**Question:** Following are features of ischemia in Anterior choroidal artery territory except

A. Loss of smell
B. Hemiparesis
C. Hemianopsia
D. Aphasia

**Core Concept:** Anterior choroidal artery (AChA) is a branch of the internal carotid artery, supplying the brain regions that it perfuses. When this artery is occluded or has reduced blood flow, various neurological deficits can occur due to the affected territories.

**Why the Correct Answer is Right:** The correct answer is D. Aphasia, because aphasia is a language disorder caused by damage to the left hemisphere of the brain, primarily involving the Broca's area and Wernicke's area. These areas are supplied by the middle cerebral artery, not the anterior choroidal artery. In contrast, the anterior choroidal artery supplies the regions associated with the following deficits:

1. Loss of smell (olfactory dysfunction) due to the involvement of the olfactory bulb and tract, which are part of the anterior choroidal artery's territory.
2. Hemiparesis (weakness on one side of the body) due to the involvement of the motor cortex and its corresponding upper and lower motor neurons.
3. Hemianopsia (visual field loss) due to the involvement of the primary visual cortex, which lies within the territory of the AChA.

**Why Each Wrong Option is Incorrect:**

A. Loss of smell is not a feature of ischemia in the middle cerebral artery territory (e.g., Broca's and Wernicke's areas).
B. Hemiparesis is a feature of ischemia in the territory of the middle cerebral artery (MCA), specifically involving the motor cortex and its corresponding neurons.
C. Hemianopsia is a feature of ischemia in the territory of the posterior cerebral artery (PCA), which supplies the occipital lobe, not the anterior choroidal artery (AChA).

**Clinical Pearl:**

Aphasia is a common neurological deficit seen after middle cerebral artery occlusion or significant stenosis. However, specific deficits related to the AChA territory help identify its involvement and differentiate it from other territories. Understanding these regional features is essential for accurate diagnosis, treatment, and prognosis in stroke patients.