What are the Arteries of the Anterior Circulation of the CNS?
Middle Cerebral A. (MCA)
Anterior Cerebral A. (ACA)
Lateral Striate A.
What are the Arteries of the Posterior Circulation of the CNS?
Anterior Spinal A. (ASA)
Posterior Inferior Cerebellar A. (PICA)
Anterior Inferior Cerebellar A. (AICA)
Posterior Cerebral A. (PCA)
What does the MCA supply?
Motor cortex - Upper Limb & Face
Sensory cortex - Upper Limb & Face
Temporal lobe (Wernicke's area) Frontal lobe (Broca's area)
What does the ACA supply?
Motor cortex - Lower limb
Sensory cortex - Lower limb
What does the Lateral Striate A. supply?
Striatum, Internal Capsule
Contralateral paralysis of the upper limb and face is d/t a stroke of what artery and region?
MCA
Motor cortex upper limb & face
Contralateral loss of sensation of upper limb and face is d/t a stroke of what artery and region?
MCA
Sensory cortex - upper limb & face
What are the symptoms of stroke to Wernicke’s area (temporal lobe) or Broca’s area? What artery is involved?
Aphasia (if in dominant hemisphere; usually Left)
Hemineglect (Nondominant side)
MCA
Contralateral paralysis and loss of sensation of the lower limbs is d/t a stroke of what artery and region?
ACA
Motor & Sensory cortex - lower limb
Contralateral Hemiparesis/Hemiplegia is d/t a stroke of what artery and region?
Lateral Striate Artery
Striatum, Internal Capsule
*Common location of LACUNAR infarcts, 2˚ to unmanaged hypertension
What does the Anterior Spinal A. (ASA) supply?
- Lateral Corticospinal tract
- Medial Lemniscus
- Caudal Medulla-Hypoglossal n.
What does PICA supply?
Lateral Medulla:
- Vestibular nuclei
- Lateral spinothalamic tract
- Spinal Trigeminal nucleus
- Nucleus Ambiguus
- Sympathetic fibers
- Inferior Cerebellar Peduncle
What does AICA supply?
Lateral Pons
- Cranial nerve nuclei
- Vestibular nuclei
- Facial nucleus
- Spinal trigeminal nucleus
- Cochlear nuclei
- Sympathetic fibers
Middle & Inferior Cerebellar Peduncles
What does the PCA supply?
Occipital cortex
Visual cortex
Contralateral hemiparesis of the lower limbs is d/t a stroke of what artery and region?
ASA - Lateral corticospinal tract
Decreased contralateral proprioception is d/t a stroke of what artery and region?
ASA - Medial lemniscus
Ipsilateral hypoglossal dysfunction is d/t a stroke of what artery and region?
ASA - Caudal medulla–Hypoglossal n.
*tongue deviates ipsilaterally – “lick your wound”
What is Medial Medullary Syndrome?
Infarct of paramedian branches of ASA & Vertebral arteries
- Alternating Hemiplegia affecting:
- Lateral Corticospinal tract
- Contralateral hemparesis (lower limb)
- Medial Lemniscus
- Contralateral loss of proprioception
- Hypoglossal n.
- Ipsilateral loss of hypoglossal function
- Lateral Corticospinal tract
What is Lateral Medullary (Wallenberg’s) Syndrome?
Infact of PICA
- Vestibular nuclei - vestibular system: vomiting, vertigo, nystagmus
- Inferior cerebellar peduncle - Ipsilateral cerebellar signs including ataxia, dysmetria (past pointing), dysdiadokokinesia
- Central tegmental tract - palatal myoclonus
- Lateral spinothalamic tract - contralateral deficits in pain and temperature sensation from body (limbs and torso)
- Spinal trigeminal nucleus & tract - ipsilateral loss of pain, and temperature sensation from face
- Nucleus ambiguus - vagus nerve and glossopharyngeal nerve - ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis: dysphagia, hoarseness, diminished gag reflex (efferent limb - CN.X)
- Descending sympathetic fibers - ipsilateral Horner’s syndrome (ptosis, miosis, & anhydrosis)
“Can’t Swallenberg - Mark Walberg was a PICA”
Nucleus Ambiguus effects are specific to a lesion of what Artery?
PICA
“Don’t PICK A (PICA) horse (hoarseness) that cant eat (dysphagia)”
What is Lateral Pontine Syndrome?
Blockage of AICA
- Lateral spinothalamic tract:
- Contralateral loss of pain and temperature from the trunk and extremities.
- Facial nucleus & facial Nerve:
(1) Ipsilateral paralysis of the upper and lower face (lower motor neuron lesion).
(2) Ipsilateral loss of lacrimation and reduced salivation.
(3) Ipsilateral loss of taste from the anterior two-thirds of the tongue.
(4) Loss of corneal relfex (efferent limb). - Spinal trigeminal nucleus and tract:
- Ipsilateral loss of pain and temperature sensation from the face (facial hemianesthesia)
- Vestibular Nuclei and intraaxial nerve fibers:
- Nystagmus, nausea, vomiting, and vertigo
- Cochlear nuclei and intraxial nerve fibers:
- Hearing loss - ipsilateral central deafness
- Middle & inferior cerebellar peduncle:
- Ipsilateral limb and gait ataxia
- Descending sympathetic tract:
- Ipsilateral Horner’s syndrome (ptosis, miosis, & anhydrosis)
Facial Nucleus effects are specific to a lesion of what artery?
AICA
“Facial droop means AICA’s pooped”
Ataxia and Dysmetria are d/t a stroke of what artery and region?
AICA - Middle & Inferior Cerebellar peduncles
A lesion to the PCA would cause what type of symptoms?
Contralateral hemianopia w/ Macular Sparing
*Occipital cortex, visual cortex
