery does NOT typically cause pure sensory strokes—this is a common misconception. AChA infarcts more commonly produce mixed sensorimotor deficits with severe neurologic impairment.

AChA Territory and Clinical Features

  • The AChA supplies the lower part of the posterior limb of the internal capsule (PLIC), lateral geniculate body, uncus, and cerebral peduncle 4
  • Type II capsular lesions (capsulo-pallidal infarcts) causing pure motor hemiplegia correspond to the perforating branches of the anterior choroidal artery 2
  • AChA infarction is most commonly associated with small artery disease (SAD), followed by large artery disease (LAD), particularly distal internal carotid artery (ICA) disease 4

Distinguishing Features

  • Definite AChA (dAchA) infarction involves the lateral geniculate body, uncus, or cerebral peduncle in addition to the PLIC 4
  • dAchA infarction is more frequently associated with cardioembolism (12% vs 2%), distal ICA steno-occlusion (35% vs 2%), and more severe neurologic deficits compared to probable AChA (pAchA) infarction confined to the PLIC 4
  • The distinction matters because isolated PLIC lesions may actually be supplied by lenticulostriate arteries rather than AChA 4

Pure Sensory Stroke: Thalamic Territory

Pure sensory stroke is classically caused by thalamic lacunar infarcts, not AChA territory infarcts. 5

Vascular Supply

  • The thalamus receives blood supply from multiple sources including thalamoperforating arteries from the posterior cerebral artery (PCA) and posterior communicating artery
  • Pure sensory stroke involves the ventral posterolateral (VPL) and ventral posteromedial (VPM) nuclei of the thalamus
  • In rare cases, complex vascular abnormalities involving the posterior circulation can cause pure sensory presentations 5

Common Pitfalls to Avoid

Oversimplification of Vascular Territories

  • Do not assume all PLIC lesions are AChA territory—many are actually supplied by lenticulostriate arteries 4
  • The inconsistent results in previous AChA studies stem from different degrees of inclusion of isolated PLIC lesions 4

Clinical Correlation Errors

  • Sensory deficits in lenticulostriate territory infarcts are not correlated with any specific location, likely because thalamo-efferent fibers have a diffuse course through the internal capsule 1
  • Visual field deficits and hemineglect always correspond to posteriorly situated lenticulostriate infarcts 1
  • Neuropsychological deficits are common in anterior and posterior subdivisions of lenticulostriate territory, with major effect of infarct size 1

Etiologic Considerations

  • While more than 75% of lenticulostriate territory infarct patients have hypertension or diabetes (small-artery disease), embolic sources are encountered in 35% (28% from large vessels, 15% from heart) 1
  • Do not assume all lacunar syndromes are purely due to small vessel disease—evaluate for embolic sources 1

References

3
Research

Anatomic and clinical correlations of the lenticulostriate arteries.

Clinical anatomy (New York, N.Y.), 2001

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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