Recurrent artery of Heubner

Last revised by Francis Deng on 5 Dec 2023

Recurrent artery of Heubner, also known as the medial striate artery or long central artery, is the largest perforating branch from the proximal anterior cerebral artery (ACA) and is the only one routinely seen on angiography.

The origin is from the anterior cerebral artery at the A1-A2 junction (level of the anterior communicating artery) or within a few millimeters in the proximal A2 segment in 90% of cases 10. The specific distribution varies by study 8,9. The remainder originate from the A1 segment. Rarely, it can have a common origin with the orbitofrontal artery, which is otherwise usually the second branch of the A2 segment 5.

The artery then curves back sharply on itself (hence its name), paralleling the A1 and is at risk during anterior communicating artery aneurysm clipping (see case 1).

The recurrent artery of Heubner provides vascular supply mainly to the following brain structures 8:

It may be absent in 3% or duplicated in 12% of individuals. In some patients it may be triplicated 9 or even quadruplicated 8

It is named after Johann Otto Leonhard Heubner, a German pediatrician (1843-1926), who first described this vessel in 1872 7.

Clinical manifestations of occlusion include

  • unilateral

    • weakness contralateral arm

    • weakness contralateral face

    • dysarthria

    • hemichorea

  • bilateral: akinetic mutism

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Cases and figures

  • Figure 1: anterior circle of Willis
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  • Case 1: infarct
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  • Case 2: infarct
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  • Case 3: infarct
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