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

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

The posterior inferior cerebellar artery (PICA), the largest branch of the vertebral artery, is one of the three main arterial blood , supplies for the cerebellum, part of the brain. Occlusion of the posterior inferior cerebellar artery or one o its branches, or of the . of vertebral artery leads to Wallenberg syndrome also called lateral medullary syndrome. 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 undersurface of the cerebellum, where it divides into two bra , branches. The medial branch continues backward to the notch between the two hemispheres of the cerebellum; while the lateral supplies t the under surface of the cerebellum, as far as its lateral border, where it anastomoses with the anterior inferior cerebellar and the superior cerebellar branches of the basilar artery artery. 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 known 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 brain

1. 2. 3. 4. 5. 6. 7. AICA Anterior Cerebral Artery Anterior Choroidal Artery Anterior Communicating Artery Basilar artery Internal Carotid Artery Middle Cerebral Artery : : : : : : : Artery that supplies the pons, along with the basilar artery of which it is a branch of. It also supplies the cerebellum Partly supplies a large proportion of the basal ganglia, also supplies medial aspects of motor and sensory strips and anterior aspects of the frontal lobes Small branch off the middle cerebral artery, near the circle of Willis that supplies the posterior limb of the internal capsule Along with the Anterior Cerebral and Middle Cerebral arteries it supplies most of the basal ganglia Artery whose pontine branches supply blood to the pons, along with AICA Supplies the Substantia Nigra and STN along with the Post. Communicating artery Partly supplies a large proportion of the basal ganglia, supplies anterior limb of internal

8. 9. 10. 11. 12.

PICA Posterior cerebral artery Posterior communicating Artery Superior Cerebellar Artery Vertebral artery

: : : : :

capsule, Broca's area, Wernicke's Area, Heschl's Gyrus and the Angular Gyrus Artery that is a branch off the vertebral artery, along with which it supplies the medulla oblongata. It also supplies the cerebellum 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 Supplies the Substantia Nigra and STN along with the Internal Carotid Artery and the thalamus along with the posterior cerebral artery Artery that allows blood from the upper pons and lower medulla to be shared. It also supplies the cerebellum Artery which supplies the medulla, along with PICA

Cerebellum 3: Function, Blood Supply and Clinical Correlates

1. 2. 3. 4. 5. 6. Adiadochokinesia All cerebellar syndromes cause signs on which side? Anterior lobe of cerebellum supplied by Archicerebellum (midline, vermis) does what motor function? Archicerebellum (midline, vermis) does what non-motor function? Cerebellar Hemisphere Syndrome signs are : : : : : : inability to perform rapid successive movements ipsilateral signs superior cerebellar artery (SCA) Equilibrium, Posture Autonomic responses, Emotion, Sexuality, Affectively important memory Ataxia, Dysmetria, Dyssynergia, Adiadochokinesia, Tremor, volitional (intentional, harder you try, more it shakes), Muscular hypotonia, Dysarthria, Nystagmus 3.Initiation of movement is via the Deep cerebellar nuclei fire simultaneously with pyramidal cortical neurons prior to movement 2. Motor learning is via Increased firing of Purkinje cells during learning of a new motor task 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) slurred speech inability to estimate range of movement (past pointing, i.e. on touch nose then touch finger, they miss finger) uneven & jerky movement limb ataxia medulloblastoma upon vermis

7. 8. 9.

Describe initiation of movement in the cerebellum Describe motor learning in the cerebellum Describe sensory-motor integration in the cerebellum Dysarthria Dysmetria Dyssynergia Lateral hemisphere lesions cause ataxia where? Midline Cerebellum syndrome, sometimes called archicerebellar syndrome can result from? Midline lesions cause ataxia where? Much of what is understood about the functions of the cerebellum has been inferred how? Nystagmus Posterior lobe of cerebellum supplied by Signs of midline cerebellum syndrome Ventral part of anterior cerebellum, and posteior lobes, also flocculurnodular lobe supplied by What are the 3 main NON-MOTOR FUNCTIONS of the cerebellum? What are the 4 motor functions of the cerebellum? What funciton does the Posterior Lobe perform? What function does the Anterior Lobe do? What function does the Floccularnodular lobe handle? What motor function does the Neocerebellum (hemispheres) do? What non-motor function does the Neocerebellum (hemispheres) do?

: : :

10. 11. 12. 13. 14.

: : : : :

15. 16.

: :

trunk ataxia after careful documentation of the effects of focal lesions in human patients, and through research on the effects of focal lesions in animals rhythmic, involuntary eye movements. posterior inferior cerebellar artery (PICA) Truncal Ataxia, Nystagmus anterior inferior cerebellar artery (AICA)

17. 18. 19. 20.

: : : :

21. 22.

: :

23. 24. 25. 26. 27.

: : : : :

A) Autonomic (respiration, intestinal motility, bladder tone, etc.), B) Behavior (mood), C) Cognition & Memory. 1. Error Detection & correction of cortically-originating movement; 2. Motor learning 3. Initiation of movement movement; and 4. Sensorymotor integration Concerned with higher order functions, Cognition in hemispheres, Limbic function in vermis Mainly involved with motor control Balance and eye movement Coordination 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.