Posterior cerebral artery

Posterior cerebral artery
The outer surface of the human brain, with the area supplied by the posterior cerebral artery shown in yellow.
The arterial circle and arteries of the brain (inferior view). The posterior cerebral arteries (bottom forks) arise from the basilar artery (center).
Details
Sourcebasilar artery (most common in adults)
Veincerebral veins
Suppliesoccipital lobe of cerebrum
Identifiers
Latinarteria cerebri posterior
Acronym(s)PCA
MeSHD020769
TA98A12.2.07.082
TA24565
FMA50583
Anatomical terminology

The posterior cerebral artery (PCA) is one of a pair of cerebral arteries that supply oxygenated blood to the occipital lobe, part of the back of the human brain. The two arteries originate from the distal end of the basilar artery, where it bifurcates into the left and right posterior cerebral arteries. These anastomose with the middle cerebral arteries and internal carotid arteries via the posterior communicating arteries.

Structure

The branches of the posterior cerebral artery are divided into two sets, ganglionic and cortical:

Central branches

Also known as the perforating branches:

  • Thalamoperforating and thalamogeniculate or postero-medial ganglionic branches: a group of small arteries which arise at the commencement of the posterior cerebral artery: these, with similar branches from the posterior communicating, pierce the posterior perforated substance, and supply the medial surfaces of the thalami and the walls of the third ventricle.
  • Peduncular perforating or postero-lateral ganglionic branches: small arteries which arise from the posterior cerebral artery after it has turned around the cerebral peduncle; they supply a considerable portion of the thalamus.
Posterior cerebral artery

Posterior (choroidal) branches

The posterior choroidal branches of the posterior cerebral artery are sometimes referred to as a single posterior choroidal artery.

Cortical branches

The cortical branches are:

Development

The prenatal development of the posterior cerebral arteries in the fetus comes relatively late and arises from the fusion of several embryonic vessels near the caudal ends of the posterior communicating arteries supplying the mesencephalon and diencephalon.[2] The PCA begins as such, as a continuation of the PCommA in the fetus with only 10–30% of fetuses having a prominent basilar origin.[3]

The fetal carotid origin of the PCA usually regresses as the vertebral and basilar arteries develop with the PCommA reducing is size. In most adults, the PCA sources from the anterior portion of the basilar artery. Only about 19% of adults retain PCommA dominance of the PCA with 72% having dominant basilar origin, and the rest having either equal prominence between PCommA and basilar artery, or a single exclusive source.[3]

Clinical significance

Stroke

Signs and symptoms: Structures involved

Peripheral territory (Cortical branches)

  • Homonymous hemianopsia (often upper quadrantic): Calcarine cortex or optic radiation nearby.
  • Bilateral homonymous hemianopsia, cortical blindness, awareness or denial of blindness; tactile naming, achromatopia (color blindness), failure to see to-and-fro movements, inability to perceive objects not centrally located, apraxia of ocular movements, inability to count or enumerate objects, tendency to run into things that the patient sees and tries to avoid: Bilateral occipital lobe with possibly the parietal lobe involved.
  • Verbal dyslexia without agraphia, color anomia: Dominant calcarine lesion and posterior part of corpus callosum.
  • Memory defect: Hippocampal lesion bilaterally or on the dominant side only.
  • Topographic disorientation and prosopagnosia: Usually with lesions of nondominant, calcarine, and lingual gyrus.
  • Simultanagnosia, hemivisual neglect: Dominant visual cortex, contralateral hemisphere.
  • Unformed visual hallucinations, peduncular hallucinosis, metamorphopsia, teleopsia, illusory visual spread, palinopsia, distortion of outlines, central photophobia: Calcarine cortex.
  • Complex hallucinations: Usually nondominant hemisphere.

Central territory (Ganglionic branches)

  • Thalamic syndrome: sensory loss (all modalities), spontaneous pain and dysesthesias, choreoathetosis, intention tremor, spasms of hand, mild hemiparesis, contralateral hemianaethesia: Posteroventral nucleus of thalamus; involvement of the adjacent subthalamus body or its afferent tracts.
  • Thalamoperforate syndrome: crossed cerebellar ataxia with ipsilateral third nerve palsy (Claude's syndrome): Dentatothalamic tract and issuing third nerve.
  • Weber's syndrome: third nerve palsy and contralateral hemiplegia: Third nerve and cerebral peduncle.
  • Contralateral hemiplegia: Cerebral peduncle.
  • Paralysis or paresis of vertical eye movement, skew deviation, sluggish pupillary responses to light, slight miosis and ptosis (retraction nystagmus and "tucking" of the eyelids may be associated): Supranuclear fibers to third nerve, interstitial nucleus of Cajal, nucleus of Darkschewitsch, and posterior commissure.
  • Contralateral rhythmic, ataxic action tremor; rhythmic postural or "holding" tremor (rubral tremor): Dentatothalamic tract.

Additional images

See also

References

  1. ↑ Atlas of Human Anatomy, Frank Netter
  2. ↑ Osborn, Anne G.; Jacobs, John M. (1999), Diagnostic Cerebral Angiography, Lippincott Williams & Wilkins, p. 153, ISBN 978-0-397-58404-8
  3. 1 2 Krayenbühl, Hugo; Yaşargil, Mahmut Gazi; Huber, Peter; Bosse, George (1982), Cerebral Angiography, Thieme, pp. 163–165, ISBN 978-0-86577-067-6
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