The mechanism is not entirely understood but is thought to be related to a hyperperfusion state, with blood-brain-barrier breakthrough, extravasation of fluid potentially containing blood or macromolecules, and resulting cortical or subcortical edema. Many causes have been described including hypertension, eclampsia and preeclampsia, immunosuppressive medications such as cyclosporine. It classically consists of potentially reversible vasogenic edema in the posterior circulation territories, but anterior circulation structures can also be involved (6). It is also known as reversible posterior Leukoencephalopathy syndrome. PRES is short for Posterior Reversible Encephalopathy Syndrome. Posterior thalamoperforating arteries branch off the P1 segment and supply blood to the midbrain and thalamus.Ĭortical branches of the PCA supply the inferomedial part of the temporal lobe, occipital pole, visual cortex, and splenium of the corpus callosum. P1 extends from origin of the PCA to the posterior communicating artery, contributing to the circle of Willis. Posterior cerebral artery (PCA in green).The deep penetrating LSA-branches are discussed above. The cortical branches of the MCA supply the lateral surface of the hemisphere, except for the medial part of the frontal and the parietal lobe (anterior cerebral artery), and the inferior part of the temporal lobe (posterior cerebral artery). The ACA supplies the medial part of the frontal and the parietal lobe and the anterior portion of the corpus callosum, basal ganglia and internal capsule. Heubner's artery is the largest of the medial lenticulostriate arteries and supplies the anteromedial part of the head of the caudate and anteroinferior internal capsule. The medial LSA' s (indicated in dark red) arise from the anterior cerebral artery (usually the A1-segment). Their territory includes most of the basal ganglia. The lateral LSA' s (in orange) are deep penetrating arteries of the middle cerebral artery (MCA). The territory of the AChA is part of the hippocampus, the posterior limb of the internal capsule and extends upwards to an area lateral to the posterior part of the cella media. Anterior Choroideal artery (AchA in blue)).These branches supply the medulla oblongata (in blue) and the pons (in green). Branches from vertebral and basilar artery.The SCA territory is in the superior and tentorial surface of the cerebellum. Superior Cerebellar Artery (SCA in grey).The larger the PICA territory, the smaller the AICA and viceversa. The PICA territory is on the inferior occipital surface of the cerebellum and is in equilibrium with the territory of the AICA in purple, which is on the lateral side (1). Posterior Inferior Cerebellar Artery (PICA in blue).White Matter Lesions - Differential diagnosis.
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