Blood supply of the brain

By: M. Atteya
 Blood supply

Arterial supply Venous drainage

Cerebral arteries

2 Vertebral A. Basilar 2 ICA

Vertebral and basilar arteries
Origin, course and branches
Origin of vertebral a.:
Arise from 1st part of subclavian a.
Course and relation:
-It is divided into 4 parts (see head and neck).
-4th part enters cranial cavity through foramen magnum.
-It runs obliquely upwards from side of medulla to the
front of it.
-Units with its fellow to form basilar a. at lower border of
pons.
-Basilar a. then ascends along basilar sulcus in front of
pons, occupies central part of cisterna pontis
Branches of vertebral a. 4
1- posterior spinal a.:
-It is the 1st branch inside cranial cavity .
-Descend as 2 branches one in front and one behind
dorsal root of spinal nerves.
2- anterior spinal a.:
- Arises near the end of vertebral a.
- The 2 arteries unite in front of medulla to form
anterior median spinal artery.
- It descends in the anterior longitudinal median
sulcus of spinal cord up to filum terminal.
- Supplies anterior part of the medulla and spinal
cord.
3- medullary arteries for the medulla
4-Posterior inferior cerebellar artery
- Largest and main branch of vertebral artery.
- Arises near the lower end of the olive.
- Has a tortious course.
- It runs backward on the side of upper part of
medulla, then turns round the inferior
cerebellar peduncle to reach inferior surface
of cerebellum.
- It divides into 2 terminal branches:
1- medial terminal branch supplies the inferior
vermis.
2- lateral terminal br. : -
Supplies posterior part of inferior surface of
cerebellum.
- It also supplies lateral and dorsal part of the
medulla - gives choroid plexus of 4th ventricle
Branches of basilar artery
1- anterior inferior cerebellar a. (AICA):
- Curves around lower border of pones.
- Supplies anterior part of inferior surface of cerebellum.
2- internal auditory artery:
Pass through internal auditory meatus with 7th and 8th cranial
nerves to supply the inner ear.
3- pontine branches :
Slender arteries supply the pons and middle cerebellar
peduncle.
4- superior cerebellar artery (SCA):
- A large artery that arise near upper end of basilar artery
- Pass posterior laterally around upper border of pons to
reach upper surface of cerebellum.
5- posterior cerebral arteries:
two terminal branches
 Cerebellum

Superior surface Inferior surface

Posterior part
Anterior part
By SCA from basilar artery

AICA from basilar PAICA from vertebral

 Unite
2 vertebral arteries Basilar artery
2 PCA
AICA SCA
Labyrinthine
PICA pontine
Medullary branches
Posterior spinal Anterior spinal
Internal carotid artery (ICA)
- origin :
In the neck as one of 2
terminal branches of
common carotid.
 course
- Has 4 parts; cervical, petrous, cavernous and
cerebral.
- Cerebral part pierces cavernous sinus on the
medial side of anterior clinoid process.
- Then it turns backwards to the region of
lateral sulcus .
- It lies lateral to optic chiasma and below
anterior perforated substance.
- It divides into ant cerebral a.(ACA) and middle
cerebral A. (MCA).
Branches of ICA
1- ophthalmic a.:
enters the optic canal to
supply orbit.
2- posterior
communicating a.
Join posterior cerebral a. to
establish circle of willis.
Anterior choroidal a.
 3-Anterior choroidal a.
- It pass backward along optic tract around cerebral peduncle as far
as LGB.
- Ends by entering inferior horn of lateral ventricle through lower
part of choroid fissure.
- Supplies: 1- optic tract
2- LGB
3- internal capsule : - posterior part of posterior limb
- retro lenticular part
- sublenticular part
4- choroid plexus of inf horn of lat ventricle
5- tail of caudate
6- amygdaloid nucleus
4- anterior cerebral a.
5- middle cerebral a.
Cerebral arteries
ACA-MCA-PCA
Rule
Each cerebral artery gives cortical branches to cerebral cortex and
central branches to central parts of the brain.
Anterior cerebral artery
Origin, course, branches, Clinical importance
Origin
Arises below anterior
perforated substance as the
smaller of the 2 terminal
branches of ICA.
Course
- Passes forward and medially above optic
nerve to reach median longitudinal sulcus.
- It bends forward in the fissure where it
becomes joined with its fellow by anterior
communicating artery.
- Then it curves round the genu of corpus
callosum (cc) and continues backward
above cc in callosal sulcus.
- Ends above splenium of corpus callosum
by turning upward in front of
parietooccipital sulcus.
Branches
A- cortical:
1- medial surface of the hemisphere from frontal
lobe to parietooccipital sulcus. This includes leg are
in paracentral lobule.
2- upper one inch of superolateral surface as far as
upper end of parietooccipital sulcus.
Medial half of orbital surface of frontal lobe.
B- central branches perforate anterior perforated
substance to supply:
1- anterior part of corpus striatum.
2- anterior part of anterior limb of internal capsule.
3- septal region including septum pellucidum.
Clinical importance and lesion
1- supply motor and sensory areas in paracentral lobule …… loss of
sensation and motor function of lower limb.
2- septal region….. Prolonged unconsciousness
3- corpus callosum…. Apraxia (inability to perform purposeful
movements despite of intact muscles)
Middle cerebral artery
Origin, course, branches and clinical importance
Origin
Arises below anterior
perforated substance
as the larger of 2
terminal branches of
ICA.
course
- Passes laterally in the stem of
lateral sulcus.
- It turns backward and
upwards in the posterior
ramus of lateral sulcus
passing over the insula.
- It terminates over the insula
by dividing into several
branches on the surface.
Branches
A- cortical branches:
1- Superolateral surface except:
- Upper 1 inch……. By ACA
- Lower 1 inch by PCA
- Lateral surface of occipital lobe ……by PCA
2- lateral half of orbital surface of cerebral
hemisphere.
3-temporal lobe and insula.
B- central branches:
1- corpus striatum.
2- posterior half of anterior limb, genu and
anterior part of posterior limb of internal
capsule
These arteries are classified into medial and
lateral groups according to relation to lentiform
nucleus.
One of these branches is large and called artery
of cerebral hemorrhage or charcot’s artery.
Clinical importance: it supplies the following:
1. Motor and sensory areas of whole body except lower limb.

2. Auditory area in superior temporal gyrus.

3. Motor speech area in in inferior frontal gyrus

4. Most of internal capsule, obstruction of its a. Causes hemiplegia.

Posterior cerebral artery
Origin, course, branches and clinical importance
origin

One of 2 terminal
branches of basilar
artery
course
- It curves laterally around
cerebral peduncle of midbrain
parallel to SCA.

- Then it pass below splenium of

corpus callosum on the medial
surface of cerebral hemisphere.
Finally it enters the calcarine
sulcus where it divides to 2
terminal branches in the
parietooccipital and post-
calcarine sulci.
Branches
A- cortical branches:
1- tentorial surface of cerebral
hemisphere except temporal
pole by MCA.
2- lower 1 inch of
superolateral surface.
3- whole occipital lobe.
B- central branches
1- medial central group(short):
Pierce posterior perforated
substance to supply :
- cerebral peduncle
- Mamillary bodies
- subthalamus
- Hypothalamus
- Anterior part of thalamus.
2-lateral central group (long)
Curve around lateral side of
midbrain.
Supply:
- cerebral peduncle.
- Tectum of midbrain.
- Geniculate bodies.
- Posterior part of thalamus.
- Epithalamus.
- Splenium of corpus callosum.
3- posterior choroidal artery
- Arises from posterior cerebral artery on the
side of midbrain below splenium of corpus
callosum.
- It passes forward in the edge of tela choroidae Posterior choroidal
to supply choroid plexus of lateral and 3rd
ventricles.
Clinical importance: it supplies :-
• The whole visual cortex in the occipital lobe.
• The center of smell in uncus.
• Thalamus and midbrain.
• Most of choroid plexus of 3rd and lateral ventricles.
Some important areas
• All sensory and motor areas by MCA Except Lower limb ACA.
• Auditory and motor speech areas MCA.
• Visual areas PCA
 Blood supply of internal capsule

MCA Posterior communicating artery

Retro lenticular + sublenticular…….. Supplied by Anterior choroidal a.

 Blood supply of corpus striatum

Mainly by MCA Partly by ACA and anterior communicating artery

 Blood supply of thalamus

Mainly by PCA Partly by posterior communicating artery

 Choroidal arteries

Choroidal a. of 4th ventric

Posterior choroidal artery
Anterior choroidal

From PICA
From ICA To inferior horn of lateral ventricle
From PCA To 3rd & lat. Ventricle.
 Venous drainage
External cerebral veins- internal cerebral veins- terminal veins
Characters of cerebral
veins.
1- thin walled with no smooth muscle fibers
and no valves.
2- most of them lie on the surfaces of the
hemisphere in the subarachnoid space. Only
few of them arise from inside of the brain.
3- in order to maintain patency, some of
them open into cranial venous sinuses
against direction of the blood flow in the
sinus.
External cerebral veins
• Superior
• Inferior
• Middle superficial
• Anterior deep
Superior cerebral veins
(6-12)

- Drain superolateral and

medial surfaces.
- Ascend toward the
superomedial border
and open into SSS.
Superficial middle cerebral vein
- It runs on the superolateral surface along posterior ramus of the
lateral sulcus.
- It terminates in the cavernous sinus.
- It drains area around posterior ramus of lateral sulcus.
- It communicate with SSS by superior anastomosing vein.

Transverse sinus by inferior anastomosing vein.

Deep middle cerebral
vein
- It drains the insula.
- It is accompanied with MCA.
- Ends in the basal vein.
Anterior cerebral vein.
- It lies in the callosal sulcus with anterior
cerebral artery.
- Drains lower part and anterior part of
medial surface + corpus callosum.
- It ends in the basal vein.
Inferior cerebral veins
1- veins draining orbital part drain into >>
SSS or superior cerebral veins.
2- veins draining tentorial surfaces drain
into >>>> basal vein and neighboring
venous sinuses (cavernous, superior
petrosal and transverse).
Internal cerebral veins.

- One on each side.

- Formed at Inter ventricular foramen by union of
1- thalamostriate vein
2- septal vein
3- choroidal vein
- Runs backward in the roof of 3rd ventricle.
- join its fellow of the opposite side below
splenium of corpus callosum to form the great
cerebral vein.
Terminal veins
Basal vein_ great cerebral vein
Great cerebral vein.

- It is a short median vein.

- Formed by union of right and left
internal cerebral veins.
- Emerge beneath splenium of
corpus callosum.
- Receives: RT and LT internal
cerebral veins + small veins from
pineal body, cerebellum and
occipital lobe.
- End by joining inf sagittal sinus to
form straight sinus.
Basal vein
- One on each side.
- Formed at anterior perforated substance by union
of deep middle cerebral V. + anterior cerebral V. +
striate Vs.
- It runs backward around cerebral peduncle.
- Terminates by joining the great cerebral v.
- Tributaries are:
1- veins forming it
2- veins from cerebral peduncle, interpeduncular
structures, tectum of mid brain, parahippocampal
gyrus and inferior cerebral veins
 Internal cerebral veins

Great cerebral vein

Basal vein

Inferior sagittal sinus

Straight sinus
N.B: all veins of cerebrum drain into various venous sinuses that
drain into internal jugular vein.