Medical Neuroscience



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Chapter 2-4



1. Courses of anterior, middle, and posterior cerebral arteries
Ophthalmic artery

Supply eyeball

From anterior proximal supraclinoid carotid artery

Above anterior clinoid of sella turcica

Posterior communicating artery

Posterior of supraclinoid carotid artery

Anterior cerebral artery

Over rostrum, genu, and body of corpus callosum

Supply entire medial surface of hemispheres to splenium of corpus callosum

Middle cerebral arteries

Laterally from carotid T-junction to sylvian fissure

* ALWAYS supply perisylvian cortex (language processing center)

Branches from insula to frontal, temporal, and parietal operculae

Over frontal, temporal, and parietal lobe

Supply most of lateral hemispheres

Basilar artery

Posterior cerebral arteries

Wrap midbrain

Branches to inferior temporal lobes to occipital lobes

Supply posterior hemisphere and calcarine cortex

Brainstem

Basilar artery

Ventral pons = pontine arteries

Paramedian pons = short circumferential arteries

Lateral brainstem & cerebellum = long circumferential arteries

AICA + SCA

Posterior cerebral arteries

Midbrain, thalamus, internal capsule

Medulla

Anterior spinal artery = from two vertebral arteries



Midline for entire spinal cord length

Supply paramedian medulla

Posterior inferior cerebellar arteries

Dorsolateral quadrants of medulla

Inferior cerebellum



Vascular Supply of Brainstem


Arterial Territory


Midbrain

Pons

Medulla

Median


Midline branches

(basilar artery)




Midline branches

(basilar artery)



Midline branches

(anterior spinal artery)



Paramedian


Short circumferential branches

(basilar artery)




Short circumferential branches

(basilar artery)




Short circumferential branches

(anterior spinal artery)




Dorsolateral/cerebellum


Posterior cerebral artery/ Superior cerebellar artery (basilar artery)


Anterior inferior cerebellar artery

(basilar artery)



Posterior inferior cerebellar artery

(vertebral artery)




Chapter 2-4



1. Blood supply of basal ganglia, thalamus, deep cerebral white matter, and brainstem
Deep gray matter

Branches of anterior, middle, and posterior cerebral arteries

Supraclinoid internal carotid artery

Basal ganglia

Lenticulostriate arteries

Branches from anterior and middle cerebral arteries

Thalamus

Thalamoperforators

Branches of basilar artery, proximal posterior cerebral, and posterior communicating arteries

Deep cerebral white matter

Lenticulostriate

Thalamoperforators

Small cortical branches of anterior, middle, and posterior cerebral arteries

Brainstem

Medial

Small branches of basilar and anterior spinal arteries



Ventrolateral

Short circumferential branches from basilar and vertebral arteries

Dorsolateral

Long circumferential branches from basilar and vertebral arteries




Chapter 2-5



1. Major loci of thrombus formation
Heart – aorta – proximal internal carotid arteries – distal-most vertebral arteries – proximal basilar artery

Microvessels of cerebrum and brainstem


2. Emboli dynamics
Bifurcation points

Largest artery with the least angle from parent artery

Carotid T-junction = usually into middle cerebral artery, rarely anterior cerebral artery
3. Pathogenesis of microvascular strokes
Transient ischemic attacks

Highly stereotyped

Due to atheromatous disease in a small penetrating vessel
4. Probabilistic principles of emboli
Cardiogenic embolism is a concern in every stroke patient

Cardiogenic embolism is unlikely in a patient with repeated events in a single vascular territory

Artery-to-artery thromboembolism is unlikely in patients with strokes in multiple vascular territories

Multiple stereotyped events

Large vessel embolism = unlikely

Microvascular thrombosis, migraine, and seizures = likely


5. Lenticulostriate end zone
Proximal cerebral artery occlusion

Alternative route

Anterior and posterior cerebral arteries – distal middle cerebral branches – trunk of middle cerebral artery – lenticulostriate arteries

Lenticulostriate end zone = deep hemispheric white matter lateral superior to body of lateral ventricle

Infarction = hemiparesis & sensory loss

Motor and sensory in corona radiata


6. Silent infarction of right hemisphere and lacunar
Non-silent territory = somatosensory, visual, motor, and language systems

“Silent” cortical infarctions

More likely in nondominant hemisphere

Lacunar infarcts = small, penetrating vessels

Small lesions inapparent

Putamen





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