Cerebral Blood Supply

Caucasus International University

2018
Review of Main Functional Areas
of Cerebral Cortex
Review of Main Functional Areas
of Cerebral Cortex
 Circle of Willis: Anterior and
Posterior Circulations
• The arterial supply to the cerebral hemispheres
is derived from the anterior circulation provided
by the bilaterally paired internal carotid
arteries, as well as by the posterior circulation
provided by the bilateral vertebral arteries
 Circle of Willis: Anterior and
Posterior Circulations
• The anterior circulation arises from the
common carotid arteries originating at the
aorta or brachiocephalic arteries;

• At the carotid bifurcation, the common carotid

splits, forming the internal carotid and
external carotid arteries.
 Circle of Willis:
Anterior and
Posterior Circulations
Circle of Willis: Anterior and
Posterior Circulations
 Circle of Willis
• These anterior and posterior circulations meet in
an anastomotic ring called the circle of Willis, from
which all major cerebral vessels arise;

• The circle of Willis provides abundant

opportunities for collateral flow;

• Anatomical variants are common, and a complete

full-caliber ring is present in only approximately
34% of individuals.
 Circle of Willis
• The main arteries supplying the cerebral
hemispheres are the anterior, middle, and
posterior cerebral arteries;

• The anterior cerebral arteries (ACAs) and

middle cerebral arteries (MCAs) are the
terminal branches of the internal carotid
arteries.
 Circle of Willis
• The posterior cerebral arteries (PCAs) arise
from the top of the basilar artery, which in turn
is formed by the convergence of the two
vertebral arteries;

• In addition to the posterior cerebral arteries,

several branches to the brainstem and
cerebellum arise from the vertebrobasilar
system
 Circle of Willis
• The anterior cerebral arteries anastomose
anteriorly at the anterior communicating artery
(AComm);

• The anterior and posterior circulations are linked

to each other via the posterior communicating
arteries (PComms), which connect the internal
carotids to the posterior cerebral arteries, thereby
joining the anterior and posterior circulations.
Circle of Willis
• The internal carotid artery has several named
segments during its course

• First comes the relatively vertical cervical

segment in the neck, followed by a sharp
horizontal bend as the internal carotid enters
the temporal bone as the petrous segment.
• Next comes the cavernous segment as the
internal carotid begins an S-shaped turn, also
known as the carotid siphon, within the
cavernous sinus;

• It then passes the anterior clinoid process to

pierce the dura and bends posteriorly to enter
the subarachnoid space as the supraclinoid,
or intracranial segment
 The main branches of the internal
carotid artery
The main branches of the supraclinoid internal
carotid are:
• Ophthalmic (provides the main blood
supply to the retina);
• Posterior communicating;
• Anterior choroidal;
• Anterior cerebral (ACA);
• Middle cerebral arteries (MCA).
 Anatomy and Vascular Territories of the
Three Main Cerebral Arteries
• The three main cerebral arteries (ACA, MCA, and PCA) give rise
to numerous branches that travel in the subarachnoid space
over the surface of the brain and into the sulci.

• Small, penetrating branches arise from these vessels to supply

the superficial portions of the brain, including the cortex and
underlying white matter.

• The deep structures of the brain, such as basal ganglia,

thalamus, and internal capsule, are supplied by small,
penetrating branches that arise from the initial segments of the
main cerebral arteries near the circle of Willis at the base of the
brain.
 Vascular Territories of the Superficial
Cerebral Structures
• The anterior cerebral artery passes forward to
travel in the interhemispheric fissure as it sweeps
back and over the corpus callosum;

• Two major branches commonly seen are the

pericallosal and callosomarginal arteries;

• The anterior cerebral artery supplies most of the

cortex on the anterior medial surface of the brain,
from the frontal to the anterior parietal lobes,
usually including the medial sensorimotor cortex.
The anterior cerebral artery
 The middle cerebral artery
• The middle cerebral artery turns laterally to enter the depths of the
Sylvian fissure.

• Within the Sylvian fissure it usually bifurcates into the superior division and
the inferior division. This is somewhat variable, and sometimes there are
three or even four main branches of the middle cerebral artery;

• The superior division supplies the cortex above the Sylvian fissure, including
the lateral frontal lobe and usually including the peri-Rolandic cortex;

• The inferior division supplies the cortex below the Sylvian fissure, including
the lateral temporal lobe and a variable portion of the parietal lobe;

• The middle cerebral artery thus supplies most of the cortex on the
dorsolateral convexity of the brain.
Superior and Inferior Divisions of the
Middle Cerebral Artery (MCA)
 The posterior cerebral artery
• The posterior cerebral artery curves back
after arising from the top of the basilar and
sends branches over the inferior and medial
temporal lobes and over the medial occipital
cortex;

• The posterior cerebral artery territory

therefore includes the inferior and medial
temporal and occipital cortex
The posterior cerebral artery
Regions of Cortex Supplied by the ACA, MCA, and PCA
 Vascular Territories of the Deep Cerebral
Structures
• The most important penetrating vessels at the
base of the brain are the lenticulostriate arteries;

• These small vessels arise from the initial portions

of the middle cerebral artery before it enters the
Sylvian fissure and they penetrate the anterior
perforated substance to supply large regions of
the basal ganglia and internal capsule.
 Vascular Territories of the Deep
Cerebral Structures
• The anterior choroidal artery arises from the
internal carotid artery. Its territory includes
portions of the globus pallidus, putamen,
thalamus, and the posterior limb of the internal
capsule extending up to the lateral ventricle;

• Thus, lacunar infarction in either the

lenticulostriate or anterior choroidal territories
often causes contralateral hemiparesis.
 Vascular Territories of the Deep
Cerebral Structures
• The recurrent artery of Heubner comes off the initial
portion of the anterior cerebral artery to supply portions
of the head of the caudate, anterior putamen, globus
pallidus, and internal capsule;

• Small, penetrating arteries that arise from the proximal

posterior cerebral arteries near the top of the basilar
artery include the thalamoperforator arteries (as well as
the thalamogeniculate and posterior choroidal arteries),
which supply the thalamus and sometimes extend to a
portion of the posterior limb of the internal capsule.
Vascular Territories of the Deep
Cerebral Structures
Vascular Territories of the Deep
Cerebral Structures
 Summary of Superficial and Deep
Blood Supply to the Cerebral Hemispheres
 Summary of Superficial and Deep
Blood Supply to the Cerebral Hemispheres
Major Clinical Syndromes of the MCA,
ACA, and PCA Territories
Major Clinical Syndromes - Left MCA
superior division
• Right face and arm
weakness of the upper
motor neuron type and a
nonfluent, or superior
Broca’s, aphasia. In some
cases here may also be
some right face and arm
cortical-type division
sensory loss.
Major Clinical Syndromes - Left MCA
inferior division
• Fluent, or Wernicke’s, aphasia
and a right visual field deficit.
There may also be some
• inferior right face and arm
cortical-type sensory loss. Motor
findings are usually absent, and
• division patients may initially
seem confused or crazy but
otherwise intact, unless carefully
• examined. Some mild right-sided
weakness may be present,
especially at the onset of
• symptoms.
Left MCA deep territory
• Right pure motor
hemiparesis of the
upper motor neuron
type. Larger infarcts
may produce “cortical”
deficits, such as aphasia
as well.
Left MCA stem
• Combination of the above,
with right hemiplegia, right
hemianesthesia, right
homonymous hemianopia,
and global aphasia.

• There is often a left gaze

preference, especially at the
onset, caused by damage to
left hemisphere cortical
areas important for driving
the eyes to the right.
Left ACA
• Left leg weakness of the
upper motor neuron type
and left leg cortical-type
sensory loss.
• Grasp reflex, frontal lobe
behavioral abnormalities,
and left hemineglect can
also be
• seen. Larger infarcts may
cause left hemiplegia.
 Left ACA
• Left leg weakness of the upper motor neuron type
and left leg cortical-type sensory loss.
• Grasp reflex, frontal lobe behavioral abnormalities,
and left hemineglect can also be seen. Larger infarcts
may cause left hemiplegia.
Left PCA
• Right homonymous
hemianopia. Extension to
the splenium of the
corpus callosum can
cause alexia without
agraphia. Larger infarcts,
including the thalamus
and internal capsule, may
cause aphasia, right
hemisensory loss, and
right hemiparesis.
 Left PCA
• Right homonymous hemianopia. Extension to the
splenium of the corpus callosum can cause alexia
without agraphia. Larger infarcts, including the
thalamus and internal capsule, may cause aphasia,
right hemisensory loss, and right hemiparesis.