Friday 31 August 2012

Cerebral artery vascular territories and consequences

Anterior cerebral artery (ACA)

Supplies:
  • Medial frontal lobe
  • Medial parietal lobe
  • Basal ganglia
  • Anterior fornix
  • Anterior corpus callosum
Signs and symptoms:
  • Contralateral hemiparesis and hemisensory loss (lower extremities > upper extremities)
  • Left hemineglect (right ACA)
  • Aphasia (left ACA)
  • Grasp and sucking reflex
  • Flat affect
  • Impaired judgment
  • Urinary incontinence


Middle cerebral artery (MCA)

Supplies:
  • Lateral frontal lobe (Superior MCA)
  • Lateral temporal lobe and portion of parietal lobe (Inferior MCA)
  • Internal capsule, corona radiata, basal ganglia (Deep MCA)
Signs and symptoms:
  • Contralateral face and upper extremity weakness and spasticity (superior MCA)
  • Non-fluent aphasia (left superior MCA)
  • Hemineglect (right superior MCA)
  • Fluent dysphasia (left inferior MCA)
  • Right visual field deficit (left inferior MCA)
  • Mild contralateral hemiparesis (right inferior MCA)
  • Severe left neglect (right inferior MCA)
  • Visual field deficits (right inferior MCA)
  • Contralateral motor hemiparesis (deep MCA)
  • Aphasia (left deep MCA)
  • Left neglect (right deep MCA)
  • Combination of everything (proximal MCA)
  • Global aphasia (left proximal MCA)
  • Left hemineglect (right proximal MCA)


Posterior cerebral artery (PCA)

Supplies:
  • Occipital lobe
  • Inferior/medial temporal lobe
  • Upper brainstem
  • Midbrain
  • Thalamus
Signs and symptoms:
  • Contralateral homonymous hemianopia
  • Contralateral hemisensory loss
  • Visual agnosia and prosopagnosia (not recognising human faces)
  • Dyslexia (difficulty reading)
  • Agraphia (difficulty writing)
  • Anomia (difficulty remembering words or names)
  • Thalamic pain (a form of chronic pain)
  • Dysesthesias (abnormal sensation)
  • Involuntary movements
  • Weber's syndrome (oculomotor nerve palsy and contralateral hemiplegia or hemiparesis)
  • Cranial nerve III palsy


Superior cerebellar artery (SCA)

Supplies:
  • Superior cerebellum
  • Dentate nucleus
  • Lateral pons

Signs and symptoms:
  • Limb ataxia
  • Dizziness with nausea/vomiting
  • Horizontal nystagmus
  • Loss of ipsilateral conjugate gaze
  • Contralateral H
  • Contralateral Horner's syndrome
  • Contralateral loss of pain/temperature sensation
  • Loss of touch, position, or vibratory sense


Posterior inferior cerebellar artery (PICA)

Supplies:
  • Lateral medulla and inferior cerebellum
  • Lateral medullary syndrome (Wallengerg's)
Signs and symptoms:
  • Ipsilateral or contralateral loss of pain and temperature on the face
  • Ipsilateral limb and gait cerebellar ataxia
  • Vertigo
  • Nystagmus
  • Ipsilateral Horner's syndrome
  • Dysphagia
  • Ipsilateral sensory loss


Anterior inferior cerebellar artery (AICA)

Supplies:
  • Lateral caudal pons
  • Small areas of the cerebellum
Signs and symptoms:
  • Ipsilateral horizontal or vertical nystagmus
  • Vertigo
  • Nausea
  • Vomiting
  • Ipsilateral facial paralysis
  • Ipsilateral loss of conjugate gaze to the side of the lesion
  • Ipsilateral deafness and/or tinnitus
  • Ipsilateral ataxia
  • Ipsilateral loss of sensation over the face
  • Contralateral impaired pain and temperature


Basilar artery (BA)

Supplies:
  • Ventral pons
  • Corticospinal tracts
  • Long tracts
  • Cranial nuclei
  • Reticular activation system
Signs and symptoms:
  • LOCKED-IN SYNDROME
    • Tetraplegia
    • Bilateral cranial nerve palsy (spared upward gaze)
    • Coma (cognition spared)

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