Anatomical Vulnerability and Vascular Supply Mechanisms in Stroke

Pathophysiological Mechanisms

The gangliocapsular region (basal ganglia and internal capsule) is supplied by lenticulostriate arteries, which are small-caliber end arteries particularly vulnerable to lipohyalinosis from hypertension and embolic occlusion, according to the American Heart Association 1, 2
Large MCA territory infarctions commonly involve both cortex and gangliocapsular structures, resulting in severe deficits, as reported by the American Stroke Association 1
Small infarctions typically involve basal ganglia and deep white matter within the anterior circulation, with a higher likelihood of causing severe deficits when involving cortex, basal ganglia, and internal capsule together, as stated by the American Heart Association 2, 1

Lesions involving cortex, basal ganglia, and internal capsule together are more likely to cause severe deficits (hemiplegia) than isolated involvement, with a significant impact on patient outcomes, as noted by the American Stroke Association 1