Branches Of Cerebral Artery Research Articles

Микрохирургическая анатомия артерий переднего продырявленного вещества головного мозга человека

Aim of study. To specify the peculiarities in spatial arrangement of arterial branches in the area of anterior perforated substance. Material and methods. The work was carried out using brain material of 25 people of both genders from the archive of the Department of Anatomy at the FSBEI HE Ryazan State Medical University MOH RF. In order to verify the arteries before formaldehyde fi xation of brain, their injection with gelatine solution was performed. Th e peculiarities in origin of central arteries from the internal carotid artery, middle cerebral artery, anterior cerebral artery as well as their calibres and quantity were examined. Results. The study has shown that the spatial arrangement of the perforating arteries in the anterior perforated substance depends on the particular site of origin. Th e origins of arterial branches flowing through the anterior perforated substance are the internal carotid artery, anterior cerebral artery, middle cerebral artery and anterior choroidal artery. Perforating branches originating from the internal carotid artery were registered in both hemispheres in 98 % of the cases. Unilateral (left ) absence of branches originating from the C4 segment was only noted in one case. The largest quantity of arteries originated from M1 segment of the middle cerebral artery. Th erewith, the majority of the branches belonged to the lateral group exceeding the quantity of such branches in the medial group by 2.3 times on average. Th ereat, the quantity of branches in each group showed no valid diff erence in relation to the side of the body. Conclusion. Knowledge of the anatomy of the anterior perforated substance, the peculiarities in spatial arrangement of the branches of middle cerebral artery and the anterior choroidal artery is important and is of interest for clinicians from the perspective of diagnosis and timely treatment of cerebral tumours and aneurisms of its arterial ring

The Prevalence of Stroke: Changing the Way We Look At Young Women

Approximately 15% of acute ischemic strokes (AIS) occur in young adults. Of all strokes among persons age 15 to 44, approximately 50% are AIS, 20% are intracerebral haemorrhage (ICH), and 30% are subarachnoid haemorrhage. Among young adults, the major contributors to stroke are cardiovascular risk factors. However, recent data suggest that despite possessing fewer cardiovascular risk factors, young women experience more strokes than men. A 30-year-old female with no medical history arrived via Emergency Medical Services with left-sided weakness that started suddenly thirty minutes prior to arrival. A neurologic exam demonstrated left facial palsy, left upper and lower extremity weakness, partial right gaze palsy, and slurred speech. The patient’s National Institute of Health Stroke Scale (NIHSS) was 14 with profound disability. Advanced neuroimaging demonstrated a large vessel occlusion of the right middle cerebral artery branches. The patient received an intravenous alteplase with a dramatic improvement of her symptoms. Upon discharge from the hospital, her NIHSS was zero and her ninety-day Modified Rankin Score was also zero. Despite comprehensive evaluations, the cause of AIS remains undetermined in approximately one-third of young patients. With more young women than men having strokes, understanding sex-mediated etiologies is critical to stroke treatment and prevention efforts in young adults.

Systemic Thrombolysis and Post-stroke Epilepsy

Systemic thrombolysis is a highly effective treatment for ischemic stroke. The effect of thrombolysis on the development of post-stroke epilepsy (PSE) remains a subject of scientific debate. The aim of this study was to clarify the clinical and neuroimaging features of PSE in patients with ischemic stroke, who underwent systemic thrombolysis. . A total of 46 patients after ischemic stroke were examined, including 33 men and 13 women aged 28 to 80 years. Group I consisted of 9 patients with PSE after systemic thrombolysis with rtPA (alteplase) at a dose of 0.9 mg/kg. Group II included 8 patients without PSE after systemic thrombolysis. Group III consisted of 29 patients with PSE, who received standard drug therapy. Comparative group analysis took into account the medical history, clinical and neuroimaging data. . Patients with PSE were characterized by the absence of clinical effect after systemic thrombolysis (p = 0.026); infarcts extending to the frontal and insular lobes (p = 0.038), insular lobe and basal nuclei (p = 0.026); development of a hemorrhagic component in the cerebral cortex (p = 0.005), as well as in the territory of the deep and terminal branches of the middle cerebral artery (MCA) (p = 0.006). Development of PSE is associated with ineffective systemic thrombolysis and the appearance of extensive and large cerebral infarcts with a hemorrhagic component.

Microscope integrated optical coherence tomography of a cerebral arachnoid cyst: A new technique to increase intraoperative security

PurposeThis technical note illustrates microscope integrated optical coherence tomography (iOCT) as an imaging technique to delineate concealed micro anatomical structures not displayable by conventional intraoperative imaging methods in the context of a cerebral arachnoid cyst. MethodsiOCT was used for the first time to scan a cerebral arachnoid cyst in vivo. Scanning sites were defined at the outer membrane of the arachnoid cyst, the inner membrane at the temporal cortex as well as at the fenestration site to the basal cisterns – a point out of reach and resolution for conventional intraoperative imaging methods like e. g. ultrasound or neuroendoscopy. ResultsiOCT was feasible during microsurgical fenestration of an arachnoid cyst. A clear delineation of the arachnoid cyst membrane was possible. The differentiation of the arachnoid cyst membrane and underlying arachnoid barrier cell membrane was possible. Trans cystic scanning at the temporal cortex could delineate the content of the subarachnoid space like subarachnoid blood vessels, trabecular sytem and vessel wall morphology of a M4 middle cerebral artery branch. Scanning of the inner membrane of the arachnoid cyst at site of fenestration to the basal cisterns excluded underlying micro anatomical structures. ConclusionThis case demonstrates that iOCT achieved to delineate concealed micro anatomical structures which are occult to conventional intraoperative imaging methods. Further studies are necessary to value iOCT as a tool to improve intraoperative security.

The Quantitative Evaluation of the Density of the Segmental Branches of the MCA in Acute Ischemic Stroke Patients.

AimThe aim of this study was to assess the density of the segmental branches of the middle cerebral artery (MCA) quantitatively as a predictor of acute ischemic stroke in patients without definitive infarct findings at cerebral parenchyma by non-contrast computed tomography (CT).Clinical rationale for the studyThe clinical rationale for the study is to evaluate if the measurement of Sylvian fissure dot sign (SDS) would help early management of patients with stroke at the emergency department.MethodsComputed tomography scans of 101 patients admitted to the emergency department with stroke symptoms and/or signs were included in the study, retrospectively. In the patient group, the quantitative density of the segmental branches of the MCA in the Sylvian fissure was measured on the affected side and the contralateral side.ResultsQuantitative density of SDS was significantly higher on the ischemic side of the brain. Receiver operating characteristic (ROC) analysis showed a cut-off value of 38.5 Hounsfield units (HU) as a predictor for acute ischemic stroke, with a sensitivity and specificity of 79% and 92%, respectively.ConclusionQuantitative density of SDS on the affected side in patients without definitive cerebral infarct findings of parenchyma can be used in the emergency room as an objective predictor sign for the diagnosis of acute ischemic stroke. Considering this finding in the differential diagnosis of acute stroke patients in the emergency room has the potential to improve their clinical management, particularly for the patients without early parenchymal and vascular signs of stroke.

Individual variability of the brain occipital lobes height and their blood supply

200 hemispheres of the brain of people who died from diseases not related to brain pathology were studied. The morphometric method was used and statistical analysis was performed. It was found that men and women with dolichocranial type of skull have an asymmetry in the height of the hemispheres of the brain. In men, the height of the left hemisphere of the brain is greater than in women, but the height of the right hemisphere of the brain in men is less. The height of the left hemisphere of the brain in men with mesocranial type is greater than the right, in women the height of the right hemisphere of the brain prevails. In people with brachycranial type of skull, the height of the left hemisphere of the brain prevails in men, in women the height of the right and left hemispheres of the brain are the same. According to the dolichocranial type of skull, the height of the left occipital lobe predominates in men, and the height of the right occipital lobe predominates in women. The height of the left occipital lobe in men with mesocranial type of skull is greater than the right. In women with mesocranial type of skull, the height of the left occipital lobe predominates. In people with brachycranial type of skull, the height of the right occipital lobe of the brain prevails in both men and women. The height of the cerebral hemispheres in men and women with brachycranial type of skull is greater than in those with mesocranial and dolichocranial. The height of the occipital lobes of the brain in men and women with dolichocranial type of skull is slightly higher than in those with mesocranial and brachycranial. Sources of blood supply to the formations of the medial surface of the occipital lobe of the brain - the branches of the posterior cerebral artery, which are divided according to their areas of blood supply to the parieto-occipital, calcarine spur and cuneus. Keywords: endbrain, occipital lobe, individual anatomical variability.

Posterior Internal Frontal Artery Vascularization of the Precentral Gyrus Responsible for Proximal Arm Movement: Insight from a Case of Coil Migration

Our knowledge of the vascularization of the precentral gyrus by branches of the anterior cerebral artery (ACA) relies mainly on anatomical cadaveric dissection. A distal branch of the ACA known as the posterior internal frontal artery (PIFA) is thought to vascularize the precentral gyrus responsible for proximal arm movement; however, no clinical correlation has yet been reported to confirm this relation. In this manuscript, we report a case of coil migration in the PIFA, causing proximal arm weakness in a 58-year-old woman treated for aneurysmal subarachnoid hemorrhage. The occurrence of clinical signs immediately following coil migration into the PIFA, combined with evidence of stroke in the cortical territory related to arm movement as seen on imaging, indicates that the PIFA indeed can vascularize this lateral portion of the precentral gyrus. This case confirms our current understanding of the vascularization of the precentral gyrus by distal ACA branches, in particular the PIFA.

Post-Traumatic Weber’s Syndrome: a Rare Presentation

Weber’s syndrome is a midbrain lesion characterized by ipsilateral oculomotor nerve palsy with contralateral hemiparesis or hemiplegia, commonly due to vascular infarct involving paramedian branches of posterior cerebral artery or basilar bifurcation perforating branches. In this case report, we have discussed about a young man who presented with penetrating injury by valve of tyre tube to the right nostril following which he had right side epistaxis with ipsilateral ophthalmoplegia and ptosis with contralateral hemiparesis. Computed tomography evaluation showed presence of sphenoidal bony fragment impinging the midbrain. Patient was managed conservatively. To our best knowledge, traumatic Weber’s syndrome is very rare.

The predictive value of mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio in acute middle cerebral artery infarction patients

Objective: The aim of this study was to determine the predictive value of mean platelet volume (MPV), neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) in patients with acute middle cerebral artery (MCA)branch infarction. Method: This examination was performed on the files of 50 patients followed up at the Anesthesia and Reanimation ICU of Onsekiz Mart University Hospital between April 2017 and September 2019 for acute occlusion in the MCA branch, with no previous history of an ischemic stroke. These patients were assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Score (mRS). The ratios of the neutrophil and platelet countsto the lymphocyte count (NLR and PLR ratios) within the first hour of the stroke and MPV were compared to a control group. Results: The study included 50 patients with the acute ischemia of the MCA branch, of which 28 (56%) were female. The control group consisted of 50 healthy people, and 24 (48%) of these were female. The mean NIHSS score of the patients was 11.4 ± 2.6, and their mean mRS was 2.5 ± 1.5. Conclusions: In our study with patients who had acute middle cerebral artery infarction, we found that the NLR, PLR, and MPV levels within the first hour of stroke were higher in the patient group in comparison to the control group ona statistically significant level. However, multicenter studies with larger subject groups are needed for the use of hematological parameters as biomarkers in an ischemic stroke

Light sheet fluorescence microscopy of optically cleared brains for studying the glymphatic system

Fluid transport in the perivascular space by the glia-lymphatic (glymphatic) system is important for the removal of solutes from the brain parenchyma, including peptides such as amyloid-beta which are implicated in the pathogenesis of Alzheimer’s disease. The glymphatic system is highly active in the sleep state and under the influence of certain of anaesthetics, while it is suppressed in the awake state and by other anaesthetics. Here we investigated whether light sheet fluorescence microscopy of whole optically cleared murine brains was capable of detecting glymphatic differences in sleep- and awake-mimicking anaesthesia, respectively. Using light-sheet imaging of whole brains, we found anaesthetic-dependent cerebrospinal fluid (CSF) influx differences, including reduced tracer influx along tertiary branches of the middle cerebral artery and reduced influx along dorsal and anterior penetrating arterioles, in the awake-mimicking anaesthesia. This study establishes that light sheet microscopy of optically cleared brains is feasible for quantitative analyses and can provide images of the entire glymphatic system in whole brains.

A Single-Center Surgical Experience of Interhemispheric Epidermoids and Proposal of a New Radiological Classification

Epidermoids account for <1.5% of all intracranial tumors. Overall, the cerebellopontine angle has been the most commonly reported location. In the supratentorial compartment, epidermoids will usually be found in the suprasellar area, sylvian fissure, and intraventricular area. The interhemispheric fissure represents an extremely rare location for supratentorial epidermoids, with limited cases reported previously. Surgery of an interhemispheric epidermoid can be challenging because of its adherence to the anterior cerebral artery branches or the brain parenchyma itself. In the present study, we have reported the largest Series of interhemispheric epidermoid tumors to better understand the clinical behavior, radiological features, and surgical outcomes. In the present study, we retrospectively evaluated the data from 22 consecutive patients with interhemispheric epidermoids treated surgically during the past 10 years (2009-2019) at our center. During the same study period, we had treated 2355 patients with brain tumors (both primary and secondary), including 262 patients with intracranial epidermoids. Therefore, interhemispheric epidermoids comprised 0.009% of all brain tumors and 8.4% of all intracranial epidermoids in our experience. These patients all had newly diagnosed tumors and had undergone surgery for the first time at our center. All surgical specimens had been confirmed histopathologically. The mean age of the patients was 31 years (range, 17-61 years), with a male predilection. Seizures and headache were the most common mode of presentation. The average tumor size was 5.2 cm (range, 3.5-10 cm). Of the 22 tumors, 21 were in the anterior two thirds of the fissure. Anatomical distortion of the corpus callosum was seen in 13 patients (59%). The extent of excision was total in 17 (77.3%), near total in 3 (13.6%), and subtotal in 2 (9%) patients. The near or subtotal excisions had been necessary because of either tumor adherence to the pericallosal artery (n= 3) or a missed tumor lobule (n= 2). The mean follow-up time was 32 months, with no tumor recurrence. Interhemispheric epidermoids can often reach a large size with substantial lateral extension found at diagnosis. The position of the anterior cerebral Artery branches can help to differentiate interhemispheric epidermoids from radiologically similar corpus callosum, velum interpositum, and cavum septum pellucidum epidermoids. Complete surgical excision with minimal complications is feasible, with good long-term outcomes.

Acute cerebral infarction with adenomyosis in a patient with fever: a case report

BackgroundIt is reported that acute cerebral infarction with adenomyosis is associated with elevated D-Dimer, elevated CA125, anemia and menstruation. However, previous reports did not notice infection known as fever, which may be a potential risk factor for developing acute cerebral infarction with adenomyosis.Case presentationWe describe a 34-year-old woman who presented headache and fever (38 °C) for 4 days and left limb weakness for 1 day during her menstrual phase. Laboratory test data showed: Hemoglobin (HGB) (112 g/L, normal: 120–150 g/L), Carcinoembryonic antigen 125 (CA125) (937.70 U/ml, normal: 0–35 U/ml), D-Dimer (27.4 mg/L, normal: 0–1.5 mg/L). Magnetic resonance imaging (MRI) indicated acute cerebral infarction in right basal ganglia and subcortical region of right frontotemporal lobe. Further, brain computed tomography angiography (CTA) showed that the M1 segment of right middle cerebral artery was strictured and the distal branches of right middle cerebral artery were significantly less than those on the opposite side. No obvious abnormality was found in cranial magnetic resonance venogram (MRV). She had a 5-year history of adenomyosis. No tumors were found by whole body positron emission tomography-computed tomography (PET-CT). We treated this patient by using anti-infective therapy for 1 week and using anticoagulant therapy with low molecular weight heparin for 2 weeks. Subsequently, the anticoagulant therapy was discontinued and replaced by antiplatelet therapy with clopidogrel. We followed up this patient for 4 months, and no recurrence of cerebral infarction was found.ConclusionsAcute cerebral infarction with adenomyosis may be related to elevated D-Dimer, elevated CA125, anemia and menstruation. Our report suggests that infection may be a potential risk factor for developing acute cerebral infarction with adenomyosis.

Factors predicting poor outcome at discharge in stroke patients with middle cerebral artery branch occlusion

ObjectivesTo better determine the usefulness of mechanical thrombectomy for stroke patients with middle cerebral artery (MCA) branch occlusion, we investigated predictive factors related to poor outcome in acute, MCA branch occlusion stroke patients who had not undergone mechanical thrombectomy. Patients and methodsWe retrospectively evaluated 204 consecutive acute stroke patients with MCA branch (M2-M4) occlusion. Two groups, based on activity of daily living scores at discharge, were compared: a dependent outcome group (mRS 3–6; n = 109) and an independent outcome group (mRS 0–2; n = 95), and the factors related to dependent outcomes at discharge determined. ResultsThe dependent group was older, had higher National Institutes of Health Stroke Scale (NIHSS) scores on admission, higher serum D-dimer and brain natriuretic peptide levels, and lower Alberta Stroke Program Early CT scores (ASPECTS) and rates of intravenous thrombolysis than the independent group. In multivariate analysis, age (OR 1.06; 95%CI 1.03–1.10), admission NIHSS score (OR 1.12; 95%CI 1.05–1.19), ASPECTS (OR 0.56; 95%CI 0.40–0.79), and intravenous thrombolysis (OR 0.22; 95%CI 0.08–0.57) were related to dependent outcomes. Decision curve analysis demonstrated that admission NIHSS scores were better predictors of dependency for threshold probabilities from 0.25 to 0.46. The optimal cutoff scores for predicting dependency were ≥8 (sensitivity 0.76, specificity 0.62) for the admission NIHSS score. ConclusionsAdmission NIHSS scores might be useful predictors of dependent outcomes at discharge in acute ischemic stroke patients with MCA branch occlusion.

Ghost Aneurysms in Acute Subdural Hematomas: A Report of Two Cases

Acute subdural hematoma (aSDH) is a common pathology encountered in neurosurgery. Although most cases are associated with trauma and injuries to draining veins, traumatic aSDH from injury to arteries or spontaneous aSDH because of a ruptured intracranial aneurysm can occur. For some patients without a clear clinical history, it can be difficult to distinguish between these etiologies purely based on radiography. The objective of this research was to describe a case series in which imaging was suggestive of the presence of distal cortical intracranial aneurysm associated with aSDH, but operative management demonstrated no evidence of aneurysm. We retrospectively reviewed 2 patients known to have aSDH with suspicion for associated aneurysm between May 2019 and September 2019 at our institution. Data collected included demographic, clinical, and operative course, including age, gender, past medical history, presenting symptoms, and pre and postoperative imaging. In 2 patients presenting with aSDH with preoperative radiographic imaging suggesting distal middle cerebral artery aneurysms, surgical exploration revealed no aneurysm. In both cases, noniatrogenic active arterial bleeding from an injured cortical middle cerebral artery branch was identified. Although there are prior reports of arterial aSDH, to our knowledge, this is the first to describe the radiographic "ghost aneurysm" sign. It is important for clinicians to be aware of this potential misleading radiographic sign, which indicates active extravasation into a spherical cast of clot.

Left Occipital Craniotomy for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video.

Medial parieto-occipital arteriovenous malformations (AVMs) are fed by distal cortical posterior cerebral artery branches and are generally considered eloquent given the proximity to the calcarine fissure and paracentral lobule. This patient was a neurologically intact 12-yr-old girl with an incidentally discovered left occipital AVM. The patient underwent preoperative angiographic evaluation with embolization of a dominant posterior cerebral artery feeding vessel. The AVM was removed in the standard manner using circumdissection. Indocyanine green angiography was utilized to demonstrate disconnection of the AVM before sacrificing the draining veins. The AVM was removed entirely, as evidenced on postoperative angiography. The patient had a partial right hemianopsia after the operation but was otherwise neurologically intact. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Clinical Significance of Blood Supply of the Fornix of Brain: A Cadaveric Study

Transient ischemic attack (TIA) of the fornix causes a spectrum of memory deficits, which increases the contributions of vascular disease to dementia which is known as early-onset dementia. As the fornix, the white matter bundle, serves as the major efferent pathway connecting the hippocampus with other human limbic structures, a variety of lesions that damage the fornix could lead to significant memory impairment. Therefore, the blood supply of fornix is a concern. This study aims to study the arterial supply of fornix. Thirty fresh human cadaveric heads were used. They were preserved by the mixture of fixation solution for fornix anatomical dissection and injected with coloured latex solution for visualization of cerebral vasculature through 6 critical steps of approaches. The result showed that the fimbriae of fornix were mainly supplied by the branches of posterior cerebral artery (PCA) and two cases were found to have the anastomoses of those branches with the choroidal artery (ChA). The proposed technique confirmed the ability of coloration of human cerebral vasculature by using colored latex solution which penetrated into cerebral small vessels leading to a precise understanding of the arterial supply of fornix in human brain which is essential for neurosurgeon, neurosurgical training and researchers.

The Posterior Perforated Substance: A Brain Mystery Wrapped in an Enigma.

There is a dearth of published information on the posterior perforated substance as compared to the anterior perforated substance. We managed to glean facts about the posterior perforated substance that can serve as a landmark for surgical operations in the adjacent regions of the midbrain and the vessels passing through it. Moreover, the posterior perforated substance contains the interpeduncular nucleus responsible for the mental state of the individual. 1) To describe the topography of the blood vessels supplying the posterior perforated substance area from the surgical point of view; 2) to investigate the functions of the interpeduncular nucleus. We assembled and analyzed results from source databases by Elsevier, NCBI MedLine, Scopus, Scholar. Google and Embase. Each article was studied in detail for practically useful information about the posterior perforated substance. The P1-segment perforating branches of the posterior cerebral artery supply the posterior perforated substance. This area is especially vulnerable in the case of vascular pathologies. The posterior communicating artery can block the surgeon's view and impede maneuverability of the tool in the area of the posterior perforated substance, which may be addressed using the separation technique, which can lead to positive results. In addition, the medial habenula-interpeduncular nucleus in the posterior perforated substance is associated with various addictions and psychiatric conditions. The posterior perforated substance area is of great interest for surgical interventions. Future studies of the interpeduncular nucleus anticipate the development of drugs to affect different types of dependencies and some mental diseases.

Stereological analysis of the vascular network in superior colliculi

Background/Aim: Superior colliculi have an important role in the visual system, some motor functions and behaviour. Branches of the posterior cerebral artery and surrounding vessels form a collicular arterial network, which gives rise to several penetrating vessels for superior colliculi. The aim of the study was to determine relative stereological parameters (volume, surface and length density) of the vascular network in superior colliculi and to correlate those parameters with age. Methods: Ten adult brainstems, both male and female, were cut transversally at the middle of superior colliculi in three-millimetre-thick strata. Every stratum was cut in 4 µm thick semiserial sections stained with Mallory method. Images of every fifth section (5, 10, 15, 20) of superior colliculus were taken with "Leica" DM 1000 microscope and "Leica" MC 170HD camera under x 400 magnification and analysed by ImageJ software with A 100 grid. Statistical analysis was performed by the SPSS software with 5 % level of significance using methods of descriptive statistics, Spearman's and Pearson's correlation coefficient. Results: The average volume density of vascular network in superior colliculi was 0.0203 mm 0 , surface density 6.133 mm-1 , and length density 205.357 mm-2. All those parameters decreased with ageing, but statistically significant change was seen only in length density (p = 0.006). Conclusion: Compared to the structures at the same transversal level, the vascular network of superior colliculi has an average density. With ageing, blood vessels become less tortuous.

Study of pattern of origin of central branches of middle cerebral artery by using 64-slice computed tomography angiography

Background and Aims: Middle cerebral artery (MCA), a branch of the internal carotid artery, is the most commonly affected vessel in cerebrovascular diseases. Various studies have reported for variations in the origin pattern of MCA. The detection of these variations is of clinical relevance for the clinicians for planning their line of treatment. The present study was performed to identify the variations using 64-slice computed tomography (CT) angiography. Materials and Methods: The present study was performed in 45 participants (32 males and 13 females). MCA was identified and observed for a different pattern of origin of the central (perforating) branches using 64-slice CT angiography. Results: The observations revealed that the M1 segment of MCA showed single, dual, or multiple origins of central branches. Single central branch of MCA originated in 8.88% of cases, double branches were observed in 11.11% of cases, whereas the multiple branches were found in 66.67% of cases and mix pattern was observed in 13.3% of cases. These central branches coursed through the anterior perforating substance to reach the basal area of the subcortical zone. Conclusions: The present study revealed the variations in origin of the central branches of MCA using 64-slice CT angiography and the knowledge of radiological identification of these variations can be of use for radiologists and neurosurgeons dealing with cerebrovascular diseases.

Cerebral deep vascular architectures and subcortical infarcts

The lenticulostriate arteries (LSA) supply the lateral half of the head of the caudate nucleus, entire putamen, anterior limb, genu and the superior part of the internal capsule (IC) and a part of the corona radiata. The LSA consists with medial, intermediate and lateral branches. The medial branches perfuse the lateral segment of the globus pallidus, the head of the caudate nucleus and the anterior limb of the IC. The intermediate branches supply the anterior half of the LSA territory, while the lateral branches supply the posterior half. The anterior cerebral artery (ACA) perforators, predominantly Heubner's artery, perfuse the inferomedial part of the caudate head, the anteromedial part of putamen, the anterior part of the lateral segment of the globus pallidus and anterior limb of the internal capsule. Such territories can be represented by the anterior and ventral basal ganglions. The anterior choroidal artery (AChA) gives off three main groups of branches including the lateral branches that supply the medial temporal lobe, the medial branches that supply the cerebral peduncle and the superior branches that supply the internal capsule and the basal ganglia. The superior branches are further discriminated into proximal branches that supply the anterior one third of the posterior limb of internal capsule (PLIC) and the medial segment of the globus pallidus and distal branches that supply the posterior two-third of PLIC, retro-lenticular part of the internal capsule and the lateral thalamic nuclei. The superficial penetrating arteries, i.e. medullary arteries, arise from the cortical branches of the middle cerebral artery (MCA) and supply the deep white matter. Infarcts caused by the medullary artery occlusion are located in the centrum-semiovale and half of them were caused by embolic mechanism. The centrum-semiovale corresponds to cortical border-zone (BZ) while the corona radiate corresponds to internal BZ.