The angular artery is the most posterior M3 branch of the middle cerebral artery, supplying the angular gyrus (Brodmann area 39) at the posterior inferior parietal lobule — the junction of the temporal, parietal, and occipital lobes. The angular gyrus is dominant for reading, number processing, and spatial cognition. The angular artery typically exits the Sylvian fissure near the lateral sulcus terminus and runs over the inferior parietal convexity.
Infarction in the angular artery territory (dominant hemisphere) produces Gerstmann syndrome — the tetrad of agraphia, acalculia, finger agnosia, and right-left disorientation — along with alexia (reading impairment) from the angular gyrus destruction. The angular gyrus is the cortical convergence zone for multimodal association, and its damage produces a syndrome of disconnection from written language and number sense. The angular artery must be identified and preserved during posterior temporal and inferior parietal craniotomies for tumour and epilepsy surgery.
Embolic occlusion of the dominant angular artery produces angular gyrus infarction with the tetrad of Gerstmann syndrome: agraphia, acalculia, finger agnosia, and right-left disorientation; concomitant alexia from posterior angular gyrus involvement is often present; the syndrome localises the lesion to the dominant angular gyrus at the posterior inferior parietal lobule.
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