Blood Supply of the Brain

and Spinal Cord

CHAPTER OBJECTIVES

To learn the areas of the

cerebral cortex and spinal
To review the main cord supplied by a To review the circle of
arteries and veins particular artery and to Willis as well as the blood
supplying the brain and understand the supply to the internal
spinal cord dysfunction that would capsule
result if the artery were
blocked
Internal Carotid Artery

begins at the bifurcation of the common carotid

artery
perforates the base of the skull by passing through
the carotid canal of the temporal bone.

perforating the dura mater.

enters the subarachnoid space by piercing the

arachnoid mater
divides into the anterior and middle cerebral
arteries
ARTERIES OF THE BRAIN
CEREBRAL PORTION
BRANCHES
• Opthalmic artery
• Posterior communicating artery
• Choroidal artery
• Anterior cerebral artery
• Middle cerebral artery
• Vertebral artery
BRANCHES OF CRANIAL
PORTION
• Meningeal branches
• Posterior spinal artery
• Anterior spinal artery
• Posterior inferior cerebellar
artery
• Medullary artery
BASILAR ARTERY
• Pontine arteries
• Labyrinthine artery
• Anterior inferior cerebellar
artery
• Superior cerebellary artery
• Posterior cerebral artery
 largest branch of the internal carotid,

join the posterior cerebral artery, supplies the “leg area” of the precentral gyrus.
thus forming part of the circle of Willis.
Frontal aspect of scalp, ethmoid &
frontal sinuses, dorsum of nose
Choroidal Artery
• The choroidal artery passes posteriorly close to the optic tract, enters the inferior
horn of the lateral ventricle, and ends in the choroid plexus.
• It gives off numerous small branches to surrounding structures, including the crus
cerebri, the lateral geniculate body, the optic tract, and the internal capsule.

Middle Cerebral Artery

• Cortical brancjhes: lateral surface of the hemisphere
• Entire motor area except the “leg area”
• Central branches: lentiform and caudate nuclei and internal capsule
Vertebral Artery
Cranial Portion
Meningeal portion
Posterior Spinal Artery
Anterior Spinal Artery
Posterior Inferior cerebellar
artery
Medullary arteries
• Bone and dura in the posterior cranial fossa
• From the vertebral artery or the posterior inferior cerebellar
artery
• Descends on anterior surface of medulla oblongata and spinal cord
• Embedded in the pia mater
• Reinforced by radicular arteries
• Largest branch of the vertebral artery
• Between the medulla and cerebellum
• Supplies vermis, central nuclei of cerebellum, cerebellar hemisphere
• Medulla oblongata and choroid plexus of fourth ventricle
• Distributed to the medulla oblongata
Basilar Artery

Formed by union of two vertebral arteries

Ascends in a groove in anterior surface of

pons
Divides into the two posterior cerebral
arteries
Basilar Artery
Branches
• enter substance of pons
Pontine arteries

• supplies the inner ear; arises as a branch of the anterior

Labyrinthine artery inferior cerebellar artery

• supplies anterior and inferior cerebellum; passes the pons

Anterior inferior cerebellar artery and medulla oblongata

• close to termination of basilar artery; supplies superior

Superior cerebellar artery cerebellum, pons, pineal glands, superior medullary velum

• temporal lobe, occipital lobe, thalamus, lentiform nucleus

Posterior cerebral artery
Posterior Cerebral Artery

Cortical Branch Central branches Choroidal branch

• Inferolateral and • Thalamus and • Supplies choroid

medial surface of lentiform nucleus plexus of lateral
temporal lobe, • Midbrain, pineal, ventricle
lateral and medial and medial • Choroid plexus of
surfaces of the geniculate bodies third ventricle
occipital lobe
• Visual cortex
Circle of Willis
Arteries to Specific Brain Areas

Middle cerebral Thalamus Midbrain

artery • Branches of posterior • Posterior cerebral,
• Corpus striatum and communicating superior cerebellar,
internal capsule artery, basilar artery, and basilar arteries
and posterior
cerebral arteries
Arteries to Specific Brain Areas

Pons Medulla oblongata Cerebellum

• Basilar and the • Vertebral, anterior and • Superior cerebellar,
anterior, inferior, and posterior spinal, anterior inferior
superior cerebellar posterior inferior cerebellar, and
arteries cerebellar, and basilar posterior inferior
arteries cerebellar arteries
Nerve Supply of Cerebral Arteries
Sympathetic postganglionic nerve fibers
Derived from superior cervical sympathetic ganglion
Vasoconstriction of cerebral arteries
Affected by carbon dioxide, hydrogen ions, oxygen
Vasodilation or vasoconstriction
Veins of the Brain
pierce arachnoid mater and meningeal layer of dura mater and drain
into cranial venous sinuses

External Cerebral Veins Internal cerebral vein Veins of specific brain areas

• Superior cerebral vein: lateral • Formed by thalamostriate • Midbrain: basal or great

surface of cerebral
hemisphere, empty into
superior sagittal sinus
• Superior middle cerebral vein:
drains lateral surface of
cerebral hemisphere, empties
into cavernous sinus
• Deep middle cerebral vein:
drains insula and joined by
anterior cerebral and striate
veins to form the basal vein
vein and choroid vein cerebral vein
• Forms great cerebral vein • Pons: basal vein, cerebellar
• Empties into straight sinus veins
• Medulla oblongata: spinal
veins
• Cerebellum: great cerebral
vein
Blood Supply of the Spinal Cord

PSA
• Posterior 1/3 of spinal cord
• Small in upper thoracic region
• T1 – T3 vulnerable to ischemia

ASA
• Anterior 2/3 of spinal cord
• Extremely small in upper and lower
thoracic segments
• T4 – L1 vulnerable to ischemia
Blood Supply of the Spinal Cord
Segmental Spinal Artery
- Arteries outside vertebral
column
- Deep cervical intercostal & lumbar
arteries
- Feeder arteries
- Great anterior medullary artery of
Adamkiewicz @T11 – L2
- Main blood to lower 2/3 spinal
cord
Cerebrovascular Accidents or Stroke
• 3rd leading cause of morbidity &
death

• Internal capsule ascending &

descending pathways

• Arterial hemorrhage or
thrombosis
Blood Supply of the
Brain
• Branches anastomose to form
the Circle of Willis
Cerebrovascular Resistance
• Contributing factors
• Sympathetic post ganglionic nerve fiber
• Norepinephrine

• Normal cerebral blood flow

• - 50 – 60 mL/ 100 g of brain/ minute
• Vasodilator influence
• increase in carbon dioxide or hydrogen ion concentration
• reduction in oxygen level
Clinical Notes
Cerebral Ischemia - Loss of consciousness
- 4 minute mark
- Most common cause
- Cardiac arrest due to coronary thrombosis
Interruption of Cerebral Circulation

Common
Deficit dependent on: carotid
1. Size of artery
2. Collateral circulation
3. Brain involved
Cerebral Artery Occlusions
Cerebral Artery Occlusions
- Ipsilateral pain, temperature
sensory loss of face,
contralateral for body
- Hemianopia or complete
cortical blindness
- Ipsilateral loss of gag reflex,
dysphagia, hoarseness
(glossopharyngeal & vagus
nerve)
- MCA occlusion
- Contralateral hemiparesis &
hemianesthesia
- Partial or complete loss of
sight on ipsilateral side
- vertigo, nystagmus,
nausea and vomitinig
- Ipsilateral Horner
syndrome
- Ipsilateral ataxia & other
cerebellar signs
- Unilateral & bilateral
hemiparesis
- coma
Impairment of Cerebral Blood Flow
Alterations in blood pressure
Postural hypotension

Physical & psychological shock

Polycythemia vera

Carotid sinus syndrome

• Sensitivity of carotid sinus
• Reflex slowing of heart rate and fall of blood pressure
• Cardioinhibitory and vasomotor center
Impairment of Cerebral Blood Flow
Alterations in blood pressure

Diseases of the heart

•Coronary thrombosis, auricular fibrillation or
heart block
•Marked fall in cardiac output
•Severe fall in arterial blood pressure and
reduction in cerebral blood flow
Impairment of Cerebral Blood Flow
Diseases of Arterial Wall

Atherosclerosis VS arteriosclerosis
Impairment of Cerebral Blood Flow
Blockage of the Arterial Lumen
thrombus formation
• atheromatous plaque in ICA, Common carotid artery and vertebral
artery
• endocarditis: mitral or aortic valve
• risk factors
• oral contraceptives (estrogen - progesterone combination)

fat globules
• fractures of one of long bones
Cerebral Aneurysm
Congenital Aneurysm

- Optic nerve, C3 –
C5 nerve,
headache, mental
confusion, death

- Clipping or ligating
aneurysm
Intracranial Hemorrhage
Trauma of cerebral vascular lesions
Rupture of atheromatous artery
Most common in patients with hypertension
Middle age, lenticulostriate artery of MCA
Hemiplegia on opposite side of the body
Loss of consciousness
Paralysis