Hemiplegia and Cerebrovascular Disease

Abstract

Hemiplegia in the aging patient is usually regarded as a stereotyped clinical event and the lesion producing it an equally stereotyped pathological disturbance. Much of this casual attitude toward this condition is probably due to the influence of Charcot's forceful and convincing manner of designating the so-called lenticulostriate branch of the middle cerebral circulation as “the artery of apoplexy”.

More extended and detailed studies by clinicians and pathologists have demonstrated no Greek simplicity in the problem of apoplexy. There are variations here as there are in other morbid processes in other organs.

BLOOD SUPPLY OF INTERNAL CAPSULE

The blood supply of the internal capsule and of the adjacent basal ganglia, which are almost invariably involved in the vascular lesion of hemiplegia, is by no means a settled matter. As pointed out by Alexander,¹ textbooks of anatomy are rather vague and perfunctory in describing this phase of cerebral circulation, and many still refer to a definite lenticulostriate artery as if it were a constant and clearly demonstrable structure.

Dismissing the concept of a single large “artery of apoplexy”, Alexander¹ demonstrated by an ingenious injection technic that the vulnerable internal capsule and the adjoining gray masses are supplied by a series of small arteries or arterioles which arise directly from the large vessels as these emerge from the circle of Willis. These small arteries are arranged in tiers or clusters and at right angles from the parent artery, and most of them penetrate the brain substance in the anterior perforated space. In. . .