Artery
Arising from
Supplying
Infarction clinical signs
Tuberothalamic artery
(AKA: polar artery)
(AKA: polar artery)
PCOM (middle 1/3)
Anteromedial and the anterolateral region of the thalamus
- Reticular
- Intralaminar
- Ventral Anterior
- Rostral Ventral Lateral
- Ventral pole of Medal dorsal
- Anterior
- Ventral internal medullary lamina
- Ventral amygdalofugal pathway,
- Mamillothalamic tract
- Fluctuating arousal and orientation
- Impaired learning, memory, autobiographical memory (mamillothalamic tract/Anterior Nuclei)
- Superimposition of temporally unrelated information
- Personality changes, apathy, abulia Executive failure, perseveration
- Dominance dependent:
- Language if VL involved on left;
- Hemispatial neglect if right sided
- Emotional facial, acalculia, apraxia
Artery of Percheron (1/3 of cases)
P1 PCA unpaired
Replaces both paramedian
arteries and superior
mesencephalic artery
arteries and superior
mesencephalic artery
Paramedian territory nuclei
- Paramedian territory also supplies tuberothalamic territory in 1/3 patients.
- Superior mesencephalic artery:
- Interpeduncular nucleus
- Decussation of the superior cerebellar peduncle
- Medial part of the red nucleus
- Nucleus of cranial nerve IlI
- Anterior part of the periaqueductal gray matter
Paramedian territory nuclei
- Altered mental status
- Vertical gaze palsy (traversing inputs to MLF),
- Memory impairment (mamillothalamic tract, DM, AN)
Rostral midbrain involvement:
- Oculomotor disturbances,
- Hemiplegia,
- Cerebellar ataxia,
- Movement disorders
Paramedian thalamic arteries
P1 portion of the PCA
Medial region of the thalamus
- Mediodorsal
- Intralaminar (CM, Pf, CL)
- Posteromedial VL, ventromedial pulvinar
- Paraventricular, LD
- Dorsal intramedullary laminar
- Decreased arousal (coma vigil if bilateral)
- Impaired learning and memory, confabulation, temporal disorientation, poor autobiographical memory
- Dominance dependent:
- Aphasia if left sided,
- Spatial deficits if right sided
- Altered social skills and personality, including apathy,
- Aggression, agitation
Posterior choroidal arteries
P2 portion of the PCA
Posterior region of the thalamus including the pulvinar)
- Lateral: LGN, lateral posterior, lateral dorsal, pulvinar (inferolateral)
- Medial: MGN, posterior CM/CL, pulvinar
- Visual field loss (hemianopsia, quadrantanopsia)
- Variable sensory loss, weakness, aphasia, memory impairment, dystonia, hand tremor
Thalamogeniculate or inferolateral arteries
P2 portion of the PCA
Ventrolateral region of the thalamus
- Principal branches:
- Ventroposterior complex: VPM, VPL, VPI
- Ventral lateral nucleus
- Ventral (motor) part
- Medial branches:
- MGN
- Pulvinar branches:
- Rostral and lateral pulvinar
- LD nucleus
- Sensory loss (variable extent, all modalities)
- Hemiataxia
- Hemiparesis
- Post lesion pain syndrome (Dejerine-Roussy): right hemisphere predominant
- Auditory consequences
- Behavioral
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