Vascular and Ventricular System

What is the origin for the arteries found in the anterior circulation

Internal carotid artery

What is the origin for the arteries in the posterior circulation

Vertebral artery

Where does the internal carotid originate

Common carotid; left CCA from the aortic arch; right CCA from brachiocephalic trunk

Where does the vertebral artery originate

Subclavian artery

Segments of the ICA

Cervical segment → Petrous segment → Cavernous segment → Supraclinoid segment

Branches of the ICA (in the order it branches)

Ophthalmic, PComm, Anterior choroidal, anterior cerebral, middle cerebral

What does the anterior cerebral artery supply

Cortex on anterior medial side surface of brain (frontal to anterior parietal)

MCA superior division supplies what areas

Lateral frontal and superior parietal (brain above the sylvian fissure)

MCA inferior division supplies what areas

Structures below sylvian fissure → lateral temporal

MCA deep division supplies what

Branches into the lenticulostriate artery that supplies basal ganglia and internal capsule

Describe which arteries are being supplies to each highlighted section

Blue = ACA, Yellow = MCA, Red = PCA

What does the anterior choroidal artery supply

Globus pallidus structures and posterior internal capsule

What does the recurrent artery of Heubner supply

Branch of ACA; supplies caudate, anterior putamen, globus pallidus

Left MCA superior division infarction causes what deficit

Face and arm weakness + Broca aphasia  on the RIGHT side

Left MCA inferior division infarction causes what deficit

Wernicke aphasia + visual field deficit on the RIGHT side

Left MCA deep division infarction causes what deficit

Pure motor hemiparesis on the RIGHT side (proportionate)

Left MCA stem infarction causes what deficit

Motor hemiparesis, numbness, visual field deficit, Global aphasia

What is the difference between left and right MCA infarction

Left side presents with aphasia, right side is neglect

Right MCA superior division infarction causes what deficit

Face and arm weakness on the LEFT side + hemineglect

Right MCA inferior division infarction causes what deficit

Left hemineglect + visual field and sensory deficit are also common

Right MCA deep division infarction causes what deficit

Pure motor hemiparesis on LEFT side

Right MCA stem infarction causes what deficit

Sensory loss, motor loss, visual field defect, hemineglect

ACA infarction causes what deficit

leg weakness + sensory loss on the OPPOSITE side of lesion

What forms the circle of willis

PComm and AComm that connect ACA and PCA

What does PICA supply

Lateral medulla and inferior cerebellum

What does AICA supply

Lateral caudal pons and small region of cerebellum

What does SCA supply

Superior cerebellum and small part of rostral laterodorsal pons

Branches of the posterior circulation

PCA, Basilar, SCA, AICA, PICA

A patient presents with numbness in this distribution, where is the lesion and cause

Lesion in the lateral medulla, cause is PICA infarction causing Wallenberg syndrome

What are the symptoms and etiologies of Wallenberg syndrome

Ipsilateral ataxia → Inferior cerebellar peduncle 

vertigo, nystagmus and nausea → Vestibular nuclei

Facial numbness → Trigeminal nucleus and tract

Decreased pain and temperature sense → Spinothalamic tract

Ptosis/Horner syndrome → Descending sympathetic tract

Hoarse voice → Nucleus ambiguus

Decreased taste → Nucleus solitarius

AICA syndrome is caused by a lesion in what area

Lateral caudal pons

What can be used to separate PICA from AICA syndrome

PICA syndrome DOES NOT have motor dysfunction; AICA main symptom is ATAXIA

What symptoms can be found in PICA syndrome but NOT AICA syndrome

Hoarse voice (nucleus ambiguus), decreased taste (nucleus solitarius)

What are the symptoms of SCA syndrome and where is the lesion

Ipsilateral ataxia; lesion of dorsolateral pons

Symptoms of PCA syndrome

Contralateral vision loss and alexia with agraphia (can read but not write)

Ventricular pathway

Lateral ventricle → Foramen of Monro → Third ventricle → Cerebral aqueduct → Forth ventricle → Foramen magendie → Spinal cord → Brain 

Venous drainage pathway from confluence of sinus to jugular vein

Confluence of sinus → Transverse sinus → Sigmoid sinus → Jugular foramen → Jugular vein