From the Research
Left subcortical hemorrhagic CVAs typically result from rupture of the lenticulostriate arteries, which are small perforating branches of the middle cerebral artery. These arteries supply blood to deep brain structures including the basal ganglia, internal capsule, and thalamus. When these vessels rupture, they cause bleeding into the subcortical regions of the brain, particularly affecting structures like the putamen, caudate nucleus, and thalamus. The lenticulostriate arteries are particularly vulnerable to damage from chronic hypertension, which causes lipohyalinosis (a degenerative process affecting small vessel walls) and microaneurysm formation, as described in a study published in 2020 1.
Some key points to consider include:
- The lenticulostriate arteries consist of medial, intermediate, and lateral branches, which perfuse different parts of the basal ganglia and internal capsule 1.
- Other arteries that may be involved in left subcortical hemorrhages include the thalamoperforating arteries (branches of the posterior cerebral artery) and the anterior choroidal artery (a branch of the internal carotid artery) 1.
- The presentation of these hemorrhages typically includes contralateral motor deficits, sensory loss, and sometimes language deficits if they extend to disrupt language pathways in the left hemisphere.
- A more recent study published in 2023 found that the length of the lenticulostriate artery and the presence of middle cerebral artery plaque are predictors of early neurological deterioration in single subcortical infarction 2.
Overall, the lenticulostriate arteries are the most commonly implicated arteries in left subcortical hemorrhagic CVAs, and their rupture can have significant consequences for morbidity, mortality, and quality of life.