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Neuro-Arteries & Stroke
Week 17, Unit 2
19
Medical
Graduate
11/07/2010

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Term
Internal Carotid Artery Structures/branches
Definition
As it enters the inferior aperture of the carotid canal it makes a right-angle and passes in the carotid canal along the axis of the petrous temporal bone . As it exits the carotid canal it makes another right-angle bend and ascends alongside the sella turcica.
Term
Internal Carotid Artery Fx
Definition
Supplies the anterior/middle circulation of the brain
Term
Vertebral Artery structures/branches
Definition
Arise from the subclavian arteries, pass through the foramen magnum to enter the skull.
2 join to form the Basilar Artery
Anterior spinal arteries descend on the anterior surface of the spinal cord
Term
Vertebral Artery Fx
Definition
Interruption of Anterior spinal artery leads to Medial Medullary Syndrome of Dejerine
Term
Posterior inferior Cerebellar artery structures/branches
Definition
Branch off the vertebral artery
Term
Posterior inferior Cerebellar artery Fx
Definition
Supply the lateral medulla
A lesion would lead too lateral medullary syndrome of Wallenberg
Term
Anterior Cerebral Artery structures/branches
Definition
A1, A2, and Anterior communicating artery
A1 gives rise to the medial striate artery (Recurrent artery of Hubner)
Orbitofrontal; frontopolar; callosomarginal; pericallosal;
Term
Anterior Cerebral Artery Fx
Definition
The medial striate artery supplies the anteriorinferior limb of the internal capsule and anterior of the Striatum
Other branches of A1 pass to the optic chiasm and hypothalamus
Term
Middle Cerebral Artery branches/structures
Definition
M1, pass onto the insula of Reil  M2 (sylvian), and M3
Lateral Striate Artery arises from the M1.
Upper division: orbitofrontal; precentral; central; and anterior parietal
Lower divison: posterior parietal; posterior temporal; and angular
Term
Middle Cerebral Artery Fx
Definition
Lateral Striate Artery feeds the internal capsule and basal ganglia
Gerstmann syndrome: agraphia, acalculia, finger agnosia, right-left confusion
Term
Posterior Cerebral Artery branches
Definition
P1 segment passes bilaterally through the incisura of the tentorium cerebella, around the cerebral peduncle
P2 segment begins at the junction with the posterior communicating artery
P3 segment has 3 branches: the anterior temporal artery, the posterior temporal, and posterior occipital artery.
Term
Posterior Cerebral Artery Fx
Definition
P1 supply the lateral half of cerebral peduncle, the subthalamus, red nucleus, substantia nigra, the posterior inferior half of the thalamus, the superior cerebellar peduncle, the geniculate bodies, the colliculi, the ependymal lining of the lateral ventricle, and the caudal part of the choroid plexus
Occlusion – syndrome of the retrolenticular capsule: lesions involve the somatosensory, optic, and auditory radiations.  contralateral hemiplegia, hemianesthesia, and hemianopsia
Term
Anterior Choroidal Artery structure/branches
Definition
Branch of the internal carotid artery
Term
Anterior Choroidal Artery Fx
Definition
Supplies inferior portion of the internal capsule and globus pallidus. It could disrupt the fibers of the internal capsule
Term
Millard-Gubler (Foville) syndrome
Definition
Involves paramedian and short circumferential arteries from the basilar artery
Contralateral hemiplegia (arm = trunk = leg)
Peripheral facial paralysis (hemiface)
LMN lesion of the abducens nucleus - ipsilateral eye cannot abduct
If very deep lesion, contralateral loss of spinothalamic tract
Term
Caudal Pontine Tegmentum Syndrome
Definition
Involves the abducens nucleus
Ipsilateral facial nerve LMN - hemiface paralysis and loss of pain and temp
BUT NO hemiparesis
Loss of lateral spinothalamic tract - contralateral hemianesthesia for pain and temp
lateral lemniscus - hearing loss
Medial lemniscus - loss of fine touch….
Destruction of the middle cerebellar peduncle - hemiataxia, intention tremor, dysdiadochokinesia, cerebellar dysarthria
Medial longitudinal fasciculus - nystagmus and gaze paresis to the side of the lesion
Central Horner Syndrome
Term
Oral Pontine Tegmentum Syndrome
Definition
Due to occlusion of the long circumferential branches of the basilar artery
ipsilateral loss of facial sensation due to interruption of all
trigeminal fibers. Contralateral loss of pain and temperature to the body (lateral
spinothalamic tract). Contralateral loss of fine touch, conscious proprioception, and vibratory sense (medial lemniscus).
Cerebellar symptoms will be produced by loss of the superior cerebellar peduncle:
hemiataxia, intention tremor, dysdiadochokinesia. Ipsilateral because the superior
cerebellar peduncle is lesioned before its decussation.
Term
LATERAL INFERIOR PONTINE SYNDROME (AICA SYNDROME)
Definition
(1) contralateral loss of pain and temperature neck and body [loss of lateral spino-
thalamic tract];
(2) ipsilateral loss of pain and temperature face [loss of spinal tract and nucleus of the
spinal tract of the trigeminal nerve];
(3) ipsilateral facial paralysis (Bell's palsy) (lower motor neuron type) [due to loss of
facial nerve] (note that the muscles above the eyes are equally affected);
(4) Ipsilateral ataxia [loss of cerebellar peduncles]
Term
LATERAL MEDULLARY SYNDROME OF WALLENBERG: (PICA)
Definition
Vestibular nuclei (nystagmus, nausea, vomiting, vertigo)
Inferior cerebellar peduncle (ipsilateral cerebellar signs: dystaxia, dysmetria, dysdiadochokinesia)
Nucleus ambiguus (Cranial nerves IX and X): ipsilateral laryngeal, pharyngeal, and palatal paralysis (loss of gag reflex; palatal and uvular deviation to the contralateral side. Loss of the efferent limb of the gag reflex, dysarthria, dysphagia, and dysphonia (hoarseness).
Glossopharyngeal nerve roots (intra-axial fibers within the brainstem): loss of gag rflex (afferent limb)
Spinothalamic tracts: contralateral loss of pain and temperature sensation from the trunk and extremities
Spinal trigeminal nucleus and tract: Ipsilateral loss of pain and temperature sensation from the face.
Descending sympathetic (hypothalamospinal) tract: ipsilateral Horner syndrome
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