Cerebrovascular Review

Jobi Whiting, M.D.

Cerebral Blood Supply

Four vessels
– Paired internal carotid

arteries – Paired Vertebral Arteries

Join to form single basilar artery

Cerebral Blood supply

Dual Circulations
– Anterior  Bilateral internal carotid arteries

– Posterior  Bilateral vertebral arteries  Single basilar artery

Cerebral Blood Supply

Dual Circulations
– Anterior

Bilateral internal carotid arteries Bilateral vertebral arteries Single basilar artery Separated by tentorium

– Posterior

Cerebral Blood Source   Heart – 20% of cardiac output destined for brain Aortic Arch – First 3 major branches go to or send branches to intracranial space  Brachiocephalic (innominate) – First branch right common carotid artery   Left common carotid Left subclavien – First branch left vertebral artery .




face.Internal Carotid Artery  Paired arteries  Major source of anterior intracranial blood supply  Common carotid artery bifurcates @ level of C3C5 in neck – Internal carotid  No extracranial branches Supplies scalp. dura – External carotid  .

Internal Carotid Artery .

Internal Carotid Artery  Intracranial portion has several important branches – Opthalmic artery – Posterior communicating artery – T-junction bifurcation  Anterior cerebral artery  Middle cerebral artery .

Opthalmic Artery .

T-junction bifurcation of ICA Anterior cereb artery Middle Cerebral artery T-junction Bifurcation of ICA .

Anterior Cerebral Artery  Smaller of T-junction bifurcation branches  Courses medially to interhemispheric fissure  Veers superiorly & posteriorly into interhemispheric fissure to course over medial aspect of hemisphere .

Anterior Cerebral Artery .

Anterior Cerebral Artery .

Anterior Cerebral Artery CM PC A2 .

ACA Vascular Territory .

Middle Cerebral Artery  Larger branch of T-junction ICA bifurcation  Courses laterally into Sylvian Fissure  Supplies lateral hemisphere  Small perforating branches from horizontal portion feed deep subcortical structures – Lenticulostriate arteries .

Middle Cerebral Artery .

Middle Cerebral Artery .

Midddle Cerebral Artery M3 M4 M2 M1 .

MCA Vascular Territory .

Anterior Communicating Artery  Single artery connecting right and left anterior cerebral arteries  Represents major anastomotic site for anterior circulation  Part of Circle of Willis .

Anterior Communicating Artery .

Vertebral Artery  Posterior Circulation  Paired arteries  Major branches – Anterior spinal artery  Single midline artery fed from bilateral vertebral arteries Paired arteries – Posterior spinal arteries  – Posterior inferior cerebellar artery (PICA) .

Vertebral Artery .

Vertebral Arteries .


Basilar Artery  Single midline artery formed from junction of bilateral vertebral arteries  Courses superiorly and anteriorly over ventral aspect of pons  Multiple small perforating branches supplies pons .

Basilar Artery  Major branches – Anterior inferior cerebellar arteries (AICA) – Superior cerebellar arteries (SCA) – Posterior cerebellar arteries  Final branches from tip of basilar artery .

Basilar Artery .


Cerebellar arteries .

Posterior Cerebral Arteries      Final branches off tip of basilar artery Bilateral Major source of blood to midbrain and occipital lobe Course laterally and posteriorly around cerebral peduncles to occipital lobe Small perforating branches near midline to thalamus – thalamoperforators .

Posterior Cerebral Arteries .



PCA Vascular Territory .

Circle of Willis  Anastomotic system between distinct intracranial circulations  Connects right and left anterior circulations – Anterior communicating artery  Connects posterior and anterior circulations bilaterally – Posterior communicating arteries .


Circle of Willis .

Cerebral Venous Drainage  Superficial draining veins  Deep draining veins  Dural sinuses .


Deep Cerebral Veins .

Superficial Cerebral Veins .

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