Circle of Willis

Overview

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Snapshot

  • A 59-year-old male presents with sensory changes on the right side of his face, left side of his body, and dizziness. He also reports some trouble with swallowing, and his wife noticed that his voice sounds hoarse. Past medical history is significant for hypertension and type 2 diabetes mellitus. On physical examination, there is a right-sided Horner’s syndrome. Uvula is deviated towards the left. There is right-sided vocal cord paralysis and absence of elevation of the right palate during phonation. There is loss of pain sensation on the right-sided face and left-sided trunk and limbs. (Lateral medullary syndrome)

Introduction

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ArterySyndromePresentation
Anterior Spinal arteryMedial medullary syndromeIpsilateral paralysis of hypoglossal nerve Contralateral hemiparesis of the upper and lower extremityMedial lemniscus (↓ contralateral vibration and proprioception) 
Posterior inferior cerebellar artery (PICA)Lateral medullary syndrome Ipsilateral manifestationsfacial loss of pain and temperatureataxia (arm and leg, gait)hoarsenessdysphagiaHorner syndromeContralateral manifestationspain and temperature hemisensory lossNausea, nystagmus, vomiting, vertigo
Anterior inferior cerebellar artery (AICA)Lateral pontine syndrome Ipsilateral manifestationsfacial paralysisloss of lacrimationreduced salivationloss of corneal reflexloss of sensation of the anterior 2/3rd of the tongueHorner syndromesensorineural hearing lossloss of facial pain and temperatureContralateral manifestationspain and temperature hemisensory loss
Posterior cerebral arteryContralateral homonymous hemianopia with macular sparing
Middle cerebral artery Contralateral manifestationsfacial paralysis and sensory lossupper extremity weakness and sensory losshemineglect (if stroke is in non-dominant hemisphere)aphasia (if stroke is in dominant hemisphere-Broca’s area)
Anterior cerebral arteryContralateral manifestationslower extremity weakness and sensory loss 
Posterior communicating artery Ipsilateral compression leading to CN III palsydown-and-out, mydriasis
Lenticular striate arteryContralateral manifestationsmotor hemiparesishemisensory lossLack of cortical signsno aphasia, neglect
Basilar arteryLocked-in syndromeQuadriplegiaPreserved reticular formationIntact vertical eye movementIntact blinking
Anterior communicating arteryCan compression of optic chiasmbitemporal hemianopiaIf rupture, ischemia in anterior cerebral artery territory