Makindo Medical Notes

Vascular Territories

• Internal carotid artery
  • Ipsilateral frontal and parietal/occipital and temporal lobes
  • Ipsilateral cortical infarction depending on the degree of collateral and COW flow
  • Mimics an MCA infarction or less as ACA may get some collateral supply across the anterior communicating artery
• Ophthalmic artery
  • Eye Monocular blindness
• Posterior communicating artery
  • Anterior choroidal artery
    • choroid plexus of lateral ventricle
    • homonymous field defect 
    • motor/sensory loss
• Anterior cerebral artery
  • Contralateral face/arm/leg weak Leg > arm
  • C/L face/arm/leg weakness leg > arm
  • C/L sensory loss
  • No hemianopia
  • C/L contralateral gaze palsy
  • Expressive Dysphasia (D)
  • Visuospatial (ND)
  • Dyspraxia (D)
  • Neglect (ND) apathy
  • Abulia, disinhibition and euphoria.
  • Paracentral lobule infarction causes urinary incontinence
• Proximal Middle cerebral artery artery M1
  • Infarction of the basal ganglia Internal capsule out towards the cortex. Damage worse the more proximal the occlusion as lenticulostriates to basal ganglia affected
  • C/L face/arm/leg weakness arm > leg
  • C/L sensory loss
  • C/L hemianopia
  • C/L contralateral gaze palsy
  • Dysphasia(D)
  • Visuospatial(ND)
  • Neglect (ND)
  • Dyspraxia (D)
• Distal MCA
  • Lenticulostriate arteries may be spared 
  • Superior branch of Middle cerebral artery
  • Frontal lobe infarction
  • Face/arm weakness and Gaze paresis
  • Expressive dysphasia (D) and dyspraxia (D)
• Posterior inferior branch  of MCA
  • Parietal lobe with sensory loss
  • homonymous hemianopia
  • Lateral striate  (lenticulostriate)
  • lacunar type infarcts of basal ganglia and internal capsule as mentioned below
• Posterior cerebral artery
  • Occlusion P1 before posterior communicating artery branch causes infarcts in the
  • Cerebral peduncle
  • Thalamus
  • Mediobasal temporal lobes and thalamus 
  • occipital cortex and resembles MCA stroke with hemiparesis, sensory loss and hemianopia.
• Posterior cerebral artery occlusion distal to posterior communicating artery branch
  • Hemianopia
  • NonDom 
  • Spatial disorientation
  • Neglect
  • Prosopagnosia
• Bilateral PCA occlusion
  • Altitudinal hemianopia, cortical blindness (blindness with preservation of pupillary light response? Anton's syndrome)
  • Bilateral thalamic stroke causes amnestic symptoms
• Basilar artery occlusion
  • Headache, dizziness, vertigo, seizures, coma, quadriplegia
  • Locked in syndrome, IIIrd nerve lesion, limb weakness
  • Only vertical gaze remains intact and opening and closing eyelids
  • Consider thrombolysis
• Top of the basilar artery occlusion
  • Usually embolic infarction of midbrain, thalamus, hypothalamus and mediobasal portions of the temporal and occipital lobes
  • IIIrd nerve palsy, Vertical gaze palsy, ataxia, sleepiness and even coma, impaired attention and memory.
• Midbrain Weber syndrome
  • Anterior brainstem infarction
  • Contralateral hemiparesis
  • ipsilateral IIIrd nerve palsy
• Benedikt syndrome
  • Paramedian midbrain (red nucleus)
  • Contralateral cerebellar dysfunction
  • Partial ipsilateral IIIrd nerve nucleus
• Nothnagel syndrome
  • Dorsolateral midbrain lesion
  • Complete contralateral loss of sensation
  • Ipsilateral Horner's syndrome
  • Ipsilateral IIIrd nerve palsy Ipsilateral cerebellar signs Basilar artery branches to
• Medial Midbrain : PCA perforating branches
  • IIIrd nerve palsy
  • C |L hemiparesis and hemiataxia or tremor
  • P1 segment of PCA supply.
• Lateral Midbrain: Basilar perforating branches
  • C |L hemisensory loss
  • Vertical gaze palsies
• Pons - Millard-Gubler syndrome: Basilar perforating branches
  • Pontine lesion involving VIth and VII
  • Contralateral hemiparesis
  • Ipsilateral 6th and 7th
• Posterior inferior cerebellar artery (or vertebral artery infarction)Lateral Medulla - Dorsolateral infarction or Wallenburg syndrome 
  • Horner's syndrome
  • IX nerve and X weakness
  • Dysphagia and hoarseness
  • Nystagmus and Cerebellar ataxia (spinocerebellar tracts) same side
  • Contralateral spinothalamic signs and Symptoms
  • Altered facial sensation.
• Medial medulla: spinal artery
  • Hypoglossal weakness same side, contralateral hemisensory Symptoms
  • Autonomic disturbance
  • Apnoea Ondine's curse?