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Blood supply to the medulla:

Blood to the medulla is supplied by a number of arteries.

Anterior spinal artery: The anterior spinal artery supplies the whole medial part of the medulla oblongata. A blockage (such as in a stroke) will injure the pyramidal tract, medial lemniscus, and the hypoglossal nucleus. This causes a syndrome called medial medullary syndrome.

Posterior inferior cerebellar artery (PICA): The posterior inferior cerebellar artery, a major branch of the vertebral artery, supplies the posterolateral part of the medulla, where the main sensory tracts run and synapse. (As the name implies, it also supplies some of the cerebellum.)

Direct branches of the vertebral artery: The vertebral artery supplies an area between the other two main arteries, including the nucleus solitarius and other sensory nuclei and fibers. Lateral medullary syndrome can be caused by occlusion of either the PICA or the vertebral arteries.

No AICA for Medulla

Blood supply to the cerebellum:

Three arteries supply blood to the cerebellum (Fig. 7):

The superior cerebellar artery (SCA),

Anterior inferior cerebellar artery (AICA), and

Posterior inferior cerebellar artery (PICA)

Artery: Posterior inferior cerebellar artery

artery (PICA) Artery: Posterior inferior cerebellar artery The three major arteries of the cerebellum: the SCA,

The three major arteries of the cerebellum: the SCA, AICA, and PICA. (Posterior inferior cerebellar artery is PICA.)

The SCA branches off the lateral portion of the basilar artery, just inferior to its bifurcation into the posterior cerebral artery. Here it wraps posteriorly around the pons (to which it also supplies blood) before reaching the cerebellum. The SCA supplies blood to most of the cerebellar cortex, the cerebellar nuclei, and the middle and superior cerebellar peduncles. The AICA branches off the lateral portion of the basilar artery, just superior to the junction of the vertebral arteries. From its origin, it branches along the inferior portion of the pons at the cerebellopontine angle before reaching the cerebellum. This artery supplies blood to the anterior portion of the inferior cerebellum, and to the facial (CN VII) and vestibulocochlear nerves (CN VIII). Obstruction of the AICA can cause paresis, paralysis, and loss of sensation in the face; it can also cause hearing impairment. Moreover, it could cause an infarct of the cerebellopontine angle. This could lead to hyperacusia (dysfunction of the stapedius muscle, innervated by CN VII) and vertigo (wrong interpretation from the vestibular semi-circular canal's endolymph acceleration caused by alteration of CN VIII). The PICA branches off the lateral portion of the vertebral arteries just inferior to their junction with the basilar artery. Before reaching the inferior surface of the cerebellum, the PICA sends branches into the medulla, supplying blood to several cranial nerve nuclei. In the cerebellum, the PICA supplies blood to the posterior inferior portion of the cerebellum, the inferior cerebellar peduncle, the nucleus ambiguus, the vagus motor nucleus, the spinal trigeminal nucleus, the solitary nucleus, and the vestibulocochlear nuclei.

Posterior inferior cerebellar artery

Posterior inferior cerebellar artery The posterior inferior cerebellar artery (PIC A), the largest branch of the

The posterior inferior cerebellar artery (PIC A), the largest branch of the vertebral artery, is one of t he three main arterial blood supplies for the cerebellum, part of the brain. Occlusion of the posterior inferior cerebellar artery or one of its branches, or of the vertebral artery leads to Wallenberg syndrom e, also called lateral medullary syndrome.

Course

It winds backward around the upper part of the medulla oblongata, passing between the origins of the vagus and accessory nerves, over the inferior cerebellar peduncle to the u ndersurface of the cerebellum, where it divides into tw o branches. The medial branch continues backward to th e notch between the two hemispheres of the cerebellu m; while the lateral supplies the under surface of the cerebellum, as far as its l ateral border, where it anastomoses with the anterior i nferior cerebellar and the superior cerebellar branches of the basilar art ery. Branches from this artery supply the choroid plexus of the fourth ventricle.

Diseases

Infarction of this artery due to thrombosis or a stroke leads to lateral medullary syndrome, also kno wn as PICA syndrome or Wallenberg syndrome. Severe occlusion of this or vertebral arteries could lead to Horner's Syndrome as well.

Blood Supply of the b rain

1. AICA

:

Artery th at supplies the pons, along with the basilar artery of w supplies the cerebellum

hich it is a branch of. It also

2. Anterior Cerebral

:

Partly su pplies a large proportion of the basal ganglia, also sup plies medial aspects of motor and sens ory strips and anterior aspects of the frontal lobes

 

Artery

3. Anterior Choroidal

:

Small br anch off the middle cerebral artery, near the circle of W illis that supplies the posterior limb of t he internal capsule

 

Artery

4. Anterior Communicating Artery

:

Along w ith the Anterior Cerebral and Middle Cerebral arteries it supplies most of the basal ganglia

5. Basilar artery

:

Artery w hose pontine branches supply blood to the pons, alon g with AICA

6. Internal Carotid Artery

:

Supplies the Substantia Nigra and STN along with the Post. Co mmunicating artery

7. Middle Cerebral Artery

:

Partly su pplies a large proportion of the basal ganglia, supplie s anterior limb of internal

 

capsule, Broca's area, Wernicke's Area, Heschl's Gyrus and the Angular Gyrus

8. PICA

:

Artery that is a branch off the vertebral artery, along with which it supplies the medulla oblongata. It also supplies the cerebellum

9. Posterior cerebral artery

:

Forms when the basilar artery splits in 2 in the upper pons, it supplies the midbrain, thalamus, inferior temporal lobes, medial occipital lobes and the cerebellum

10. Posterior communicating Artery

:

Supplies the Substantia Nigra and STN along with the Internal Carotid Artery and the thalamus along with the posterior cerebral artery

11. Superior Cerebellar

:

Artery that allows blood from the upper pons and lower medulla to be shared. It also supplies the cerebellum

 

Artery

12. Vertebral artery

:

Artery which supplies the medulla, along with PICA

Cerebellum 3: Function, Blood Supply and Clinical Correlates

1. Adiadochokinesia

:

inability to perform rapid successive movements

2. All cerebellar syndromes cause signs on which side?

:

ipsilateral signs

3. Anterior lobe of cerebellum supplied by

:

superior cerebellar artery (SCA)

4. Archicerebellum (midline, vermis) does what motor function?

:

Equilibrium, Posture

5. Archicerebellum (midline, vermis) does what non-motor function?

:

Autonomic responses, Emotion, Sexuality, Affectively important memory

6. Cerebellar Hemisphere Syndrome signs are

:

Ataxia, Dysmetria, Dyssynergia, Adiadochokinesia, Tremor, volitional (intentional, harder you try, more it shakes), Muscular hypotonia, Dysarthria, Nystagmus

7. Describe initiation of movement in the cerebellum

:

3.Initiation of movement is via the Deep cerebellar nuclei fire simultaneously with pyramidal cortical neurons prior to movement

8. Describe motor learning in the cerebellum

:

2. Motor learning is via Increased firing of Purkinje cells during learning of a new motor task

9. Describe sensory-motor integration in the cerebellum

:

4. Sensory-motor integration, in which the cerebellum is involved in generating the prediction of the sensory consequence of movement (e.g. Inhibition of self tickle response)

10. Dysarthria

:

slurred speech

11. Dysmetria

:

inability to estimate range of movement (past pointing, i.e. on touch nose then touch finger, they miss finger)

12. Dyssynergia

:

uneven & jerky movement

13. Lateral hemisphere lesions cause ataxia where?

:

limb ataxia

14. Midline Cerebellum syndrome, sometimes called archicerebellar syndrome can result from?

:

medulloblastoma upon vermis

15. Midline lesions cause ataxia where?

:

trunk ataxia

16. Much of what is understood about the functions of the cerebellum has been inferred how?

:

after careful documentation of the effects of focal lesions in human patients, and through research on the effects of focal lesions in animals

17. Nystagmus

:

rhythmic, involuntary eye movements.

18. Posterior lobe of cerebellum supplied by

:

posterior inferior cerebellar artery (PICA)

19. Signs of midline cerebellum syndrome

:

Truncal Ataxia, Nystagmus

20. Ventral part of anterior cerebellum, and posteior lobes, also flocculurnodular lobe supplied by

:

anterior inferior cerebellar artery (AICA)

21. What are the 3 main NON-MOTOR FUNCTIONS of the cerebellum?

:

A) Autonomic (respiration, intestinal motility, bladder tone, etc.), B) Behavior (mood), C) Cognition & Memory.

22. What are the 4 motor functions of the cerebellum?

:

1. Error Detection & correction of cortically-originating movement; 2. Motor learning 3. Initiation of movement movement; and 4. Sensory- motor integration

23. What funciton does the Posterior Lobe perform?

:

Concerned with higher order functions, Cognition in hemispheres, Limbic function in vermis

24. What function does the Anterior Lobe do?

:

Mainly involved with motor control

25. What function does the Floccularnodular lobe handle?

:

Balance and eye movement

26. What motor function does the Neocerebellum (hemispheres) do?

:

Coordination

27. What non-motor function does the Neocerebellum (hemispheres) do?

:

Planning, Memory, Language, Learning

REGIONAL ARTERIAL SUPPLY OF THE BRAIN

Brain stem

The medulla oblongata is supplied by the branches of the

Vertebral,

Anterior and posterior spinal,

Posterior inferior cerebellar and

Basilar arteries,

(Which enter along the anterior median fissure and the posterior median sulcus. Vessels that supply the central substance enter along the rootlets of the glossopharyngeal, vagus, accessory and hypoglossal nerves. There is an additional supply via a pial plexus from the same main arteries.)

The pons is supplied by the

Basilar artery and

Anterior inferior and

Superior cerebellar arteries.

Direct branches from the basilar artery enter the pons along the ventral medial groove (basilar sulcus). Other vessels enter along the trigeminal, abducens, facial and vestibulcochlear nerves and from the pial plexus.

The midbrain is supplied by the

Posterior cerebral,

Superior cerebellar and

Basilar arteries.

The crura cerebri are supplied by vessels entering on their medial and lateral sides. The medial vessels enter the medial side of the crus and also supply the superomedial part of the tegmentum, including the oculomotor nucleus, and lateral vessels supply the lateral part of the crus and the tegmentum. The colliculi are supplied by three vessels on each side from the posterior cerebral and superior cerebellar arteries. An additional supply to the crura, and the colliculi and their penduncles, comes from the posterolateral group of central branches of the posterior cerebral artery.

Cerebellum

The cerebellum is supplied by the

Posterior inferior,

Anterior inferior and

Superior cerebellar arteries.

The cerebellar arteries form superficial anastomoses on the cortical surface. Anastomoses between deeper, subcortical, branches have been postulated.

The choroid plexus of the fourth ventricle is supplied by the posterior inferior cerebellar arteries.