INTRODUCTION

About 18% of the total blood volume in the body

circulates in the brain, which accounts for about

2% of the body weight.
Loss of consciousness occurs in less than 15

seconds after blood flow to the brain has stopped, and irreparable damage to the brain tissue occurs within 5 minutes.

INTRODUCTION
Cerebrovascular disease or stroke, occurs as a result

of vascular compromise or haemorrhage and is one of the most frequent sources of neurologic disability.
Nearly half of the admissions to many busy neurologic

services are because of strokes.

Cerebrovascular disease is the third most common

cause of death in industrialized societies.

Arteries of brain
Two sources

Internal carotid artery: supplies anterior 2/3 of cerebral hemisphere and parts of diencephalon Vertebral artery: supplies postterior 1/3 of cerebral hemisphere and parts of diencephalon, brain stem and cerebellum

INTRODUCTION

 The greater part of the of the

brain is supplied by Circle of Willis Formed by four large arteries : 1.Two internal carotid arteries 2. two vertebral arteries Int. carotid arteries give off : Two anterior cerebral arteries Two middle cerebral arteries Vertebral unites to form Basilar artery ends by dividing into Two posterior cerebral arteries

Circle of Willis (circulos arteriosus)

The circle of Willis is a confluence of vessels that

gives rise to all of the major cerebral arteries. It is fed by the paired internal carotid arteries and the basilar artery. When the circle is complete, it contains a posterior communicating artery on each side and an anterior communicating artery. The circle of Willis shows many variations among individuals.

 The two anterior cerebral

arteries are connected to each other by anterior communicating artery The posterior cerebral arteries are connected to the internal carotids by posterior communicating arteries Basilar artery is formed by the union of vertebral arteries Vertebral arteries arise from the first parts of the subclavian arteries and go to the cranium through the foramina of the transverse processes of the cervical vertebrae; enter the cranium through the foramen magnum They join to form the basilar artery

SUMMARY

The CIRCLE OF WILLIS is therefore formed by 2 internal carotid arteries 2 anterior cerebral arteries 2 posterior cerebral arteries 1 anterior communicating artery 2 posterior communicating arteries ` 1 Basilar artery

Cerebral arterial circle ( circle of Willis )

Formation: formed by

anterior communicating artery, both anterior cerebral arteries, internal carotid arteries, posterior communicating arteries, and posterior cerebral arteries Position: lies on sella turcica around optic chiasma, tuber cinereum and mamillary bodies

CIRCLE OF WILLIS
1 Vertebral artery 2 Ant. Inf. Cerebellar Art. 3 Basilar artery 4 Superior cerebellar artery 5 Posterior cerebral artery (PCA) 6 Posterior communicating artery 7 Middle cerebral artery (MCA) 8 Int. carotid art. (ICA) 9 Opthalmic artery 10 Anterior cerebral artery (ACA) 11 Anterior communicating artery 12 Hypothalamic artery 13 Anterior choroidal artery

INTERNAL CAROTID ARTERY

Arises from the COMMON CAROTID ARTERY
Enters skull through carotid canal in the temporal

bones (petrous) Passes anteromedially through the cavernous sinus divides at medial end of the lateral sulcus
anterior and middle cerebral arteries

anterior circulation of the brain

Branches of Int. Carotid Artery

Anterior cerebral arteries smaller terminal branch of the ICA enters longitudinal fissure connected to the opposite anterior cerebral artery by anterior communicating artery (part of the CoW) central branch supply deep masses of gray matter w/in the cerebral hemisphere Supply:

cortical branches supply all medial surface of cerebral cortex up to parieto-occipital sulcus corpus callosum approximately 1 inch of the frontal and parietal cortex on the superior aspect of their lateral surface (this include the leg area of the precentral gyrus) anterior portions of the basal ganglia and internal capsule

Anterior cerebral artery

Joined the fellow of the opposite side by the anterior communicating artery Cortical branches: supply all medial surface of the cerebral cortex as far back as the parietooccipital sulcus and superior border of the suprolateral surface of the cerebral hemisphere Central branches: supply caudate nucleus, anterior part of lentiform nucleus and anterior limb of internal capsule

Branches of Int. Carotid Artery

Middle Cerebral Arteries: largest branch. runs laterally in the lateral sulcus . cortical branches supply entire lateral surface of the hemisphere EXCEPT
area supplied by anterior cerebral artery inferolateral surface supplied by posterior cerebral artery occipital pole

central branch supply deep masses of gray matter within the

cerebral hemisphere Supply:

cortical branches supply all medial surface of cerebral cortex up to parieto-occipital sulcus corpus callosum approximately 1 inch of the frontal and parietal cortex on the superior aspect of their lateral surface (this include the leg area of the precentral gyrus) anterior portions of the basal ganglia and internal capsule

Middle cerebral artery

Cortical branches: supply most of superolateral surface of cerebral hemisphere and insular lobe Central branches: supply lentiform and caudate nuclei, genu and posterior limb of internal capsule (lenticulostriate artery)

Middle Cerebral Arteries: branches

Ophthalmic artery enters orbit through optic canal, below and lateral to optic nerve supplies the eye, including retina and optic nerve Posterior communicating artery runs backward to join posterior cerebral artery at interpeduncular fossa

deep depression on inferior of midbrain between cerebral peduncles part of the circle of Willis

Choroidal artery enter inferior horn of lateral ventricle to supply choroid plexus branches may help supply the optic tract, LGB, internal capsule and crus cerebri

VERTEBRAL ARTERY
Branch of the 1st part of the subclavian artery ascends the neck through the transverse foramina of upper

6 cervical vertebrae Enters skull through foramen magnum Cranial branches

meningeal arteries

anterior and posterior spinal arteries

posteroinferior cerebellar artery largest branch of the vertebral artery and supplies parts of the cerebellum and the dorsolateral portion of the rostral medulla Occlusion: lateral medullary syndrome medullary arteries along with posteroinferior cerebellar artery, supply most of the medulla

Branches contd.
At lower border of pons, vertebral arteries unite to form

the BASILAR ARTERY

ascends along the ventral midline of the pons and

terminates near the rostral border of pons by dividing into 2 posterior cerebral arteries Branches: branches to pons, cerebellum, internal ear

labyrinthine artery: follows the course o the CN VIII and supplies inner ear anterior inferior cerebellar artery: supplies part of the pons and the anterior and inferior regions of the cerebellum superior cerebellar artery: supplies part of the rostral pons and superior region of the cerebellum pontine branches : supply most of pons

Branches contd.

Posterior cerebral arteries formed by the terminal bifurcation of the basilar artery anastomoses with the posterior communicating artery in the Circle of Willis Supply: lateral surface of the hemisphere occipital pole and inferior temporal lobe medial surface of the hemisphere occipital lobe and posterior 2/3 of temporal lobe

Posterior cerebral artery Cortical branches: supply medial and inferior surfaces of temporal lobe and occipital lobe Central branches: supply dorsal thalamus, medial and lateral geniculate bodies, hypothalamus and subthalamus

VENOUS DRAINAGE OF BRAIN

Veins of the brain have no muscular tissue in the wall

and no valves Venous sinuses located between 2 layers of the dura superficial and deep veins of the brain drain into the dural venous sinuses (which in turn drain into the internal jugular veins) The venous blood from the deep areas of the brain is collected into channels called the venous sinuses.

VENOUS DRAINAGE
The venous drainage of the brain and

coverings includes: the veins of the brain itself, the dural venous sinuses, the dura's meningeal veins, and the diploic veins between the tables of the skull.

VENOUS DRAINAGE OF BRAIN

Superficial veins drain the cortex and the more superficial hemispheric white mater mainly into the superior sagittal and cavernous sinuses Deep or internal veins drain the deep hemispheric white mater and basal ganglia into the 2 internal cerebral veins w/c unite to form the great cerebral vein Great cerebral vein formed by the union of 2 internal cerebral veins and drains into the straight sinus

Veins of brain
Superficial cerebral veins Drain blood from cortex and subcortical medullary substance and empty into adjacent sinuses of dura mater

Veins of brain
Deep cerebral veins:

drain deeper parts of hemispheres, basal nuclei, internal capsule, diencephalon and choroid plexus, ultimately form great cerebral vein which enter straight sinus

 The dural venous sinuses of

the brain are formed by layers of dura mater lined by endothelium. The main venous sinuses are : 1 superior sagittal sinus 1 inferior sagittal sinus 1 straight sinus 2 transverse sinus or lateral sinuses 2 sigmoid sinuses The sigmoid sinuses situated close to the mastoid air sinuses continue as internal jugular veins