What is the circulation distribution of the left anterior Centrum semiovale?

Vascular Supply of the Left Anterior Centrum Semiovale

The left anterior centrum semiovale is primarily supplied by the perforating medullary branches from the superficial (pial) middle cerebral artery system.1

Anatomical Overview

The centrum semiovale represents the core of the hemispheric white matter and receives its blood supply through a specific vascular network:

• Primary Supply: Perforating medullary branches from the superficial middle cerebral artery (MCA) system 1
• Direction of Flow: These branches course from the cortical surface toward the lateral ventricles 1
• Territory Classification: The centrum semiovale falls within the "perforating MB territory" (medullary branches territory) in the classification of subcortical infarcts in the carotid system 1

Vascular Architecture

The vascular supply to the centrum semiovale has several important characteristics:

• Watershed Area: The anterior centrum semiovale represents a watershed zone between different vascular territories, making it vulnerable to hemodynamic compromise
• Deep White Matter Location: Located between the cortical gray matter and deep structures, receiving terminal branches with limited collateral supply
• Anatomical Sampling: When studying vascular pathology, sampling of fixed brains should follow protocols that include anterior centrum semiovale blocks 2

Clinical Significance

Understanding the vascular supply of the centrum semiovale is important for several reasons:

• Stroke Patterns: Infarcts in the centrum semiovale can be classified into two main types:

  • Large infarcts: Associated with severe disease of the ipsilateral carotid artery 1
  • Small round/ovoid infarcts: Associated with hypertension or diabetes, often presenting with "lacunar syndromes" 1

• Neurological Manifestations: Lesions in this area can present with various symptoms:

  • Motor deficits due to involvement of pyramidal tract fibers 3
  • Rare presentations such as hemichorea have been reported with centrum semiovale infarction 4

• Imaging Findings: On MRI, pathology in this region may appear as:

  • High signal areas on T2-weighted images extending along white matter tracts 3
  • Abnormal diffusion characteristics on diffusion-weighted imaging 3
  • Visible perivascular spaces that may correlate with underlying pathology 5

Pathological Considerations

The centrum semiovale is vulnerable to several pathological processes:

• Small Vessel Disease: Both hypertensive small vessel disease and cerebral amyloid angiopathy can affect this region 5
• Wallerian Degeneration: Following infarction, secondary degeneration can occur along pyramidal tracts 3
• Perivascular Space Changes: Enlarged perivascular spaces in the centrum semiovale may be markers of underlying vascular pathology 5

Diagnostic Implications

When evaluating pathology in the left anterior centrum semiovale:

• MRI Protocols: Should include sequences that can visualize both the parenchyma and vascular structures
• Diffusion Imaging: Helpful in determining acute ischemia and characterizing white matter tract integrity 3
• Consideration of Watershed Vulnerability: This region is susceptible to hypoperfusion during systemic hemodynamic compromise

Understanding this vascular anatomy is crucial for accurate interpretation of neuroimaging findings and appropriate management of cerebrovascular disease affecting this region.