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Disease is also common in the vertebral and basilar arteries. Severe stenosis of these vessels can cause hypoperfusion of the brainstem and occipital lobes, resulting in symptoms of vertigo, diplopia, syncope, and cortical blindness. Distal BA occlusion can result in “top o’ the basilar syndrome,” and acute thrombotic occlusion of the whole BA frequently results in coma or death. 19). The posterior cerebral arteries are divided into several segments as they pass from the basilar apex to the PCOM segment of the PCA (P1, precommunicating or mesencephalic segment), then through the ambient (P2, ambient segment) and quadrigeminal (P3, quadrigeminal segment) cisterns, and finally through the calcarine fissure (P4, calcarine segment) to the occipital lobes (Fig.

Steal syndromes Subclavian (reverse flow in VA from a subclavian artery obstruction proximal to the VA origin). Carotid (CCA occlusion with ECA flow reversal), jaw claudication. Abbreviations: BA, basilar artery; CCA, common carotid artery; ECA, external carotid artery; ICA, internal carotid artery; VA, vertebral artery. References 1. Martini FH, Timmons MJ. Human Anatomy, 2nd ed. Prentice Hall; 1997 2. Schoenwolf GC, Bleyl SB, Brauer PR, Francis-West P. Larsen’s Human Embryology, 4th ed. Churchill Livingstone; 2009 3.

The final segment (C7) of the ICA is the communicating segment from which the posterior communicating artery (PCOM) originates. The PCOM sends multiple perforating branches to the thalamus and internal capsule. The largest branch from the PCOM is the anterior thalamoperforating artery that passes through the anterior perforating substance to supply the medial thalamus and third ventricular wall. The PCOM is the normal physiological communication between the anterior and posterior intracranial circulation, but some patients may continue to have persistent fetal connections.

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Adult & Pediatric Spine


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