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Anatomy of IOM
Middle cereberal
Anterior cereberal
Anterior choroidal artery
Ophthalmic artery
Posterior communicating artery
Internal carotid artery
External carotid artery
Common carotid artery
Fig. 2.26 Anterior cerebral circulation
The left and right anterior circulations are
connected via the anterior communicating artery.
A lesion in the vascular territory of the MCA
will result in sensorimotor deficits in the contralateral face and upper extremity. The deficits are
contralateral because the sensory and motor pathways affected are crossed pathways. We will discuss this in greater detail below. An ACA territory
lesion results in sensorimotor deficits in the contralateral lower extremity. These cerebral functional areas are best monitored by the upper and
lower extremity sensory and motor evoked
Cerebral areas supplied by overlapping terminal branches of both the MCA and ACA are
known as watershed areas. These areas have
reduced blood flow compared to the rest of the
vascular territory and, as such, are more vulnerable to reductions in blood flow. The watershed
areas are the most frequent site of stroke, comprising approximately 10 % of all strokes. Strokes
in this area are termed watershed infarcts.
The posterior circulation is supplied by the
vertebrobasilar complex consisting of the vertebral and basilar arteries and their branches
(Fig. 2.27). The posterior circulation supplies the
occipital lobes of the brain, subcortical structures
such as the thalamus, as well as the brainstem and
cerebellum. A pair of vertebral arteries arising
from the subclavian arteries ascends through the
transverse foramina of the cervical vertebrae
before joining at midline to form the basilar
artery. The anterior spinal artery is given off from
the vertebral arteries and supplies the anterior
two thirds of the spinal cord. There is only one
anterior spinal artery, but it receives contributions
from both the left and right vertebral arteries.
The largest branch of the vertebral artery is the
posterior inferior cerebellar artery (PICA), which
is one of the three main blood vessels supplying
the cerebellum. The two other main cerebellar
arteries are the anterior inferior cerebellar artery
(AICA) and the superior cerebellar artery (SCA),
both are branches of the basilar artery. Branching