Introduction

Brain is one of the most metabolically active organs of the body. Although it
constitutes only 2% of the total body weight, it receives 17-20% of the total
cardiac output and consumes 20% of the total O2 used by the body. It
is supplied by Four arteries:

▪ Two internal carotid arteries.

▪ Two vertebral arteries.

Describe the origin and course of vertebral artery.

▪ It arises from the 1st part of subclavian artery, ascends up in the neck.
▪ It passes through the foramen transversarium of all the cervical
vertebrae EXCEPT seventh cervical vertebra.
▪ It enters the cranial cavity via the foramen magnum.
▪ Ascends up on the ventral surface of medulla oblongata.
▪ The arteries of both the sides unite to form basilar artery at the lower
border of the pons.
▪ The basilar artery ascends in the midline on the ventral surface of
the pons and at its upper border ends by dividing into left and right
posterior cerebral arteries.
Describe origin and course of internal carotid artery.

▪ Internal carotid arteries arise from common carotid arteries at the level
of superior border of thyroid cartilage (C4 vertebral level). It ascends in
the neck without giving any branches.
▪ It enters the cranial cavity via carotid canal.
▪ It then takes a sinuous course via the cavernous sinus, pierces the dural
roof of the sinus and ends at below the cerebral hemisphere lateral to
the optic chiasma by dividing into its two terminal branches viz. middle
cerebral artery and anterior cerebral artery.

Name the branches of the arteries that supply brain.

VERTEBRAL ARTERY BASILAR ARTERY CEREBRAL PART OF INTERNAL CAROTID

Anterior spinal artery Anterior inferior cerebellar artery Middle cerebral artery

Posterior spinal artery Pontine arteries Anterior cerebral artery

Meningeal arteries Labyrinthine artery Ophthalmic artery

VERTEBRAL ARTERY BASILAR ARTERY CEREBRAL PART OF INTERNAL CAROTID

Medullary arteries Superior cerebellar artery Posterior communicating artery

Posterior inferior cerebellar artery Posterior cerebral artery Anterior choroidal artery

Descibe the formation and branches of circle of Willis.

Circle of Willis is formed by anastomosis between the branches of basilar

and internal carotid arteries at the base of brain in the interpeduncular
fossa. It is formed:

▪ Anteriorly: by the anterior communicating artery and anterior cerebral

arteries.
▪ Posteriorly: by the two posterior cerebral arteries .
▪ Laterally on every side: by the posterior communicating artery
connecting the internal carotid artery with the posterior cerebral artery.

What is the function of Circle of Willis?

Normally there is little or no mixing of blood between the right and left
halves of Circle of Willis. For that reason, right half of the brain is supplied by
right vertebral and right internal carotid arteries and left half of the brain is
supplied by left vertebral and left internal carotid arteries. But in case, one of
the major arteries forming the circle of Willis is blocked, the circle of Willis
allows collateral route for circulation.

Describe the arterial supply of cerebrum.

The cerebrum is supplied by three pairs of cerebral arteries, viz. anterior,

middle and posterior. The cerebral arteries give three types of branches,
viz.

▪ Cortical branches: The cortical branches anastomose in the pia mater

on the surface of the cerebral cortex. From this plexus branches pierce
the cortex at right angle, these arteries are end arteries.The cortical
branches supply the cerebral cortex.
▪ Central branches: Central branches are perforating branches, which
supply the deeper parts of the cerebral hemisphere such as corpus
striatum, internal capsule, etc. The central arteries arise from the
arterial circle of Willis and are end arteries. They are divided into
following four groups (see the diagram above):
 ▪ Anteromedial (AM) group.
▪ Anterolateral group (AL) (lateral striate arteries).
▪ Posteromedial(PM) group.
▪ Posterolateral(PL) group.
▪ Choroidal branches: The choroidal arteries form capillary plexus which
is covered by pia mater (choroid plexus) and project into the
ventricles The branches are:
▪ Anterior choroidal artery.
▪ Posterior choroidal artery.
▪ All the three surfaces of the cerebral hemisphere are supplied by
the three cerebral arteries, viz. anterior, middle and posterior.
▪ Most of the superolateral surface is supplied by middle cerebral
artery, most of the medial surface by the anterior cerebral artery
and most of the inferior surface by the posterior cerebral artery.

Arterial Supply of Superolateral Surface of Cerebral Hemisphere

The superolateral surface of the cerebral hemisphere is supplied by the three

cerebral arteries.

▪ Middle cerebral artery: Most of the superolateral surface is supplied

by the middle cerebral artery which include most of the primary
motor and sensory functional areas and frontal eye field. In the left
(dominant) hemisphere it includes the Broca and Wernicke’s speech
areas.
▪ Anterior cerebral artery: A narrow strip of the cerebral cortex (about
finger breadth) adjoining superomedial border up to the parieto-
occipital sulcus is supplied by anterior cerebral artery. The upper parts
of primary motor and sensory areas are located in this region.
▪ Posterior cerebral artery: A narrow strip along the lower border of
temporal lobe (excluding temporal pole) and occipital lobe are supplied
by posterior cerebral artery. The posterior parts of visual area is
located in this area.
Arterial Supply of Medial Surface of Cerebrum.

The medial surface of the cerebral hemisphere is also supplied by all the
three cerebral arteries:

▪ Anterior cerebral artery:Most of the medial surface is supplied by the

anterior cerebral artery. It supplies the parts of motor and sensory
regions (paracentral lobule) concerned with perineum, leg and
foot.
▪ Middle cerebral artery: Temporal pole of the temporal lobe is
supplied by the middle cerebral artery.
▪ Posterior cerebral artery: Medial surface of the occipital lobe is
supplied by the posterior cerebral artery. The area supplied contains
the visual cortex.

Arterial Supply of Inferior Surface of Cerebrum.

The inferior surface of the cerebral hemisphere is also supplied by all the
three cerebral arteries:

▪ Posterior cerebral artery: Most of the inferior surface with the

exception of the temporal pole is supplied by the posterior cerebral
artery.
▪ Middle cerebral artery: Lateral part of the orbital surface of the frontal
lobe and temporal pole of the temporal lobe are supplied by the middle
cerebral artery.
▪ Anterior cerebral artery: Medial part of the orbital surface of the
frontal lobe is supplied by the anterior cerebral artery.

Applied Aspect

Occlusion of middle cerebral artery

It results in:

▪ Contralateral hemiplegia and hemianesthesia including primarily

the face and arm (leg is spared), because of involvement of most of the
primary motor and sensory areas. Primary motor and sensory area
where leg is represented is supplied by anterior cerebral artery.
▪ Aphasia occurs in case the left middle cerebral artery is involved
which supplies Broca’s motor and Wernike’s sensory speech areas ( in
most of the people left cerebral hemisphere contains these areas)
▪ Contralateral homonymous hemianopia because of involvement of
optic radiation.