Give me a chart of stroke and vessels that cause stroke

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I now have comprehensive data from multiple textbooks. Let me compile the complete chart.

Here is a comprehensive reference chart of stroke syndromes organized by the vessel involved, synthesized from Adams and Victor's Principles of Neurology (12th Ed.), Harrison's Principles of Internal Medicine (22nd Ed.), and Neuroanatomy through Clinical Cases (3rd Ed.):

Stroke Syndromes by Vessel

ANTERIOR CIRCULATION (Carotid System)

Vessel	Territory	Key Clinical Features
Internal Carotid Artery (ICA)	Entire ipsilateral hemisphere (variable, depends on collaterals)	Contralateral hemiplegia + hemisensory loss; ipsilateral monocular blindness (amaurosis fugax); aphasia (dominant); "ophthalmic" + MCA combo
Anterior Cerebral Artery (ACA)	Medial frontal & parietal lobes; paracentral lobule	Contralateral leg > arm weakness/sensory loss (foot/leg most affected, hand/face spared); urinary incontinence; contralateral grasp reflex; abulia; personality change (frontal); gait apraxia
ACA - bilateral (both from single stem)	Bilateral medial hemispheres	Paraplegia, profound abulia, incontinence, nonfluent aphasia
Artery of Heubner (recurrent branch of ACA)	Head of caudate, adjacent white matter	Caudate infarction; historically seen in meningovascular syphilis
Middle Cerebral Artery (MCA) - main stem	Lateral hemisphere, deep structures	Contralateral hemiplegia + hemisensory loss (face & arm > leg); homonymous hemianopia; gaze deviation toward lesion; aphasia (dominant hemisphere)
MCA - Superior Division	Frontal & anterior parietal cortex	Contralateral face & arm weakness > leg; Broca's aphasia (dominant); ideomotor apraxia; sensory loss (discriminative)
MCA - Inferior Division	Posterior temporal & parietal cortex	Wernicke's aphasia (dominant); superior quadrantanopia or hemianopia; left visual neglect (non-dominant); agitated confusional state (non-dominant)
Anterior Choroidal Artery	Posterior limb internal capsule, optic tract, hippocampus, globus pallidus	Contralateral hemiplegia, hemisensory loss, homonymous hemianopia (triad); variable expression

POSTERIOR CIRCULATION (Vertebrobasilar System)

Vessel	Territory	Key Clinical Features
Posterior Cerebral Artery (PCA) - cortical	Occipital lobe, inferomedial temporal lobe	Contralateral homonymous hemianopia (macular sparing); prosopagnosia; alexia without agraphia (dominant); visual hallucinations; amnesic aphasia; anomia (colors)
PCA - bilateral	Both occipital lobes	Cortical blindness; Anton syndrome (denial of blindness); Balint syndrome (bilateral occipitoparietal); severe amnesia (bilateral hippocampal)
PCA - proximal (thalamogeniculate branches)	Thalamus (VPL, VPM nuclei)	Contralateral hemisensory loss (all modalities); thalamic pain syndrome (Dejerine-Roussy); contralateral hemiballismus (subthalamic nucleus)
Basilar Artery - top of basilar	Midbrain, thalamus, occipital lobes	Somnolence/coma; bilateral long-tract signs; oculomotor palsies (CN III); convergence-retraction nystagmus; vertical gaze palsy; Korsakoff amnesia
Basilar Artery - mid-basilar	Ventral pons	Bilateral weakness; locked-in syndrome (basilar occlusion with bilateral ventral pons involvement): quadriplegia + anarthria + preserved consciousness
Vertebral Artery (V4) / PICA	Lateral medulla, inferior cerebellum	Lateral medullary (Wallenberg) syndrome: vertigo, vomiting, nystagmus, ipsilateral facial numbness, contralateral body pain/temp loss (crossed), ipsilateral Horner's syndrome, dysphagia, dysarthria, hoarseness, ipsilateral limb ataxia
Anterior Inferior Cerebellar Artery (AICA)	Lateral pontomedullary junction, anterior inferior cerebellum	Ipsilateral facial palsy (CN VII), ipsilateral hearing loss (CN VIII), ipsilateral Horner's, contralateral pain/temp loss, ipsilateral ataxia
Superior Cerebellar Artery (SCA)	Superior surface of cerebellum, upper pons	Ipsilateral ataxia (severe), nausea/vomiting; contralateral pain/temp loss; ipsilateral Horner's; partial CN IV palsy
Anterior Spinal Artery	Ventral medulla, upper cervical cord	Ipsilateral tongue weakness (CN XII), contralateral arm/leg hemiparesis (pyramid), contralateral proprioception loss (medial lemniscus) - medial medullary syndrome

LACUNAR INFARCTS (Small Penetrating Vessels)

These occur from lipohyalinosis or microatheroma of perforators, typically in hypertensive patients. No cortical signs (no aphasia, no hemianopia, no neglect).

Syndrome	Clinical Features	Location	Vessel
Pure Motor Hemiparesis	Unilateral face + arm + leg weakness, ± dysarthria	Posterior limb internal capsule; ventral pons; corona radiata; cerebral peduncle	Lenticulostriate arteries; basilar perforators; small MCA branches
Ataxic Hemiparesis	Weakness + ipsilateral ataxia (same side)	Same as pure motor	Same as pure motor
Pure Sensory Stroke	Contralateral hemisensory loss (all modalities), face + body	Thalamus (VPL + VPM)	Thalamoperforating branches of PCA
Sensorimotor Stroke	Combined motor + sensory deficit	Thalamocapsular region	Lenticulostriate + thalamoperforating
Dysarthria - Clumsy Hand	Dysarthria + unilateral hand clumsiness	Ventral pons; genu of internal capsule	Basilar perforators; lenticulostriate arteries

Quick Memory Aid

ACA  → LEG (medial cortex, paracentral lobule)
MCA  → FACE + ARM (lateral cortex)
PCA  → VISION + THALAMUS (occipital + posterior structures)
PICA → WALLENBERG (lateral medulla: crossed sensory, Horner's, ataxia, dysphagia)
AICA → LATERAL PONS (hearing loss + facial palsy)
SCA  → CEREBELLAR ATAXIA (superior cerebellum)
Basilar → EVERYTHING (locked-in, coma, bilateral deficits)
Lacunar → PURE syndromes (no cortical signs)

Sources:

Adams and Victor's Principles of Neurology, 12th Ed. - ACA, MCA, PCA, vertebrobasilar stroke syndromes
Harrison's Principles of Internal Medicine, 22nd Ed. - vertebral artery disease, Wallenberg syndrome, basilar artery disease
Neuroanatomy through Clinical Cases, 3rd Ed. - lacunar syndromes table (Table 10.3)

Create a visual poster of stroke territories on a brain diagram

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Medical education poster titled "Stroke Territories & Affected Vessels" showing a brain diagram with color-coded vascular territories. The poster includes: Top section: A lateral view of the left cerebral hemisphere with clearly labeled colored zones: - RED zone: Middle Cerebral Artery (MCA) territory covering the large lateral surface (frontal, parietal, temporal lobes) - labeled with key deficits: contralateral face & arm weakness, aphasia (dominant), hemianopia - BLUE zone: Anterior Cerebral Artery (ACA) territory covering the medial frontal and parietal strip along the top - labeled: contralateral LEG weakness, abulia, incontinence - YELLOW/GOLD zone: Posterior Cerebral Artery (PCA) territory covering the occipital lobe and inferior temporal - labeled: homonymous hemianopia, visual agnosia, thalamic pain Middle section: A brainstem posterior view showing: - PURPLE zone: Basilar Artery territory (ventral pons, midbrain) - labeled: locked-in syndrome, bilateral deficits, coma - GREEN zone: PICA territory (lateral medulla) - labeled: Wallenberg syndrome - vertigo, crossed sensory loss, Horner's, dysarthria - ORANGE zone: AICA territory (lateral pons) - labeled: facial palsy, hearing loss, ataxia - TEAL zone: SCA territory (superior cerebellum) - labeled: severe ataxia, contralateral pain/temp loss Bottom section: A small axial brain slice showing lacunar infarct sites: - Internal capsule (lenticulostriate): pure motor hemiparesis - Thalamus (thalamoperforators): pure sensory stroke - Pons (basilar perforators): dysarthria-clumsy hand Color legend box on right side matching each color to vessel name. Clean white background, professional medical illustration style, bold labels, clear arrows pointing to each territory.

Here's the visual poster showing stroke territories on a brain diagram. It covers:

Lateral hemisphere view - MCA (red/largest lateral territory), ACA (blue/medial strip), PCA (yellow/occipital)
Brainstem view - Basilar artery, PICA (Wallenberg), AICA, and SCA territories
Axial slice - Lacunar infarct locations (internal capsule, thalamus, pons) with their associated vessels
Color-coded legend matching each vessel to its territory and key deficits

This pairs well with the chart from earlier - use the poster for quick visual recall and the chart for detailed syndrome features in study or clinical review.

Blood supply of brain

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I now have comprehensive data from Gray's Anatomy, Neuroanatomy through Clinical Cases, Goldman-Cecil Medicine, and Adams & Victor's. I have all I need for a complete, well-organized answer with textbook diagrams.

Blood Supply of the Brain

The brain receives ~20% of cardiac output despite being only 2% of body weight. It is supplied by two systems that meet at the Circle of Willis.

Arterial Supply: Two Systems

70% from Internal Carotid Arteries (Anterior Circulation) 30% from Vertebral Arteries (Posterior Circulation)

Here are the anatomical diagrams from Neuroanatomy through Clinical Cases, 3rd Ed.:

Anterior and Posterior Circulations - lateral and posterior neck view

Fig. 10.2 - Anterior circulation (ICA) and posterior circulation (vertebral arteries), showing their origins from the aorta and course to the brain.

Circle of Willis and Main Branches - inferior view of brain

Fig. 10.3 - Inferior view of the brain showing the Circle of Willis and all major cerebral branches.

1. Internal Carotid Artery (ICA) - Anterior Circulation

The ICA arises from the common carotid artery at the carotid bifurcation and passes through four named segments:

Segment	Location
Cervical	Neck - no branches
Petrous	Petrous canal of temporal bone
Cavernous	Cavernous sinus - gives off ophthalmic artery
Supraclinoid	Enters the dura - terminal branches

Terminal branches of the ICA:

Branch	Supplies
Ophthalmic artery	Retina, orbit (first branch after entering dura)
Anterior choroidal artery	Optic tract, posterior limb of internal capsule (inferior part), hippocampus, amygdala, geniculate body
Posterior communicating artery (PComm)	Links ICA to PCA; completes the Circle of Willis
Anterior cerebral artery (ACA)	Medial frontal and parietal lobes (leg area)
Middle cerebral artery (MCA)	Lateral frontal, parietal, temporal lobes (face + arm area)

2. ACA - Anterior Cerebral Artery

Travels anteriorly then turns posteriorly along the medial hemisphere
Supplies medial frontal and parietal lobes, paracentral lobule, corpus callosum
The A1 segment (before anterior communicating artery) gives off lenticulostriate branches
The recurrent artery of Heubner (large medial striate branch) supplies: anterior internal capsule, head of caudate, putamen, anterior globus pallidus, hypothalamus
Left and right ACAs connected by the anterior communicating artery (AComm)

3. MCA - Middle Cerebral Artery

Largest branch of ICA; supplies the bulk of the lateral hemisphere
The M1 segment gives rise to all lateral lenticulostriate arteries supplying the basal ganglia and internal capsule
Bifurcates (20-30%) or trifurcates (70%) in the Sylvian fissure:
- Superior division - frontal and parietal lobes (Broca's area dominant hemisphere)
- Inferior division - lateral temporal lobe (Wernicke's area dominant hemisphere)

4. Vertebral Arteries - Posterior Circulation

Arise from subclavian arteries
Ascend through foramina transversaria of C6-C1 vertebrae
Enter skull through foramen magnum
Unite to form the basilar artery
The fourth segment (V4) gives branches to brainstem and cerebellum

Branches of vertebral artery:

Branch	Supplies
Posterior inferior cerebellar artery (PICA)	Lateral medulla + inferior cerebellum
Anterior spinal artery	Ventral medulla + upper cervical cord (pyramids, medial lemniscus, CN XII)

5. Basilar Artery

Formed by the union of the two vertebral arteries. Runs along the ventral surface of the pons.

Branch	Supplies
Anterior inferior cerebellar artery (AICA)	Lateral pontomedullary junction, anterior inferior cerebellum
Pontine perforators (paramedian + circumferential)	Basis pontis, MLF, pontine reticular nuclei, corticospinal tracts
Superior cerebellar artery (SCA)	Superior cerebellum, upper pons
Posterior cerebral artery (PCA) (terminal branch)	Occipital lobe, inferior temporal lobe, thalamus

6. Circle of Willis

An anastomotic ring at the base of the brain providing collateral flow. Only a complete full-caliber ring is present in ~34% of individuals.

        ACA ─── AComm ─── ACA
         |                  |
        ICA                ICA
         |                  |
       PComm             PComm
         |                  |
        PCA ─── Basilar ─── PCA
                   |
              Vertebrals (x2)

Components:

Anterior part: 2x ACA + anterior communicating artery (AComm)
Posterior part: 2x PCA + 2x posterior communicating arteries (PComm)
Connecting: 2x ICA (supraclinoid) joining anterior to posterior via PComm

Functional significance: In a complete circle, the entire intracranial circulation can theoretically be supplied by a single patent ICA or vertebral artery. Common variants (hypoplastic A1 or P1 segments) reduce this collateral capacity.

7. Deep Perforating Arteries (End Arteries)

These are small vessels with no collaterals - occlusion causes lacunar infarcts:

Vessel	Structure Supplied	Source
Lateral lenticulostriate arteries	Putamen, caudate head/body, anterior internal capsule	MCA (M1)
Medial lenticulostriate arteries	Anterior internal capsule, caudate	ACA (A1) + Heubner
Thalamoperforators	Thalamus (VPL, VPM nuclei)	PCA (P1)
Thalamogeniculate arteries	Geniculate bodies, lateral thalamus	PCA
Basilar perforators (paramedian)	Ventral pons, corticospinal tracts	Basilar
Anterior choroidal artery	Posterior limb internal capsule (inferior), hippocampus	ICA

8. Venous Drainage

Venous drainage is avalvular throughout. Blood flows: cortical veins → dural venous sinuses → internal jugular vein.

Dural Venous Sinuses (Gray's Anatomy for Students):

Sinus	Location	Drains to
Superior sagittal	Superior edge of falx cerebri	Confluence of sinuses
Inferior sagittal	Inferior edge of falx cerebri	Straight sinus (via great vein of Galen)
Straight sinus	Junction of falx + tentorium	Confluence of sinuses
Confluence of sinuses	Internal occipital protuberance	Transverse sinuses bilaterally
Transverse sinuses	Along tentorium cerebelli	Sigmoid sinuses
Sigmoid sinuses	Groove of temporal/occipital bone	Internal jugular vein (via jugular foramen)
Cavernous sinuses	Lateral to sella turcica	Superior/inferior petrosal sinuses
Superior petrosal	Superior petrous ridge	Transverse sinus
Inferior petrosal	Petrous-occipital groove	Internal jugular vein

Great vein of Galen drains deep structures (basal ganglia, deep white matter) → straight sinus.

Summary Diagram

AORTA
  ├── Brachiocephalic → Right Common Carotid → Right ICA
  ├── Left Common Carotid → Left ICA
  │       └── ICA branches: Ophthalmic, AChoroidal, PComm, ACA, MCA
  └── Subclavian (both sides) → Vertebral Arteries (x2)
            └── Unite at pons → BASILAR ARTERY
                    └── Branches: AICA, SCA, Pontine perforators, PCA (terminal)

CIRCLE OF WILLIS = ACA + AComm + ICA + PComm + PCA (basilar end)

VENOUS DRAINAGE:
  Cortical veins → Dural sinuses → Confluence → Transverse → Sigmoid → Internal Jugular Vein
  Deep veins → Great vein of Galen → Straight sinus → Confluence

Sources:

Neuroanatomy through Clinical Cases, 3rd Ed. (Blumenfeld) - Figures 10.2 & 10.3, Circle of Willis anatomy
Goldman-Cecil Medicine, International Ed. - Anterior choroidal, MCA, PCA, Circle of Willis variants
Gray's Anatomy for Students - Venous drainage, dural venous sinuses (Table 8.3)
Barash Clinical Anesthesia, 9th Ed. - 70%/30% supply proportions

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