Middle Cerebral Artery

The middle cerebral artery (MCA) is a terminal branch of the internal carotid artery and
is part of the anterior cerebral circulation. It arises within the interpeduncular fossa, from
the internal carotid artery from the lateral angle of the Circle of Willis. It courses laterally
between the frontal and temporal lobes, traversing the Sylvian fissure. It then passes
over the posterosuperior surface of the insula, where it bifurcates into the superior and
inferior trunks. The trunks travel together through the Sylvian fissure towards the lateral
surface of the brain. The MCA supplies many deep brain structures, the majority of the
lateral surface of the cerebral hemispheres, and the temporal pole of the brain. It travels
from the base of the brain through the lateral sulcus (of Sylvius), before terminating on
the lateral surface of the brain. MCA is divided into four segments (M1-M4), which give
rise to a total of 10 branches.
The four segments of the MCA
M1 (sphenoidal/horizontal) segment travels in an almost horizontal fashion from the
internal carotid artery to a point of MCA bifurcation between temporal and frontal lobes.
It is situated within the sphenoidal part of the Sylvian fissure, through which it courses
as far as to the junction of the sphenoidal and operculoinsular segment of the Sylvian
fissure. At the site of termination of M1 segment, the trunks of the middle cerebral artery
take a 90° turn in the posterosuperior direction, which is demarcated as the genu (lat.
“knee”) of MCA. Here, the MCA divides into the superior and inferior trunks.
M2 (insular) segment begins at the point of MCA bifurcation and consists of a superior
and inferior trunk. This segment starts with the genu of MCA at the level of limen insulae
and then travels along the surface of the insula. It terminates at the level of the circular
sulcus of insula.
M3 (opercular) segment begins to ascend from the circular sulcus of insula towards the
surface of the brain. This segment courses over the inner surfaces of the parietal and
temporal portion of the insular operculum.
M4 (terminal, cortical) segment continues onto the M3 segment once it emerges
through the lateral fissure to reach the surface of the brain and travels over the surface
of the cerebral hemisphere.
Branches and supply
The middle cerebral artery has 10 branches, which are classified into the central and
cortical.
The numerous central branches arise from the middle cerebral artery as it enters the
Sylvian fissure. They are also called striate or lateral lenticulostriate arteries, and their
main function is to supply the deep structures of the brain.
The cortical branches ramify from the middle cerebral artery once it emerges on the
surface of the brain. The main function of the cortical branches is to supply most of the
lateral surface of the brain, i.e. the orbital, frontal, parietal and temporal parts of
the cerebral cortex.
Central branches
The central branches of the middle cerebral artery arise within the Sylvian fissure, from
the M1 and M2 segments of the MCA. They are all collectively called the lateral striate
(lenticulostriate) arteries.
The lateral lenticulostriate arteries pierce the floor of the Sylvian fissure and course as
deep as to the external surface of the thalamus. They supply the basal ganglia, i.e. the
striatum, much of the head and body of the caudate nucleus, and large portions of the
lenticular nucleus and of the external and internal capsules.
Cortical branches
The cortical branches of the middle cerebral artery arise from all of its segments. They
gradually increase in size, with those originating from M1 being the shortest, while those
that originate from M4 are the longest. It is noteworthy that the cortical branches which
arise before the bifurcation of the MCA are often termed as the early central
branches for the sake of the neurosurgical distinction.
The cortical branches are named according to the region of the brain that they supply;
Anterior temporal arteries vascularize the temporal pole of the brain, which is the most
anterior aspect of the temporal lobe. They arise from the M1 segment of MCA.
Lateral frontobasal artery supplies the lateral part of the orbital surface of the frontal
lobe, as well as the inferior frontal gyrus. It arises from the M2 segment of the MCA.

The remainder of the cortical branches arises from the M4 segment of the MCA;

 Prefrontal artery supplies the anterior aspects of the inferior and middle frontal gyri
 Artery of precentral sulcus travels in the precentral sulcus to supply the posterior
aspect of the inferior and middle frontal gyri, Broca’s area and the precentral
gyrus, which contains the primary motor cortex for the head, upper limb, and trunk.
 Artery of central sulcus travels within the central sulcus and contributes to the
blood supply of the pre- and postcentral gyri
 Artery of postcentral sulcus travels in the postcentral sulcus to supply the anterior
aspect of parietal lobe and the postcentral gyrus which contains the primary
somatosensory cortex for the head, upper limbs, and trunk
 A variety of parietal branches supply the lateral aspect of the parietal lobe,
including the superior and inferior paracentral lobules.
 Angular artery supplies the angular and supramarginal gyri of the parietal lobe, the
posterior part of the superior temporal gyrus, and the superior part of the lateral
surface of the occipital lobe.
  Middle temporal branches supply the middle aspect of the superior and middle
temporal gyri, as well as the primary auditory cortex and Wernicke’s area

Heart
Your heart is the main organ of your cardiovascular system, a network of blood vessels
that pumps blood throughout your body. It also works with other body systems to control
your heart rate and blood pressure. Your family history, personal health history and
lifestyle all affect how well your heart works.
Your heart contains four main sections (chambers) made of muscle and powered by
electrical impulses. Your brain and nervous system direct your heart’s function.
Inside of the Heart

Outside of the heart

Heart chambers
Your heart is divided into four chambers. You have two chambers on the top (atrium,
plural atria) and two on the bottom (ventricles), one on each side of the heart.
Right atrium: Two large veins deliver oxygen-poor blood to your right atrium. The
superior vena cava carries blood from your upper body. The inferior vena cava brings
blood from the lower body. Then the right atrium pumps the blood to your right ventricle.
Right ventricle: The lower right chamber pumps the oxygen-poor blood to
your lungs through the pulmonary artery. The lungs reload blood with oxygen.
Left atrium: After the lungs fill blood with oxygen, the pulmonary veins carry the blood to
the left atrium. This upper chamber pumps the blood to your left ventricle.
Left ventricle: The left ventricle is slightly larger than the right. It pumps oxygen-rich
blood to the rest of your body.
Heart valves
Your heart valves are like doors between your heart chambers. They open and close to
allow blood to flow through.
The atrioventricular (AV) valves open between your upper and lower heart chambers.
They include:
Tricuspid valve: Door between your right atrium and right ventricle.
Mitral valve: Door between your left atrium and left ventricle.
Semilunar (SL) valves open when blood flows out of your ventricles. They include:
Aortic valve: Opens when blood flows out of your left ventricle to your aorta (artery that
carries oxygen-rich blood to your body).
Pulmonary valve: Opens when blood flows from your right ventricle to your pulmonary
arteries (the only arteries that carry oxygen-poor blood to your lungs).
Blood vessels
Your heart pumps blood through three types of blood vessels:
Arteries carry oxygen-rich blood from your heart to your body’s tissues. The exception is
your pulmonary arteries, which go to your lungs.
Veins carry oxygen-poor blood back to your heart.
Capillaries are small blood vessels where your body exchanges oxygen-rich and
oxygen-poor blood.
The circle of Willis

The circle of Willis (cerebral arterial circle or circulus arteriosus) is an anastomotic ring of
arteries located at the base of the brain. This arterial anastomotic circle connects the two
major arterial systems to the brain, the internal carotid arteries and the vertebrobasilar
(vertebral and basilar arteries) systems. It is formed by four paired vessels and a single
unpaired vessel with numerous branches that supply the brain.

The main function of the circle of Willis is to provide a collateral blood flow between the
anterior and posterior arterial systems of the brain. Additionally, it offers the alternate
blood flow pathways between the right and left cerebral hemispheres. This way the circle
protects the brain from ischemia and stroke in cases of vascular obstruction or damage.

There are two paired arteries which are responsible for the blood supply to the brain:
the vertebral arteries, and the internal carotid arteries. These arteries arise in the neck
and ascend to the cranium.
Within the cranial vault, the terminal branches of these arteries form an anastomotic
circle, called the Circle of Willis. From this circle, branches arise which supply the
majority of the cerebrum.