CEREBRAL VASCULARIZATION

Arterial Blood Supply of the Brain

Derived from:
- Internal carotid artery:
to anterior 2/3 of the cerebral hemispheres

- Vertebral artery:
to the remaining posterior and medial
regions of the hemispheres, most of the
diencephalon, brainstem, cerebellum, and
cervical spinal cord.
Arteries of the brain lie in the subarachnoid
space
 Anastomosis
The carotid and vertebral-basilar are
anatomically interconnected with each other,
and with their counterparts in the opposite
site, through the circle of Willis.

These circle usually cannot carry enough

blood flow to maintain adequate cerebral
circulation if either a carotid or a vertebral
artery is suddenly blocked.
 Circulus arteriosus Willis
1. Basilar
2. Posterior cerebral
3. Posterior communicating
4. Internal carotid
5. Anterior cerebral
6. Anterior communicating
 Branches of Internal
Carotid Artery
• cavernous part • cerebral part
- cavernous - ophthalmic
- hypophyseal - anterior cerebral
- meningeal - middle cerebral
- anterior choroid
to: globus pallidus, caudate
nucleus, amygdala,
hypothalamus, red nucleus,
substansia nigra, capsula
interna (post. limb), optic
radiation, hippocampus.
- posterior
communicating
Internal carotid artery in the
cavernous sinus
Anterior Cerebral Artery
Areas supplied by anterior cerebral artery:
• Septal area
• Primary motor cortex for legs, foots, urinary bladder
• Additional motor planning areas in the medial frontal
lobe anterior to precentral gyrus
• Most of the corpus callosum except its posterior part
Middle Cerebral Artery
Central branches: Lenticulostriate artery
Through: anterior perforate substance
To: lentiform nucleus, caudate nucleus and internal
capsule

Cortical branches:
Superior branch to:
• Primary motor cortex for face and arm
• Broca’s area
• Frontal eye fields (for “looking at” eye
movements to the opposite site)
• Primary somatosensory cortex for face & arm
• Parts of lateral frontal & parietal lobe for 3-D
visual perceptions and for ability to interpret &
express emotion
 Middle Cerebral Artery
Cortical branches (cont.)
Inferior branches to
• Wernick’s area
• Parts of posterior parietal lobe for 3-D
visual perceptions and for ability to
interpret & express emotion
• Optic radiation particularly fibers that
represent information from the
contralateral superior quadrants of the
visual field
Outer surface of hemispherium showing
areas supplied by cerebral arteries
Medial surface
 Branches of Vertebral & Basilar
arteries
Vertebral:
- posterior & anterior spinal
- posterior inferior cerebellar
Basilar:
- pontine
- labyrinthine
- anterior inferior cerebellar
- superior cerebellar
- posterior cerebral
- posterior communicating
 Areas supplied by vertebral-
basilar arteries
Rostral midbrain:
- Pyramidal tract (PT), superior cerebellar
peduncle, n. III nucleus, medial longitudinal
fasciculus (MLF), reticular formation (RF)

Mid pons:
- MLF, RF, PT, middle cerebellar peduncle
(MCP), trigeminal sensory & motor nuclei
 Areas supplied by vertebral-basilar
arteries (cont.)
Caudal pons:
- n. VI nucleus, motor fibers n. VII, lateral gaze
center, PT
- n. VII nucleus, MCP, descending tract nucleus n.
V, spinothalamic tract (ST), vestibular & cochlear
nuclei

Rostral medulla:
- n. XII nucleus, PT, medial lemniscus
- nucleus ambiguus, n. IX & X, descending tract
nucleus n. V, ST, Vestibular nuclei, Inferior
cerebellar peduncle
Structures supplied by posterior
cerebral artery
- Diencephalon
- Midbrain
- Optic radiation & striate cortex (primary
visual cortex)
- Splenium of the corpus callosum
- Hippocampal formation & the posterior of
fornix (important for new declarative
memory)
Cerebral Blood flow

• Every minute,
- 50 ml/100 g/min
- about 600-700 ml of blood flow
through the carotid arteries and
their branches
- about 100-200 ml flow through
the vertebral-basilar system.
 Cerebral Blood flow
Cerebral blood flow constant despite variation in
blood pressure (65-140 mm Hg).
Below this range cbf decrease
Above cbf increase

Control by sympathetic in subarachnoid space and

by adrenegic intrinsic inside the brain
CO2 and O2 also important

Intracranial pressure & cbf complex autoreg

 Blood-Brain Barrier
Located at capillary endothel within brain,
except circumventric. system
Depends on the tight junction between
endothel and a relative lack of transport

Function
Protect brain from circulating substance
Selective transport of substances by specialized
transport system
Metabolism & modification of blood or brain borne
substance
 Atheromatous plaques

Atheromatous plaques tend to form at

branchings and curves of the cerebral
arteries.
In the carotid circulation the most frequent
sites:
- in the internal carotid artery at its origin
- in the stem MCA or its bifurcation into
superior and inferior divisions
- in the ACA as it curves backwards over
 Emboli
Emboli tend to enter the carotid circulation far more
frequently than they enter the vertebral circulation

Large emboli carried up the carotid tend to be

swept into the MCA --> prone to getting stuck at its
branches in the Sylvian fissure

Emboli can also lodge in one of the major cortical

branches of MCA as well as in the smaller branches
 Lenticulostriate arteries

• Small diameter arteries originate as right angle

branches of MCA.
• Particularly susceptible to damage from
hypertension.
• Rupture of the artery produces an intracerebral
hemorrhage, initially centered in the region they
supply
• Occlusion produces a lacunar infarct.
--> leads to stereotyped stroke syndromes.
 Lenticulostriate arteries
Hemorrhage:
- may remain localized to the putamen (and
caudate)
- may involve neighboring structures (internal
caps.etc)
- may rupture into ventricular system

Lacunar infarct:
- may have serious functional consequences if
they involve internal capsule
- may “silent” if they involve small region of white
matter or basal ganglia.
Paramedian vessels supplying the medial parts of
the brainstem are at risk for hypertensive damage,
particularly in the pons.
Large pontine hemorrhages involve the
corticospinal tract and reticular formation
bilaterally.
Pontine lacunar infarcts may also damage the
corticospinal tracts.
Penetrating cerebellar vessels are also at risk for
hypertensive hemorrhage, with bleeding often
occuring near the dentate nucleus
--> deficits related to the cerebellum such as limb
ataxia.

It may also affect brainstem function by

compression or by rupture into the fourth ventricle
Arterial Blood Supply of the spinal cord

1. Posterior & anterior spinal

arteries
2. Spinal branches of vertebral,
deep cervical, intercostal and
lumbar arteries
 Blood supply of the
meninx
• Blood Supply
anterior, middle & posterior
meningeal arteries
 Blood supply to the cerebral hemisphere

Comes from cortical branches of the:

- ant.or, middle & post.or cerebral arteries
Subarachnoid vessels pass into subpial
space --> enter the cortex perpendicularly
and divide: --> long & short ramies

Long branches penetrate white matter 3-4

cm without anastomosing --> terminal
arteries
Short branches to cortex & makes
anastomoses
 Dural venous sinuses
• Blood-filled spaces situated
between layers of dura mater:
– Superior & inferior, straight,
transverse, sigmoid, and occipital
sinuses
- Confluens of sinuses
- Cavernous sinuses
- Superior and inferior petrosal
sinuses