Angiogram - Internal Carotid Artery

Digital Subtraction Angiogram

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Identify the following structures on the anterior-posterior angiogram of the internal carotid artery:

Internal Carotid Artery and its individual segments
Anterior Cerebral Artery
Anterior Communicating Artery
Pericallosal Artery
Posterior Communicating Artery
Middle Cerebral Artery and its segments
Lateral Lenticulostriate Arteries

Additional angiograms will be posted in the near future.

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Anterior Cerebral Artery - Coronal Plane

INTERNAL CAROTID AND BRANCHES
Digital Subtraction Angiogram
ANTEROPOSTERIOR VIEW

Move the cursor along the course of the vessels on the angiogram to identify individual segments.

A1 Segment
(Anterior Cerebral Artery)

From Internal Carotid Bifurcation to Anterior Communicating Artery.

NEUROVASCULAR SYNDROME
Occlusion of the Anterior Cerebral Arteries at the stem results in infarction of the anteromedial surface of the cerebral hemispheres:

Contralateral Paraplegia
Incontinence
Abulic and motor aphasia Personality change
Contralateral grasp reflex.

Penetrating Branches:
Infarction of anterior corpus callosum and basal ganglia structures (caudate, globus pallidus). Transient hemiparesis seen. Individual may become inattentive, forgetful, or agitated and psychotic

Pericallosal Artery

Continuation of the Anterior Cerebral Artery as it arches superiorly and posteriorly.

Supplies the medial surface of the cerebral hemispheres and corpus callosum.

Horizontal (M1) Segment
Middle Cerebral Artery

Branches include lateral lentciulostriate arteries.

NEUROVASCULAR SYNDROME
Unilateral occlusion of
Proximal M1 Segment
results in deficits in:

MOTOR
Contralateral Hemiplega
(face and arm, lower extremity less affected.

SENSORY
Homonoymous Hemianopia + Deviation of head/eyes toward the side of the lesion.

LANGUAGE
LEFT lesions: Global aphasia.
RIGHT lesions: Anosognosia.

Sylvian (M2) Segment
Middle Cerebral Artery

Segment divides into superior and inferior divisions which can be a site for an embolus to lodge.

NEUROVASCULAR SYNDROME
Superior Division Infarction:
"Brachiofacial paralysis"
Sensorimotor deficit involving face and arm, leg to a lesser extent. Foot is spared.
Ipsilateral deviation of head/eyes.
With Left lesion may have initial global aphasia -> motor aphasia.
No impairment of alertness.
(Can be further subdivided if only one branch of division is affected).

Inferior Division Infarction:
Rarer than Superior Division Infarctions.
Superior quadrantanopia / homonymous hemianopia.
LEFT lesion: Wernicke aphasia (deficit in comprehension of spoken/written language)
RIGHT lesion: Left-sided visual neglect.

Cortical (M3) Segment
Middle Cerebral Artery

Distal branches of MCA course laterally to insular cortex and loop around operculum - "Candelabra" effect seen on lateral angiograms.

Embolization of individual cortical branches can produce highly circumscribed infarctions accompanied by specific neurologic deficits.

Lateral
Lenticulostriate Arteries

Branch of M1 Segment of MCA.

Supplies basal ganglia structures: Part of head and body of caudate, globus pallidus, putamen, and the posterior limb of the internal capsule.

NEUROVASCULAR SYNDROME
Lateral Lenticulostriate A.:
Damage to the internal capsule resulting in contralateral hemiparesis and sensory deficit. Speech may be affected (medial tempora lobe) as well as visual function (Meyer's loop: optic radiations affected).

Supraclinoid Segment
Internal Carotid Artery

Begins after penetration of dura, continues until bifurcation into Anterior and Middle Cerebral Arteries

Three Branches:
Ophthalmic Artery,
Posterior Communicating Artery, and Anterior Choroidal Artery.

Cavernous Segment
Internal Carotid Artery

Passes through cavernous sinus with Abducens Nerve.

Branches supply posterior pituitary (Meningohypophyseal Artery).

Petrous Segment
Internal Carotid Artery

Extends from base of skull to apex of petrous bone

Enters cranial vault via foramen lacerum.

Branches normally not seen angiographically - may be enlarged with carotid occlusive disease.

Cervical Segment
Internal Carotid Artery

Begins at the bifurcation of Common Carotid Artery (level of C4).

Extends to the base of the skull.

No branches normally seen.

Posterior Communicating Artery

Second branch of supraclinoid internal carotid.

Connects
anterior circulation (carotid system)
with posterior circulation (vertebrobasilar system)

Supplies thalamus, hypothalamus, optic chiasm, and mamillary bodies.

Common site for aneurysms -
AS IS SEEN IN THIS CASE

Ophthalmic Artery

Usually arises intradurally (80-90%), below anterior clinoid process.

Supplies globe, orbit, frontal scalp, the frontal and ethmoidal sinuses.

Ophthalmic artery branches anastamose with Maxillary artery branches - potential for collateral flow in cases of proximal carotid occulsion.

Anterior Choroidal Artery

Last branch to originate from Internal Carotid Artery.

Cisternal segment: Artery passes through crural cistern, supplies optic tract, posterior limb of internal capsule, branches to midbrain,and lateral geniculate nucleus.

Plexal segment: Supplies choroid plexus of anterior portion of temporal horn of lateral ventricles.

Anterior Cerebral Artery

One of the terminal branches of internal carotid artery.

A1 Segment:
From Internal Carotid Bifurcation to Anterior Communicating Artery.

A1 Branches:
Medial Lenticulostriate Arteries (supply basal ganglia, anterior limb of internal capsule)
Recurrent Artery of Heubner (supplies head of caudate and anteroinferior internal capsule).

Infarction syndrome:
Medial Lenticulostirate Artery Contralateral impairment of motor function of face and arm