Vascular anatomy and arterial areas

Question 1

What is the recurrent artery of Heubner?

Answer 1

The longest branch from proximal ACA (the only one seen routinely on angiogram). ACA medial striate artery

Question 2

Where does Heubner usually go off?

Answer 2

In the junction between ACA and A.Com a (90% from proximal A2)

Question 3

On an axial plane, what artery supplies the middle frontal region?

Answer 3

ACA

Question 4

On an axial plane, what artery supplies the middle posterior region incl Thalamus?

Answer 4

PCA (PCom and basilar also supplies thalamus)

Question 5

What artery supplies most of the posterior limb and retrolentiform part of capsula interna?

Answer 5

The anterior choroidal artery (from distal ICA, between pCOm and the ICA bifurcation.)

Question 6

What is the Recurrent artery of Heubner supplying

Answer 6

= The medial striate artery.

*The head of the caudate nucleus
* Medial globus Pallidus
* Anterior limb of the internal capsule.
* Anterior hypothalamus
* Nucleus accumbens
w more
part of hippocampi

Question 7

What is the major vessel supplying hippocampus?

Answer 7

P2

Question 8

What is the pericallosal artery?

Answer 8

The distal continuation of ACA. It extends from the exit of callosomarginal artery along sulcus of corpus callosum to the splenium

Question 9

HOw many sehments does ACA have?

Answer 9

2 or 3 dependent on author.

Question 10

Where does the A2 branch bifurcate?

Answer 10

At the pericallosal artery and callosomarginal artery

Question 11

WHat is Heubners artery?

Answer 11

Its origin is near the A1-ACom-A2 junction of the ACA, arising from the proximal A2 in 90% of cases, and from the distal A1 in 10% of cases. Supplies the anteromedial part of the head of the caudate and anterior inferior internal capsule.

Question 12

WHat does the MCA supply?

Answer 12

The cortical branches of the MCA supply the lateral surface of the hemisphere, except for the medial part of the frontal and the parietal lobe, which is supplied by the ACA, and the inferior part of the temporal lobe, which is supplied by the PCA.

Question 13

What other important artery extend fro PCA?

Answer 13

pCOmA

Question 14

What does Posterior thalamoperforating arteries branching off the P1 segment of PCA do?

Answer 14

Supply blood to the midbrain and thalamus

Question 15

WHat important structures does the cortical branches of PCA supply?

Answer 15

The inferomedial part of the temporal lobe, occipital pole, visual cortex, and splenium of the corpus callosum. In addition, the arterial supply of hippocampus usually arises from PCA.

Question 16

Where are the two major watershed areas located?

Answer 16

*Cortical border zone infarctions
Infarctions of the cortex and adjacent subcortical white matter located at the border zone of ACA/MCA and MCA/PCA

*Internal border zone infarctions
Infarctions of the deep white matter of the centrum semiovale and corona radiata at the border zone between lenticulostriate perforators and the deep penetrating cortical branches of the MCA or at the border zone of deep white matter branches of the MCA and the ACA

Question 17

The corpus callosum has a rich blood supply, relatively constant and is uncommonly involved by infarcts. The majority of the corpus callosum (CC) is supplied by the pericallosal arteries. Where do they come from?

Answer 17

Branches from the anterior and posterior cerebral respectively.
(In 80% of patients additional supply comes from the anterior communicating artery, via either subcallosal artery or median callosal artery.)

Question 18

The basal ganglia are supplied by perforating branches of the anterior cerebral artery and middle cerebral artery. What are they called?

Answer 18

Medial lenticulostriate arteries, from the ACA, supply the globus pallidus and medial portion of the putamen.

Lateral lenticulostriate arteries, from the MCA, supply the lateral portion of the putamen.

Recurrent artery of Heubner, arising as a large branch from the ACA supplies the caudate nucleus.

Question 19

How is the Midbrain supplied?

Answer 19

Small penetrating branches from:

basilar artery

superior cerebellar artery

posterior cerebral artery

Question 20

How is the Pons supplied?

Answer 20

medial branches of the superior cerebellar artery

pontine branches of basilar artery, thalamoperforator arteries

Question 21

How is the medulla supplied?

Answer 21

posterior inferior cerebellar artery (PICA)

anterior spinal artery

direct branches of the distal vertebral artery

Question 22

What does PICA supply?

Answer 22

Has a variable territory depending on the size of the AICA, but usually supplies:

posteroinferior cerebellar hemispheres (up to the great horizontal fissure)

inferior portion of the vermis

18% arise extracranially, inferior to the foramen magnum

10% arise from the basilar rather than vertebral artery

2% bilaterally absent

occasionally loops around the cerebellar tonsil

Question 23

WHat does SCA supply?

Answer 23

This vessel supplies:

whole superior surface of the cerebellar hemispheres down to the great horizontal fissure

the superior vermis

dentate nucleus

most of the cerebellar white matter

Question 24

Där man ser hörselgångarna på en axial, med en cerebellär infarkt, vilket kärl har trombotiserat?

Answer 24

PICA

Question 25

What does the artery of Percheron supply?

Question 26

What is cerebral hyperperfusion syndrome?

Answer 26

A rare complication seen after treatment of long-standing severe carotid stenosis by carotid endarterectomy or carotid artery stenting. It is believed to be the result of a failure of normal cerebral blood flow autoregulation.

Question 27

WHat is this?

Answer 27

The presence of a crescent sign on fat-saturated T1 imaging surrounding the left carotid artery is consistent with a carotid dissection.

Question 28

Explain the major cerebral vascular territories

Answer 28

Question 29

What are the two artery territories seen?

Answer 29

Green=basilar
Purple=PICA

Question 30

Explain the arterial areas of posterior fossa-pontic level.

Answer 30

Question 31

Explain the vascular territories in the level of the eyebulb, just before the basilar apex

Answer 31

Question 32

What is “artery of Percheron”?

Answer 32

Its a variant of the posterior cerebral circulation characterized by a solitary arterial trunk that supplies blood to the paramedian thalami and the rostral midbrain bilaterally.

Question 33

Lateral medullary syndrome, also known as Wallenberg syndrome, is a clinical syndrome caused by an acute ischemic infarct of the lateral medulla oblongata.
What areries might be causing it?

Answer 33

PICA or VA

Question 34

Expected symtoms from this ischemia?

Answer 34

Lower motor neuron facial nerve palsy including loss of sensation of the taste in anterior two-thirds of the tongue and hyperacusis, diplopia and horizontal conjugate gaze palsy.

(This is infarct involves the facial colliculus which is formed by the fibers of the facial nerve passing behind the abducens cranial nerve nucleus before heading anterolaterally towards its exit at the pontomedullary junction. The medial longitudinal fasciculus (MLF) is located near the midline and may be involved. )

Question 35

WHat is a fetal type posterior artery?

Answer 35

Variant of cerebrovascular anatomy in which the distal posterior cerebral artery (PCA) territory is practically a part of the anterior circulation.

Question 36

how common is fetal type PCA?

Answer 36

estimated to occur in 20-30% of individuals

Question 37

WHat happen if fetal PCAs are seen bilaterally?

Answer 37

The basilar artery is significantly smaller than normal.

Question 38

what artery arises between the internal carotid artery between the posterior communicating artery and the ICA bifurcation

Answer 38

the anterior choroidal artery.

Question 39

What is an azygous anterior cerebral artery?

Answer 39

Rare and characterized by a single vessel which provides the blood supply to both anterior cerebral hemispheres.