1

Cerebral circulation and Cerebrospinal

fluid (CSF)

By: Biruk A
September, 2021

10/15/2021
 Outline
2

 Objective
 Introduction
 Arterial blood supply
 Venous blood drainage
 Clinical application
 Cerebrospinal Fluid

10/15/2021
 Objectives
3

 At the end of this Class, learners will able to :

 Understand the arterial cerebral circulation
 List the components of Circle of willis
 Explain the production & resorption of CSF
 Explain the physiologic roles of CSF

10/15/2021
 Introduction
4

Brain :
 2% of body weight(1400mg)
 Receives:15 % of cardiac output

 Consumes 20% of entire Oxygen used by the body.

o Loss of consciousness occurs in less than 15 seconds after blood

flow to the brain has stopped, and
o irreparable damage to the brain tissue occurs within 5 minutes.
o Most neurologic disorders are due to vascular lesions.
o Brain is highly vulnerable to disruption in blood flow.

10/15/2021
 Introduction…
5

 It is the blood flow to the brain:

 Supplies oxygen, glucose and nutrients.
 Removes CO2, lactic acid & metabolites.
 Cerebral vasculature has unique physiology & anatomy.

10/15/2021
 Blood supply to the brain
6

o High demand of oxygen and nutrients to the brain

o brain is supplied by four arteries:

 Two internal carotid and Two vertebral arteries.

o Anterior and Posterior cerebral Circulations:

 Anterior – Internal carotid arteries

 Posterior – Vertebral arteries

o Venous blood drainage is via internal jugular veins.

10/15/2021
 Cerebral circulation…
7

o The vessels are interconnected in brain to form an arterial circle

(Circle of Willis) below the hypothalamus.
 Circle of willis :
 serves as a potential vascular shunt, assisting in development
of collateral circulation if one of the proximal vessels is
occluded.
 6 large vessels originate from Circle of willis which supply the
cerebral cortex.
10/15/2021
 Cerebral circulation…
8

The common carotid artery

 Arises from the Brachiocephalic artery on the right and from the
Arch of the aorta on the left.

 Each common carotid artery passes up the neck in the carotid

sheath along with the internal jugular vein and the vagus nerve.

 At the level of the upper border of the thyroid cartilage (C3-C4),

it divides into internal and external carotid arteries.

10/15/2021
 Cerebral circulation…
9

10/15/2021
 External carotid artery
10

 ECA arises anterior and medial to ICA(95%).

 Ascends in the neck a little in front of the internal carotid to

divide into its two terminal branches, the maxillary and

Superficial temporal arteries, in the substance of the parotid
gland.
Branches:
 The ascending pharyngeal artery, superior thyroid artery, The

lingual artery, facial artery, occipital artery, maxillary artery

and Superficial temporal artery.

10/15/2021
 Internal carotid artery
11

◙ Its origin is from the common carotid artery where carotid sinus
and carotid body found.
◙ The internal carotid has no branches in the neck.
◙ It enters the cranial cavity via the carotid canal in the petrous
temporal bone, at the region of middle cranial fossa,enters to
foramen lacerum.
◙ Within the skull it passes forwards in the cavernous sinus, and
then turns backwards behind the anterior clinoid process to break
up into its three terminal branches.

10/15/2021
 Anterior& posterior circulation
12

10/15/2021
 Anterior & posterior circulation…
13

 The internal branch bifurcates into the anterior and middle

cerebral arteries Anterior cerebral circulation.
 The posterior circulation results from the vertebral arteries.
 The two vertebral arteries join to form the basilar artery.
 The basilar artery ascends along the brainstem before
dividing into the posterior cerebral arteries.

10/15/2021
 Posterior circulation
14

Vertebral artery :
 Enters cranial cavity via foramen magnum
 Right and left vertebral arteries join each other at pontomedullary
junction to form basilar artery.
 basilar artery runs along midline of anterior surface of pons and
ends at upper end of pons by dividing into 2 posterior cerebral
arteries.
 vertebral and basilar arteries give branches that supply spinal
cord, brainstem, cerebellum and posterior parts of cerebral
hemispheres.

10/15/2021
 Anterior &posterior circulation
15

 The anterior and posterior circulations anastomose through the

posterior communicating artery to provide collateral blood flow.
 Collateral circulation can also occur through the anterior
communicating artery connecting the bilateral anterior cerebral
arteries.

10/15/2021
 Circle of Willis
16

10/15/2021
 Circle of willis …
17

 Vertebral  Internal carotid

 Basilar artery  Middle cerebral
 Anterior cerebral
 Posterior cerebral artery  Anterior communicating artery
 Posterior communicating artery

CIRCLE OF WILLIS
10/15/2021
 Anterior Anterior cerebral
communicating artery
artery

Internal Middle cerebral

carotid artery
artery
Posterior
communicating
artery
Sup cerebellar A
Posterior cerebral
artery Basilar A

Ant Inf cerebellar A

Post Inf cerebellar A

18 Vertebral arteries 10/15/2021

 Circle of willis…
19

 These arteries unite together forming the circle of Willis from

which 6 cerebral arteries arise to supply the brain.
 No crossing of circulation from one side to the other (because
pressure is equal on both sides).

10/15/2021
 Circle of Willis…
20

10/15/2021
 Stroke or cerebrovascular accident
21

1. Blockage in the artery – cerebral infarction

 Carotid artery
 Basilar artery

2. Bleeding within the brain – intracerebral haemorrhage

 Aneurysm
 Subarachnoid haemorrhage
 Intracerebral haemorrhage - hypertension

10/15/2021
 CVA – due to blockage
22

10/15/2021
 CVA – due to haemorrhage
23

10/15/2021
 Venous drainage
24

 The venous drainage of the brain and coverings includes:

 the veins of the brain itself,
 the dural venous sinuses,
 the dura's meningeal veins,
 and the diploic veins between the tables of the skull.

10/15/2021
 Venous drainage…
25

 Venous drainage:
Cerebral veins

Cerebral venous sinuses

Internal jugular veins

10/15/2021
 Innervations
26

 Cerebral vessels are innervated by sympathetic fibers that enter

the skull around the carotid arteries. These fibers originate in the
superior cervical ganglia .
 These are also cholinergic fibers from the sphenopalatine ganglia
and facial nerve.
 Cerebral vessels are supplied by sensory fibers originating in the
trigeminal ganglia.

10/15/2021
 Cerebrospinal fluid (CSF)
27

Meninges:
3 connective tissue layers which protect the CNS
 Supports blood vessels and Contains cerebrospinal fluid

 Pia mater : Innermost layer (outer “skin” of brain).

 Subarachnoid space – beneath the arachnoid Contains CSF.

 Arachnoid Mater: Middle layer

 Subdural space – area between dura mater and arachnoid mater

 Dura Mater: Outermost layer: Serves as periosteum for skull’s

inner layer.

10/15/2021
 The Meninges
28

10/15/2021
 Clinical Anatomy
29

10/15/2021
 Cerebrospinal Fluid
30

 Clear, colorless liquid that bathes the

brain and spinal cord (circulates
within subarachnoid space)
Functions:
 Cushions the brain within the skull
 Shock absorber for the CNS
 Circulates nutrients and chemicals
filtered from the blood and removes
waste products from the brain

10/15/2021
 CSF Production
31

Produced by :
 Choroid plexus and secreted at ciliated cuboidal epithelial cell
surfaces of the microvilli into the ventricles.
 Capillary ultrafiltrate (Virchow-Robin spaces).
 Metabolic H2O production.

 Produced at rate of 500 cc/day or approximately 20cc/hour (0.3-0.5

cc/kg/hr). Eliminated by being absorbed into the arachnoid villi -->
dural sinus --> jugular system . 10/15/2021
 CSF production…
32

 The secretion of fluid by the choroid plexus depends on the

active Na+-transport across the cells into the CSF.
 The electrical gradient pulls along Cl-, and both ions drag
water by osmosis.
 The CSF has lower [K+], [glucose], and much lower
[protein] than blood plasma, and higher concentrations of
Na+ and Cl-.
 The production of CSF in the choroid plexuses is an active
secretory process, and not directly dependent on the
arterial blood pressure.

10/15/2021
 CSF Circulation
33

 They are connected by:

 The foramen of monro (lateral ->
third),
 Cerebral aqueduct

( third -> fourth), and

 The foramen of magendie and
Luschka. (fourth -> subarachnoid
space/ cisterna magna). 
10/15/2021
 Lateral ventricle

Interventricular
foramen (Monro)

Cerebral
aqueduct

Fourth ventricle
Third ventricle

Central canal of
medulla
oblongata &
spinal cord

34
Lateral view to show the ventricular system of the CNS
10/15/2021
 Site of formation
Choroid plexus of the
lateral ventricle
1. Lateral ventricle
Superiorly Interventricular foramina
Superiorly

2. Third ventricle
Cerebral aqueduct Absorbed
Absorbed
3. Fourth ventricle

Lateral foramina Lateral foramina

(Luschka) (Luschka)

Median foramen (Magendie)

4. Subarachnoid space

35 10/15/2021
Inferiorly
 CSF Reabsorption
36

 CSF is reabsorbed into the blood of the venous sinuses via the

arachnoidal villi. The absorption is directly related to the CSF pressure in

the cranial cavity.

 Hydrostatic pressure in subarachnoid space > pressure in dural sinuses.

 Arach villi are one-way valves that open when the hydrostatic pressure of

CSF in the subarachnoid space is about 1.5 mm Hg greater than venous

hydrostatic pressure in the dural sinuses (i.e., passive process).

10/15/2021
37

Thank you!!!

10/15/2021