Involuntary movements after anterior cerebral artery territory infarction

Background and Purpose-Patients with anterior cerebral artery territory infarction presenting with involuntary movements have rarely been described in the literature. Case Descriptions-The author reports 9 such patients: 3 with asterixis, 5 with hemiparkinsonism (tremor, rigidity, hypokinesia), and 1 with both. Asterixis developed in the acute stage in patients with minimal arm weakness, whereas parkinsonism was usually observed after the motor dysfunction improved in patients with initially severe limb weakness. Asterixis correlated with small lesions preferentially involving the prefrontal area; parkinsonism is related to relatively large lesions involving the supplementary motor area. Conclusions-Anterior cerebral artery territory infarction should be included in the differential diagnosis of asterixis and hemiparkinsonism.