Cerebellar arteries !

The three cerebellar arteries on each side feed the cerebellum and parts of the brainstem, which control balance and coordination.

Official name: Superior cerebellar artery

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What it is

Three pairs of arteries from the vertebral and basilar arteries.

What it does

Feed the cerebellum and parts of the brainstem; a PICA stroke causes the lateral medullary syndrome.

Key facts

Origin: SCA and AICA from the basilar; PICA from the vertebral
Branches: Hemispheric and vermian branches; AICA gives the labyrinthine artery (often)
Supplies: PICA: lateral medulla, inferior vermis, tonsil, fourth-ventricle choroid plexus (lateral medullary syndrome); AICA: anterior inferior cerebellum, middle peduncle, lower lateral pons, inner ear; SCA: upper cerebellum, superior peduncle, inferior colliculus

Relations

Course: PICA leaves the vertebral artery beside the olive and winds round the medulla to the lower cerebellum; AICA leaves the lower basilar for the cerebellopontine angle; the superior cerebellar artery leaves the upper basilar and winds round the pons to the upper surface
Above: Superior cerebellar artery: separated from the posterior cerebral artery by the oculomotor nerve; a loop can touch the trigeminal nerve root
Lateral: AICA: the facial and vestibulocochlear nerves at the cerebellopontine angle, often with a loop toward the internal acoustic meatus
Below: PICA: rootlets of the glossopharyngeal, vagus, accessory and hypoglossal nerves, and the cerebellar tonsil

How to find it

None can be felt. The superior cerebellar artery runs just below the tentorium, under the oculomotor nerve; the anterior inferior artery loops near the facial and vestibulocochlear nerves at the internal acoustic meatus; the posterior inferior artery winds around the medulla among the lower cranial nerves. The retrosigmoid approach exposes all three.

Examination

HINTS in acute continuous vertigo: a normal head impulse, nystagmus that changes direction or a skew deviation points to a central (stroke) cause
Same-side cerebellar signs: finger–nose and heel–shin ataxia, dysdiadochokinesia; truncal ataxia when sitting or standing

On imaging

Diffusion-weighted MRI is the test of choice; CT often misses early infarcts in the posterior fossa.

Clinical notes

A loop of the superior cerebellar artery pressing on the trigeminal root is the classic cause of trigeminal neuralgia; microvascular decompression moves it away
Vertebral artery dissection, sometimes after neck trauma or manipulation, often presents as a PICA-territory stroke with neck pain
Isolated vertigo can be the only sign of a cerebellar stroke

Anatomical variants

PICA is often small or absent, with AICA supplying its territory (AICA–PICA dominance)
PICA can arise outside the skull, below the foramen magnum

Memory aid

Wallenberg: "Don't PICA horse (hoarseness) that can't eat (dysphagia)".

Trigeminal neuralgia

Test yourself

Think of the answer, then tap the question to see it.

Which cerebellar artery is involved in lateral medullary (Wallenberg) syndrome, and what is the sensory pattern?

PICA (or the vertebral artery): loss of pain and temperature on the same side of the face and the opposite side of the body.

Why is there no limb weakness in Wallenberg syndrome?

The pyramids are spared; signs are vertigo, same-side Horner and ataxia, hoarseness and dysphagia (nucleus ambiguus).

How does an AICA stroke differ from a PICA stroke?

AICA gives a lateral pontine syndrome: similar, but with same-side facial weakness and hearing loss (labyrinthine branch).

Which cerebellar artery classically causes trigeminal neuralgia?

The superior cerebellar artery, whose loop presses on the trigeminal root; microvascular decompression moves it away.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): arteria superior cerebelli TA2 4563
Official Spanish (DeCS): Arterias cerebelosas superior, anteroinferior y posteroinferior
English (TA2): Superior cerebellar artery
Also called: arteria cerebellaris superior · sCA

Sources: Terminologia Anatomica (TA2); Neuroanatomy, Anterior Inferior Cerebellar Arteries; Neuroanatomy, Vertebrobasilar System.

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Representative model, for educational purposes only.

Cerebellar arteries highlighted on the Durgical 3D model