Download Anterior Cerebral Artery

 Anterior circulation: Carotid system
 Posterior circulation: Vertebrobasilar system (VB system)
Circle of Willis
CNS vessels
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Anterior Circulation
Common carotid artery (CCA)
External carotid artery (ECA)
Internal carotid artery (ICA)
Anterior cerebral artery (ACA)
Anterior communicating artery
(Acom)
Middle cerebral artery (MCA)
Cortical branches
Lenticulostriate artery
CNS vessels
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Posterior Circulation
Posterior cerebral artery
(PCA)
Posterior communicating
artery (Pcom)
Vertebral artery (VA)
Basilar artery (BA)
Anterior spinal artery (ASA)
CNS vessels
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Internal Carotid Artery
CNS vessels
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Internal Carotid Artery
(cavernous segment)
CNS vessels
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Meningohypophysial trunk from
the cavernous & postclinoid
segment of ICA
Internal Carotid Artery
Hypophysial arteries
Posterior hypophysial
arteries: posterior lobe of
pituitary gland
Anterior hypophysial
arteries: medial eminence
of hypothalamus; forming
hypophysial portal system
Ophthalmic artery
Posterior communicating artery
(Pcom)
Anterior choroidal artery
CNS vessels
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Internal Carotid Artery
1: meningohypophyseal
trunk
2: lateral
mainstem
CNS vessels
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Middle Cerebral Artery
CNS vessels
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Middle Cerebral Artery
CNS vessels
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Middle Cerebral Artery
1: M1
2: lat. lenticulostriate
3: lat. fissure
CNS vessels
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Middle Cerebral Artery
Terminal branches
Cortical branches
Lenticuostriate arteries (deep branch)
Clinical note: depends on the site of
occlusion
Main trunk of MCA
Branches of MCA: cortical vs. deep branches
CNS vessels
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Anterior Cerebral Artery
CNS vessels
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Anterior Cerebral Artery
CNS vessels
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Anterior Cerebral Artery
CNS vessels
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Anterior Cerebral Artery
Branches:
recurrent artery of Heubner (medial striate artery):
proximal to Acom; penetrating anterior perforated
substance; supplying head of caudate nucleus, putamen,
anterior limb of internal capsule, corpus callosum
Course: ascending in longitudinal fissure; bending
backwards around corpus callosum; continuing as
pericallosal artery and callosomarginal artery following the
cingulate sulcus
Territory: medial surface of cerebral hemisphere
Clinical syndrome: motor and sensory deficits in
contralateral leg; sometimes mental confusion. Why?
CNS vessels
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Anterior Cerebral Artery
CNS vessels
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Vertebrobasilar System
Vertebral artery (VA):
arising from the subclavian artery
ascending in foramina of transverse processes of upper
6 C-vertebrae
piercing posterior atlanto-occipital membrane on
reaching skull base
entering subarachnoid space at the level of foramen
magnum; forming
Basilar artery (BA) by joining of 2 VA at ponto-medullary
junction; dividing into
Posterior Cerebral Arteries (PCA) at midline of midbrain
CNS vessels
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Vertebral artery (VA)
1: Pcom
2-5: anastomosis
between ICA and VB
CNS vessels
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VB system
Spinal arteries:
single Anterior Spinal Artery
as continuation of VA
Posterior Spinal Artery as a
branch of either VA or PICA
Posterior Inferior Cerebellar
Artery (PICA)
CNS vessels
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VB system: PICA
Posterior Inferior Cerebellar
Artery (PICA)
the largest branch of VA
pursuing an irregular
course between medulla
and cerebellum
supplying posterior part
of cerebellar hemisphere,
inferior vermis, nuclei of
cerebellum and choroid
plexus of 4th ventricle
with medullary branches
to dorsolateral region of
medullla
CNS vessels
1-7: br of PICA
8: AICA; 9: SCA
10: Ant spinal a.
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VA system: Basilar Artery
Basilar artery with branches: Anterior Inferior
Cerebellar Artery (AICA), Labyrinthine artery, Pontine
Arteries, Superior Cerebellar Artery
AICA: arising from caudal end of BA; supplying cortex
of inferior surface of anterior cerebellum and
underlying white matter and central nuclei; supplying
upper medulla and tegmentum of lower pons by small
branches
Labyrithine artery: a branch of either BA or AICA;
entering internal acoustic meatus and supplying
membranous portion of internal ear
CNS vessels
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Pontine Arteries
slender branches of variable length:
Paramedian arteries: basal part of pons (corticospinal
fibers, pontine nuclei and transverse pontocerebellar
fibers)
Circumferrential arteries: lateral part of pons and middle
cerebellar peduncle; the floor of 4th ventricle and
tegmentum by turning medially
CNS vessels
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Pontine arteries
Paramedian branches
Circumferential branches
CNS vessels
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Superior Cerebellar
Artery
branch immediately before
terminal bifurcation of BA;
Supply dorsal surface of
cerebellum (cortex, white
matter and central nuclei),
rostral pontine tegmentum,
superior cerebellar
peduncle, and inferior
colliculus
CNS vessels
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Posterior Cerebral Artery (PCA)
curve around midbrain and reach medial surface of cerebral
hemisphere beneath splenium of corpus callosum
with temporal branches (inferior surface of temporal lobes:
hippocampus), calcarine (primary and association cortex of
vision), and parieto-occipital branches
Posterior choroidal artery: from the splenium region beneath
corpus callosum
supplying choroid plexus of the lateral and 3rd ventricles,
thalamus, fornix and tectum of midbrain
anastomosing with anterior choroidal artery within choroid
plexus of the lateral ventricle
CNS vessels
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Posterior Cerebral Artery
CNS vessels
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Posterior Cerebral Artery (PCA)
1-2: thala. A
3-4: post choroidal a
5-6: temp. a
7: parieo-occipital a
8: calcarine a
9: splenial a
CNS vessels
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Central Arteries
slender, thin-walled vessels
directly from the circle of Willis
ganglionic, nuclear, striate or
thalamic perforating arteries
supply corpus striatum, internal
capsule, diencephalon and
midbrain
recurrent artery of Heubner,
anterior and posterior choroidal
arteries
groups: anteriomedial,
anteriolateral, posteromedial,
posterolateral
CNS vessels
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Central Arteries (1/2)
Anteriomedial group: from
ACA; penetrating anterior
perforated substance; to
hypothalamus (preoptic and
suprachiasmatic)
Anteriolateral group (striate
arteries; lateral striate
arteries): from MCA;
penetrating anterior
perforated substance; to
supply corpus striatum
CNS vessels
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Central Arteries (2/2)
Posteromedial group: from
PCA and Pcom ; penetrating
posterior perforated
substance (the floor of
interpeduncular fossa); to
diencephalon & midbrain
(medial portion of cerebral
peduncle)
Posterolateral group: from
PCA; curving around
midbrain; to portion of
thalamus and midbrain
(tectum, lateral portion of
cerebral peduncle)
CNS vessels
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CNS vessels
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CNS vessels
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CNS vessels
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CNS vessels
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Clinical Notes of Stroke
Vasomotor Control
Autoregulation: to ensure constant rate of blood
flow depending on local vasodialtor metabolites
Stroke syndromes
example: visual pathway and cerebral circulation
CNS vessels
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Visual pathway and cerebral circulation
CNS vessels
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Visual pathway and stroke
CNS vessels
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Venous Drainage
Brainstem and cerebellum:
drained by unnamed veins into dural venous sinuses
of posterior cranial fossa
Cerebrum:
by external cerebral veins (surface) and internal
cerebral veins (central core, beneath corpus callosum
in transverse fissure);
both systems finally draining into dural venous sinuses
CNS vessels
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Venous Drainage:
External Cerebral Venous System
Superior cerebral veins: over lateral surface of hemisphere
into superior sagittal sinus
Superficial middle cerebral vein: downward along lateral
sulcus and into cavernous sinus; with anastomotic channels:
superior anastamotic vein (of Trolard) into superior
sagittal sinus
inferior anastomotic vein (of Labbé) into transverse sinus
Deep middle cerebral vein: anterior cerebral vein and basal
vein (of Rosenthal)
CNS vessels
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Eexternal Cerebral Venous System
CNS vessels
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Internal cerebral
venous system
Thalamostriate vein
(vena terminalis)
Choroidal vein
Internal cerebral vein
Great cerebral vein
(of Galen)
CNS vessels
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Cerebral Venous System
CNS vessels
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CNS vessels
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Spinal Arteries
Anterior spinal artery:
from VA
Posterior spinal arteries:
paired; from VA or PICA
running longitudinally
throughout the length of
spinal cord
Spinal arteries from VA:
only sufficient for upper
cervical cord
Segmental spinal arteries
CNS vessels
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Segmental spinal arteries
from VA of cervical segment, posterior intercostal branches
of thoracic aorta and lumbar branches of abdominal aorta;
enter vertebral canal through intervertebral foramina;
give anterior and posterior radicular arteries running along
the ventral and dorsal roots of spinal nerves; of small
caliber, only for nerve roots and vascular plexus in pia;
join the anterior and posterior spinal arteries in lower
cervical, lower thoracic and upper lumbar regions; with the
largest one (spinal artery of Adamkiewicz) for upper lumbar
region
CNS vessels
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CNS vessels
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Segmental Spinal Arteries
Anterior spinal artery
ventral horn
portion of dorsal horn
ventral and lateral white funiculi
Posterior spinal artery
dorsal funiculi
the remaining part of dorsal horn
CNS vessels
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Segmental Spinal Arteries
CNS vessels
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Spinal Veins
Variable in course
Anterior spinal vein: along
midline and ventral rootlets
Posterior spinal vein: along
the midline and dorsal rootlets
Drained by anterior radicular
veins and posterior radicular
veins into epidural venous
plexus, further into external
vertebral plexus via
intervertebral foramina and
finally into vertebral,
intercostal and lumbar veins
CNS vessels
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Imaging of brain in vascular disorders
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Cerebral angiography
Regular angiography
Computed tomography angiography (CTA)
Magnetic resonance angiography (MRA)
Ultrasound
CNS vessels
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CT and MRI
CNS vessels
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Vascular territories on neuroimaging:
border zone (watershed) infarct
(cortical border zone infarct JNNP)
CNS vessels
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Clinical-Neuroanatomical correlations
CNS vessels
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Clinical-Neuroanatomical correlations
CNS vessels
Somatosensory
Motor
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Cerebral angiography
CNS vessels
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Cerebral angiography
CNS vessels
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CNS vessels
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Case report
A 47-year-old male was sent to Emergency Department
(ER) due to
acute onset of right hemiplegia, right facial plasy
(central type), and global aphasia (motor + sensory
aphasia).
Neurological examinations showed upper motor
neuron signs on the right side.
You are the VS in charge of ER:
Localization of lesion: where is the lesion according
to clinical neuroanatomical correlations?
Underlying pathophysiology: which vessel is
occluded?
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CNS vessels
Localization of lesion
CNS vessels
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Underlying pathophysiology:
Magnetic resonance angiography
CNS vessels
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CNS vasculature
Brain
Circle of Willis, Carotid system, VB system
Territory of vessels and functional correlations
Spinal cord
Anterior and Posterior spinal artery
Venous system
Internal cerebral venous system
Dural sinuses
CNS vessels
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