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Neuro - Blood Supply


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List the arteries that branch off the vertebral/basilar arteries from caudal to rostral.
PICA (off vertebral) w/anterior spinal arteries joining medially, AICA, pontine arteries, SCA,(CNIII), PCA
What supplies the anterior 2/3 of the spinal cord?
anterior spinal arteries
What region does PICA supply?
dorsolateral medulla (dorsal to inf olive
What region does AICA supply?
Inferior cerebellum, cerebellar nuclei, ventrolateral caudal pons
What region does SCA supply?
dorsal cerebellar hemispheres, sup cerebellar peduncle
What region does PCA supply?
Major midbrain supplier, thalamus, occipital lobe (including visual cortex and hippocampal formation)
What region does ACA supply?
medial aspect of frontal and parietal lobes (primary motor and sensory cortex - leg/foot)
What region does MCA supply?
outer cortical: lateral surface of frontal, parietal, upper temporal lobes

lenticulostriate (deep): internal capsule, caudate, putamen, globus pallidus
What is the most common site of aneurysm in the Circle of Willis and what sx does it cause?
AComm; bitemporal lower quadrantopia
What is the second most common site of aneurysm in the Circle of Willis, and what sx does it cause?
PComm; third nerve palsy
What are the deficits that result from ACA blockage?
contralateral spastic paralysis and anesthesia of lower limb, and frontal lobe abnormalities
What deficits result from PCA occlusion?
contralateral hemianopia w/macular sparing
What deficits result from MCA occlusion?
Contralateral spastic paralysis and anesthesia of upper limb/face, GAZE PALSY, aphasia and Gerstmann syndrome if in dominant hemisphere, hemi-inattention and neglect of contralateral body (if in parietal lobe)
What syndrome results from anterior spinal artery occlusion?
Medial Medullary Syndrome
What are the deficits in Medial Medullary Syndrome?
Pyramid: contralateral spastic paresis
Medial lemniscus: contralateral loss of touch, pressure, proprioception for body
CN XII: ipsilateral flaccid hemiparalysis of tongue (points toward lesion)
What syndrome results from PICA occlusion?
Lateral Medullary Syndrome (aka Wallenberg Syndrome)
What are the symptoms of Lateral Medullary Syndrome?
Inferior cerebellar peduncle: ipsilateral cerebellar signs (dystaxia, dysmetria(past pointing), dysdiadochokinesia(lightbulb))
Vestibular nuclei: vertigo, nystagmus (away from lesion), nausea/vomiting
Nucleus ambiguus (CN IX, X, XI): ipsilateral paralysis of larynx, pharynx, palate -> dysarthria, dysphagia, loss of gag reflex
Spinal Nuc and Tract of V: ipsilateral pain and temperature loss of face
Spinothalamic tracts: ipsilateral pain and temperature loss of body
Descending hypothalamics: ipsilateral Horner's syndrome (ptosis, miosis, anhidrosis, enophthalmos)
What syndrome results from AICA occlusion?
Lateral Pontine Syndrome
What are the symptoms of Lateral (inferior) Pontine Syndrome?
Facial nucleus/fibers: ipsilateral facial paralysis; loss of taste (ant 2/3), lacrimation, salivation, and corneal reflex; hyperacusis (acute hearing)
Cochlear nuclei/VIII fibers: ipsilateral hearing loss
Middle cerebellar peduncle: ipsilateral limb/gait dystaxia
Vestibular nuclei: vertigo, nausea/vomiting, nystagmus
Spinal nuc/tract of V: ipsilat pain/temp loss (face)
Spinothalamic tract:
ipsilat pain/temp loss (body)
Descending sympathetics: ipsilateral Horner's syndrome
What syndrome results from occlusion of the paramedian branches of the basilar artery?
Medial (inferior) Pontine Syndrome
What are the sx of Medial (inferior) Pontine Syndrome?
Corticospinal tract: contralateral spastic hemiparesis
Medial lemniscus: contralateral loss of touch/press/position sense on body
Fibers of CN VI: ipsilateral lateral rectus paralysis (medial strabismus)
Sx of Dorsal Midbrain (Parinaud) Syndrome?
(tumor in pineal region)
Superior colliculus/pretectal area: paralysis of upwards (and downwards) gaze, pupillary disturbances, no convergence
Cerebral aqueduct: noncommunicating hydrocephalus
What syndrome results from occlusion of branches of PCA?
Medial Midbrain (Weber) Syndrome
Sx of Medial Midbrain (Weber) Syndrome?
Fibers of CN III: ipsilateral oculomotor palsy (down and out, ptosis, fixed and dilated pupil)
Corticospinal tract: Contralateral spastic hemiparesis
Corticobulbar fibers: contralateral spastic hemiparesis of face (forehead spared) (uvula and palate are pulled to normal side, tongue points to weak side)

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