Figure 361-1.

Diagram of the brainstem, cerebellum, inferior right frontal lobe, and

transected temporal lobe. Principal branches of the vertebral basilar arterial system are
pictured. The stem of the middle cerebral artery with its small, deep penetrating
lenticulostriate arteries and the circle of Willis with its small, deep penetrating branches
are shown. Roman numerals I, II, III, and IV represent some of the possible variations of
the circle of Willis due to atresia of one or more of its arterial components. A, B, C, and
D arrows indicate the four levels of the brainstem diagrammed below (D, Fig. 361-6; A,
Fig. 361-7; B, Fig. 361-8; C, Fig. 361-9). Although typical vascular syndromes of the
pons and medulla have been designated by the shaded areas in Figs. 361-6, 361-7,
361-8, and 361-9, the shading is approximate only. Great variability in infarct size and
location occurs when the basilar or vertebral arteries or one of their penetrating
branches becomes occluded. This variability is because of variation in arterial anatomic
location and available collateral circulation. Thus the stroke syndromes produced are
often atypical, incomplete, or merge with one another.
(Courtesy of CM Fisher, MD.)

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