Cerebral Circulation

„ Brain needs a lot of nutrients

… Oxygen
… Glucose

„ Interrupt
… 5s = unconscious
…5 minutes = brain damage

Supply
„ Internal Carotid Arteries
„ Vertebral Arteries
„ Basilar Arteries

Internal Carotid
„ Common->
… Internal
… External
„ 4 segments
… Cervical
… Intrapetrosal
„ Temporal bone
… Intracavernous
„ Cavernous sinus
… Cerebral

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 Internal Carotid
„ Feeds branches:
… Ophthalmic
„ Optic nerve &
retina
„ Anastomotic
connections with
external carotid
… Bypass for
internal carotid
occlusion

Internal Carotid
„ Feeds branches:
… Anterior choroidal
„ Optic tract,
cerebral
peduncles, LGN,
posterior limbic
system
„ Small diameter
… Prone to
occlusion by
thrombus

Internal Carotid
„ Feeds branches:
… Anterior cerebral
„ Left and right
connected by anterior
communicating artery
„ Medial surface of
cerebral hemisphere
„ Occlusion
… Contralateral lower
extremity
ƒ Weakness
ƒ Paralysis
ƒ Sensory deficit

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 Anterior Cerebral
„ Medial striate
… Striatum

„ Orbitofrontal
… Orbitalgyri
… Septal area
… Displaced by
tumors
„ Angiogram

Anterior Cerebral
„ Frontopolar
… Frontal lobe
„ Callosomarginal
… Parietal lobe
„ Pericallosal
… Parietal lobe

Internal Carotid
„ Feeds branches:
… Middle cerebral
„ Primary and
association motor &
somatosensory
„ Prefrontal cortex
„ Broca’s and
Wernicke’s
„ Occlusion
… Contralteral
paralysis
… Contralateral
somatosensory loss
… Aphasia
… Changes in
personality and
thinking

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 Middle Cerebral Artery
„ Cortical
… Frontal
„ Rolandic
… S1 & M1
… Temporal
„ Angular
… Parietal
„ Central
… Basal ganglia

Internal Carotid
„ Feeds branches:
… Posterior
communicating
„ Interior carotid to
posterior cerebral

Vertebral Artery
„ Off of subclavian
„ Enters through foramen
magnum
„ Internal surface of medulla
„ 2 vertebrals join at pons to
form basilar artery
„ Posterior spinal
… Posterior medulla, posterior
column and dorsal horn
„ Anterior spinal
… Ventral medulla, anterior 2/3
of spinal cord
… Occlusion
„ Paralysis below spinal
location
„ Posterior inferior cerebellar
artery
… Olive, inferior cerebellum, part
of medulla, choroid plexus of
4th ventricle, deep cerebellar
nuclei
… Occlusion
„ Lateral medullary syndrome

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 Basilar Artery
„ Paramedian „ Long circumferential
penetrating … Anteriorinferior
… Brainstem cerebellar
„ Inferior cerebellum,
„ Short circumferential tegmentum
… Lateral pons … Superior cerebellar
„ Long circumferential artery
… Auditory artery „ Superior cerebellum,
tegmentum, inferior
„ Inner ear and root of colliculus
facial nerve
„ Occlusion: deafness

Basilar Artery
„ Posterior cerebral
… Medial occipital lobe,
temporal lobe, caudal
parietal lobe, corpus
callosum
… Occlusion
„ Homonymous
hemianopia
… Spares macular
vision
ƒ Occipital
pole
ƒ Middle
cerebral
artery
„ Bilateral
… Prosopagnosia
… Achromatopsia
… Increased intracranial
pressure
„ Compresses
„ Cortical blindness

Circle of Willis
„ Anterior, middle
and posterior
cerebral arteries
„ Anterior and
posterior
communicating
arteries
„ Collateral
circulation
„ Really only a circle
in 20% of people

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 Cerebral vasculature
„ Arteries
… Thinner walls
… Lack of external elastics
… Astrocyte processes are part of walls
„ BBB
… Surrounded by arachnoid/pia membranes
„ Capillaries
… Surrounded by astrocyte processes
„ Veins
… Thinner walls
… No valves/muscles
„ Allow flow in either direction
… Reversal of flow in occlusion

Cerebral Venous Drainage

„ Superficial
drainage
… Superior cerebral
„ Superior sagittal
sinus
… Middle cerebral
„ Cavernous sinus
… Inferior cerebral
„ Cavernous and
transverse sinuses

Cerebral Venous Drainage

„ Internal Cerebral
… Thalamostriate vein
… Septal vein
„ Basal Vein of
Rosenthal
… Base of brain
„ Great Cerebral Vein
of Galen
… Internal cerebral &
basal veins
… Straight sinus

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Strokes
„ Infarcts
… Occlusions
„ Thrombosis or embolism
„ Hemorrhage
„ Aneurysm
„ Characterized by abrupt onset of a neurological
deficit
„ Small strokes can add up over time so the
damage is less noticeable.

Middle Cerebral Artery Syndrome

Middle Cerebral Artery Syndrome

„ Contralateral
hemiplegia/hemiparesis
… Face/upper extremities
„ Contralateral kinesthia
loss
„ Contralateral visual field
defect
… Optic radiation damage:
lose quadrant or hemifield
„ Contralateral gaze
paralysis
… FEF involvement
„ Transient (1-2 days)
„ Aphasia
… If left hemisphere
„ Contralateral neglect
„ Spatial disorders
… If right hemisphere
„ Gerstmann syndrome
… Finger agnosia, acalculia,
right-left disorientation

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 Anterior Cerebral Artery Syndrome

Anterior Cerebral Artery Syndrome

„ Unilateral „ Bilateral
… Contralateral … Unilateral signs plus
hemiplegia/hemiparesis involvement of
„ Lower extremity „ Orbitofrontal cortex, limbic
… Contralateral sensory system, supplemental motor
cortex, cingulate gyrus
deficit
… Loss of initiative/spontaneity
„ Lower extremity
… Motor aphasia … Profound apathy
„ If left hemisphere … Memory/emotional
disturbances
… Akinetic mutism
… Disturbance in gait & posture

Hemorrhage
„ Hypertension „ Signs
„ Aneurysm … Sudden onset of
„ Headache
„ Arteriovenous „ Neck stiffness
malformation „ Loss of consciousness
„ Head trauma
„ Bleeding disorder

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Aneurysm

Arteriovenous malformation