CEREBRAL VASCULARIZATION

Arterial Blood Supply of the Brain

Derived from:
- Internal carotid artery:
to anterior 2/3 of the cerebral hemispheres
- Vertebral artery:
to the remaining posterior and medial regions of
the hemispheres, most of the diencephalon,
brainstem, cerebellum, and cervical spinal cord.
Arteries of the brain lie in the subarachnoid space

Anastomosis
The carotid and vertebral-basilar are anatomically
interconnected with each other, and with their
counterparts in the opposite site, through the circle of
Willis.
These circle usually cannot carry enough blood flow
to maintain adequate cerebral circulation if either a
carotid or a vertebral artery is suddenly blocked.

Circulus arteriosus Willis

1.
2.
3.
4.
5.
6.

Basilar
Posterior cerebral
Posterior communicating
Internal carotid
Anterior cerebral
Anterior communicating

Branches of Internal Carotid Artery

cavernous part
- cavernous
- hypophyseal
- meningeal

cerebral part
- ophthalmic

- anterior cerebral
- middle cerebral
- anterior choroid
to: globus pallidus, caudate
nucleus, amygdala, hypothalamus,
red nucleus, substansia nigra,
capsula interna (post. limb), optic
radiation, hippocampus.
- posterior communicating

Internal carotid artery in the cavernous

sinus

Anterior Cerebral Artery

Areas supplied by anterior cerebral artery:

Septal area

Primary motor cortex for legs, foots, urinary bladder

Additional motor planning areas in the medial frontal lobe anterior

to precentral gyrus

Most of the corpus callosum except its posterior part

Middle Cerebral Artery

Central branches: Lenticulostriate artery
Through: anterior perforate substance
To:
lentiform nucleus, caudate nucleus and internal capsule
Cortical branches:
Superior branch to:

Primary motor cortex for face and arm

Brocas area
Frontal eye fields (for looking at eye movements to the
opposite site)
Primary somatosensory cortex for face & arm
Parts of lateral frontal & parietal lobe for 3-D visual
perceptions and for ability to interpret & express emotion

Middle Cerebral Artery

Cortical branches (cont.)
Inferior branches to
Wernicks area
Parts of posterior parietal lobe for 3-D visual
perceptions and for ability to interpret & express
emotion
Optic radiation particularly fibers that represent
information from the contralateral superior
quadrants of the visual field

Outer surface of hemispherium showing areas

supplied by cerebral arteries

Medial surface

Branches of Vertebral & Basilar arteries

Vertebral:
- posterior & anterior spinal
- posterior inferior cerebellar

Basilar:
- pontine
- labyrinthine
- anterior inferior cerebellar
- superior cerebellar
- posterior cerebral
- posterior communicating

Areas supplied by vertebral-basilar

arteries
Rostral midbrain:
- Pyramidal tract (PT), superior cerebellar peduncle,
n. III nucleus, medial longitudinal fasciculus (MLF),
reticular formation (RF)
Mid pons:
- MLF, RF, PT, middle cerebellar peduncle (MCP),
trigeminal sensory & motor nuclei

Areas supplied by vertebral-basilar arteries

(cont.)
Caudal pons:
- n. VI nucleus, motor fibers n. VII, lateral gaze center, PT
- n. VII nucleus, MCP, descending tract nucleus n. V,
spinothalamic tract (ST), vestibular & cochlear nuclei

Rostral medulla:
- n. XII nucleus, PT, medial lemniscus
- nucleus ambiguus, n. IX & X, descending tract nucleus n.
V, ST, Vestibular nuclei, Inferior cerebellar peduncle

Structures supplied by posterior

cerebral artery
- Diencephalon
- Midbrain
- Optic radiation & striate cortex (primary visual
cortex)
- Splenium of the corpus callosum
- Hippocampal formation & the posterior of fornix
(important for new declarative memory)

Cerebral Blood flow

Every minute,
- 50
ml/100 g/min
- about 600-700 ml of blood flow through the
carotid arteries and their branches
- about 100-200 ml flow through the vertebralbasilar system.

Cerebral Blood flow

Cerebral blood flow constant despite variation in blood
pressure (65-140 mm Hg).
Below this range cbf decrease
Above cbf increase
Control by sympathetic in subarachnoid space and by
adrenegic intrinsic inside the brain
CO2 and O2 also important
Intracranial pressure & cbf complex autoreg

Blood-Brain Barrier
Located at capillary endothel within brain, except
circumventric. system
Depends on the tight junction between endothel and
a relative lack of transport
Function
Protect brain from circulating substance
Selective transport of substances by specialized transport
system
Metabolism & modification of blood or brain borne substance

Atheromatous plaques
Atheromatous plaques tend to form at branchings and
curves of the cerebral arteries.
In the carotid circulation the most frequent sites:
- in the internal carotid artery at its origin
- in the stem MCA or its bifurcation into superior
and inferior divisions
- in the ACA as it curves backwards over the corpus
callosum.

Emboli
Emboli tend to enter the carotid circulation far more
frequently than they enter the vertebral circulation
Large emboli carried up the carotid tend to be swept into
the MCA --> prone to getting stuck at its branches in the
Sylvian fissure
Emboli can also lodge in one of the major cortical branches
of MCA as well as in the smaller branches

Lenticulostriate arteries
Small diameter arteries originate as right angle branches of
MCA.
Particularly susceptible to damage from hypertension.
Rupture of the artery produces an intracerebral
hemorrhage, initially centered in the region they supply
Occlusion produces a lacunar infarct.
--> leads to stereotyped stroke syndromes.

Lenticulostriate arteries
Hemorrhage:
- may remain localized to the putamen (and caudate)
- may involve neighboring structures (internal caps.etc)
- may rupture into ventricular system
Lacunar infarct:
- may have serious functional consequences if they involve
internal capsule
- may silent if they involve small region of white matter or
basal ganglia.

Paramedian vessels supplying the medial parts of the

brainstem are at risk for hypertensive damage, particularly
in the pons.
Large pontine hemorrhages involve the corticospinal tract
and reticular formation bilaterally.
Pontine lacunar infarcts may also damage the corticospinal
tracts.

Penetrating cerebellar vessels are also at risk for

hypertensive hemorrhage, with bleeding often occuring
near the dentate nucleus
--> deficits related to the cerebellum such as limb ataxia.
It may also affect brainstem function by compression or by
rupture into the fourth ventricle

Arterial Blood Supply of the spinal cord

1. Posterior & anterior spinal arteries
2. Spinal branches of vertebral, deep cervical,
intercostal and lumbar arteries

Blood supply of the

meninx
Blood Supply
anterior, middle & posterior meningeal
arteries

Blood supply to the cerebral hemisphere

Comes from cortical branches of the:

- ant.or, middle & post.or cerebral arteries
Subarachnoid vessels pass into subpial space --> enter
the cortex perpendicularly and divide: --> long &
short ramies
Long branches penetrate white matter 3-4 cm without
anastomosing --> terminal arteries
Short branches to cortex & makes anastomoses

Dural venous sinuses

Blood-filled spaces situated between
layers of dura mater:
Superior & inferior, straight, transverse,
sigmoid, and occipital sinuses
- Confluens of sinuses
- Cavernous sinuses
- Superior and inferior petrosal sinuses