0:00

I'd like to take a look at the often-forgotten blood

0:02

supply of the midline.

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For many of us,

0:04

think about the blood supply when we have medial

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lateral anatomy, like an axial or a coronal.

0:09

But we see so many of these and vascular disease on

0:14

this particular cut can be a little confusing.

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By the way,

0:16

pay no attention to this little finger-like projection,

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which is just volume averaging of a gyrus

0:21

in the inferior frontal region.

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Let's start out with the anterior cerebral artery in red.

0:26

I think you're going to be surprised

0:28

at how far back it goes.

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We've already told you the frontal

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lobe goes up and back pretty far,

0:34

but the anterior cerebral artery will encompass portions

0:37

of the precuneus.

0:39

So, let's take that pretty far back.

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And then, I need to take it down a little further.

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And I could color all this in right here.

0:47

And this would be anterior cerebral artery distribution.

0:50

Now, there's some variability in how the

0:52

ACA and PCA intersect each other.

0:55

I'm going to use kind of deep purple

0:57

in honor of Jimi Hendrix

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to finish out the posterior cerebral artery.

1:02

And the posterior cerebral artery will come down and

1:05

encompass everything right up to the

1:08

collicular plate right there.

1:09

And then, there are sometimes collicular perforators that

1:12

may come from the back, and it stops

1:14

just shy of the cerebellum.

1:17

Then to be anatomically consistent,

1:20

we're working away from top to bottom.

1:22

Let's go with a green color for the upper portion of the

1:25

cerebellum, which is probably about half the cerebellum.

1:29

That's going to be the SCA or superior cerebellar artery.

1:33

I should mark the PCA with PCA,

1:37

just for your perusal and interest.

1:39

The next stop is going to be PICA,

1:43

which is going to encompass the inferior cerebellar

1:45

vermis and the cerebellar tonsil.

1:48

And some of you are familiar with pica syndrome

1:50

or Wallenberg syndrome,

1:51

which is a pretty important one,

1:53

especially for you medical students.

1:55

Then we work our way into the region

1:58

of the corpus callosum.

2:00

And here we've got medial anticular stripes

2:03

and callosal perforators.

2:05

And these pretty much have their own locus.

2:08

I'll use a light blue for this and

2:10

I'll color in the callosum.

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Although the back of the callosum is not supplied by these perforators,

2:15

the back of the callosum, I should note,

2:18

is supplied by the posterior cerebral artery.

2:21

I'll give it a little deeper purple.

2:23

So, that's still posterior cerebral

2:25

artery blood supply right there.

2:27

Now, let's work our way into the brainstem.

2:30

I think I'll try something a little bit orange for the midbrain.

2:34

And projecting from the midbrain

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up into the thalamus.

2:41

Pretty tall, almost columnar-like area encompasses

2:45

some of the mammillary body as well.

2:47

I'll color it in.

2:48

And that is the posterior choroidal and

2:51

posterior thalamoperforating arteries from

2:53

the posterior cerebral artery circulation.

2:56

So, perhaps I'll label it as officially

2:59

PCA, but there are perforates.

3:02

They are not the main vessels that supply that area.

3:05

Then we'll come down to kind of a deeper blue.

3:09

And we're in the pons now.

3:11

And these are perforating branches of the basilar artery.

3:14

Pretty simple.

3:15

I'm not going to...

3:16

Actually, I will draw them in.

3:19

Basilar artery perforators.

3:20

BAP.

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And now down to the region of the

3:25

medulla of the brainstem.

3:27

These are perforating branches of the vertebral artery.

3:29

I'm going to use something a little aesthetically

3:30

less pleasing.

3:31

Brown.

3:32

And there you have it.

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The midline blood supply of the brain

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often overlooked.

3:37

Pomeranz out.