2026 American Academy of Neurology Abstract Website

Objective:

Describe complete corpus callosum infarction mechanisms due to ACA ischemia.

Background:

Corpus callosum infarcts are uncommon, most often involving the splenium.1 Complete corpus callosum infarction is rare due to dual anterior and posterior circulation supply.1 The medial and subcallosal arteries supply the rostrum and genu, the pericallosal artery the body, and the posterior pericallosal artery the splenium, with anastomoses at its tip.1 Only two prior cases of pan-corpus callosum infarction have been reported.2,3 We describe three additional cases attributable to anterior cerebral artery (ACA) ischemia, suggesting a variant pattern where ACA and anterior communicating branches supply the entire corpus callosum.

Design/Methods:

Three patients with MRI-confirmed corpus callosum infarcts were retrospectively identified. Clinical, imaging, demographic and vascular data were reviewed.

Results:

Case 1: 68-year-old woman with global aphasia and left-hand disconnection signs (agraphia, apraxia, astereognosis). MRI showed infarction of the corpus callosum, parasagittal frontal cortex, cerebellum, and right occipital lobe. CTA revealed severe left A2 ACA stenosis with multifocal atherosclerosis, consistent with atheroembolic ACA infarction.

Case 2: 63-year-old man with aphasia, right facial droop, and left-hand agraphia. MRI showed infarction of the genu and splenium, left superior frontal lobe, cingulate gyrus, and thalamus. CTA demonstrated left A1 occlusion with ACA-distribution hypoperfusion.

Case 3: 65-year-old man with encephalopathy and global aphasia. MRI revealed near-complete corpus callosum infarction (left > right) with bilateral white matter and cerebellar involvement. CTA showed distal left A2 near-occlusion and left ICA stenosis, consistent with mixed atheroembolic and hypoperfusion injury.

Conclusions:

These cases illustrate complete corpus callosum infarction due to ACA pathology, indicating that ACA and anterior communicating branches may, in some individuals, provide dominant callosal perfusion. All cases, as in prior reports, involved left ICA stenosis or occlusion, suggesting a predisposition from left anterior circulation compromise.2,3 Recognition of this variant may improve understanding of disconnection syndromes and ischemic vulnerability patterns.