Blood Supply to the Brain

What major areas are supplied by the ACA?

• Anterior frontal lobe
• Medial frontal/parietal surfaces

What is the classic motor/sensory deficit of an ACA stroke?

• Contralateral weakness/sensory loss
• Lower extremity > upper extremity

What other deficits can occur with ACA involvement?

• Loss of bowel/bladder control
• Behavioral changes
• Neglect
• Aphasia
• Apraxia
• Agraphia
• Perseveration

What can significant bilateral ACA involvement cause?

• Akinetic mutism
• Severe LE involvement/paraplegia

What is the most common site of a CVA?

Middle cerebral artery (MCA)

What is the classic motor/sensory pattern of an MCA stroke?

• Contralateral weakness/sensory loss
• Face and UE > LE

What language deficit can dominant MCA damage cause?

• Wernicke's aphasia
• Other aphasias depending on location

What visual deficit commonly occurs with MCA involvement?

• Homonymous hemianopsia

What can right/nondominant MCA damage cause?

• Impaired spatial relationships
• Anosognosia
• Flat affect

What major regions are supplied by the PCA?

• Occipital cortex
• Inferior temporal lobe
• Thalamus
• Portions of midbrain

What are common deficits of PCA involvement?

• Visual deficits
• Homonymous hemianopsia
• Memory impairment
• Visual agnosia
• Thalamic pain syndrome

What can bilateral PCA involvement cause?

• Cortical blindness

What major structures are supplied by the vertebrobasilar system?

• Brainstem
• Cerebellum
• Posterior cerebral circulation

What deficits can occur with vertebrobasilar involvement?

• Loss of consciousness
• Hemiplegia/tetraplegia
• Locked-in syndrome
• Vertigo
• Nystagmus
• Dysphagia
• Dysarthria
• Syncope
• Ataxia

What syndrome can result from severe pontine/vertebrobasilar involvement?

• Locked-in syndrome

How do you quickly differentiate ACA, MCA, and PCA strokes?

• ACA = leg > arm

• MCA = face/arm > leg

• PCA = vision

• Vertebrobasilar = brainstem/cerebellar signs