Blood supply of the nervous

system.

02/13/2024 1
 Introduction
• Extremly high demand for oxygen and nutrients:
• human brain represents 2% of the body weight,
but receives
– 15% of the cardiac output,
– 20% of total body oxygen consumption and
– 25% of total body glucose utilization.

• Cerebrovascular diseases and stroke are among

the major causes of death.
02/13/2024 2
02/13/2024 3
 Introduction
• The cerebral blood supply is derived from the
– internal carotid arteries (anterior circulation).
– vertebral arteries (posterior circulation).

02/13/2024 4
 Introduction
• The venous blood of the brain flows from the
deep and superficial cerebral veins into the
venous sinuses of the dura mater, and thence
into the internal jugular veins on both sides.

02/13/2024 5
02/13/2024 6
 Introduction
• Protracted interruption of blood flow to a part
of the brain causes loss of function and, finally,
ischemic necrosis of brain tissue (cerebral
infarction).
• The most common causes of ischemia on the
arterial side of the cerebral circulation are
emboli .

02/13/2024 7
 Introduction
• Another cause of the stroke syndrome is
intracranial hemorrhage,
– Intraparechymal
– Subarichinoid

02/13/2024 8
 Introduction
• The blood supply of the spinal cord is mainly
supplied by single Anterior spinal artery
contributed many segmental arteries and
two posterior spinal arteries.
• Like the brain, the spinal cord can be damaged
by hemorrhage or by ischemia of arterial or
venous origin.

02/13/2024 9
02/13/2024 10
 carotid system (anterior circulation)
• Common carotid artery.
• The internal carotid artery originates at the
bifurcation of the common carotid artery at
the level of the thyroid cartilage and ascends
to the skull base without giving off any major
branches.

02/13/2024 11
 internal carotid artery
• It passes through the carotid canal of the
petrous bone, where it is separated from the
middle ear only by a thin, bony wall, and then
enters the cavernous sinus.

02/13/2024 12
 internal carotid artery
• It curves upward and backward within the
cavernous sinus, forming a loop that is open
posteriorly (the carotid siphon).
• Fine extradural branches of the internal
carotid artery supply the floor of the tympanic
cavity, the dura mater of the clivus, the
semilunar ganglion, and the pituitary gland.

02/13/2024 13
 internal carotid artery
• Injury or rupture of the internal carotid artery
within the cavernous sinus produces a “short-
circuit” connection between its arterial blood
and the venous blood of the sinus (carotid-
cavernous fistula).

02/13/2024 14
 C7 cavernous sinus
C6
C5
C4 carotid canal
C3

ant. clinoid proc.

C2

C1
foramen lacerum
02/13/2024 15
 Internal carotid artery
• The internal carotid artery enters the
subarachnoid space medial to the anterior
clinoid process.
• At this point it gives of ophthalmic artery.
– Which supply contents of the orbit the sphenoid
sinus, the ethmoid air cells, the nasal mucosa, the
dura mater of the anterior cranial fossa, and the
skin of the forehead, root of the nose, and eyelids.

02/13/2024 16
 Internal carotid artery
• After ophthalmic artery ICA gives of Posterior
communicating artery, which gives off fine
perforating branches to the :
– tuber cinereum, mamillary body, rostral thalamic
nuclei, subthalamus, and part of the internal
capsule.

02/13/2024 17
 ICA
• ICA immediately after PCA it gives off Anterior
choroidal artery.
– To supply the choroid plexus of the temporal horn
of the lateral ventricle.

02/13/2024 18
02/13/2024 19
 Terminal branches.
• The internal carotid artery bifurcates above
the clinoid process, giving rise to
– The anterior cerebral artery medially and
– the middle cerebral artery laterally.

02/13/2024 20
 Middle Cerebral Artery
• The middle cerebral artery (MCA) is the
largest branch of the internal carotid artery.
• The middle cerebral artery divides into its
major cortical branches within the insular
cistern.
• These branches supply large areas of the
frontal parietal, and temporal lobes.

02/13/2024 21
The major branches of the middle cerebral
artery
• orbitofrontal(I),
• prerolandic (II),
• rolandic (III),
• anterior parietal (IV), and
• posterior parietal arteries (V),
• the artery of the angular gyrus (VI), and the
• temporooccipital( posterior temporal) (VII),
and anterior temporal (VIII) arteries.
02/13/2024 22
 MCA
• The cortical areas supplied by the middle
cerebral artery include, among others:
– the primary sensory and motor cortices (except
for their parasagittal and medial portions),
– the language areas of Broca and Wernicke,
– the primary auditory cortex, and
– the primary gustatory cortex.

02/13/2024 23
02/13/2024 24
 Anterior Cerebral Artery
• The anterior cerebral artery (ACA) originates
from the bifurcation of the internal carotid
artery and then courses medially and rostrally.

02/13/2024 25
 Branches of the anterior cerebral artery.

• The proximal (basal) segment of the anterior

cerebral artery gives off numerous small
perforating branches that supply the:
– paraseptal region,
– rostral portion of the basal ganglia and
diencephalon, and
– the anterior limb of the internal capsule

02/13/2024 26
 ACA
• The recurrent artery of Heubner is a large
branch of the proximal segment of the
anterior cerebral artery that supplies the basal
ganglia; it is sometimes visible on an
angiogram

02/13/2024 27
 ACA
• The major cortical branches of the anterior
cerebral artery are:
• the orbital (I),
• frontopolar (II),
• frontal, pericallosal (III),
• callosomarginal (IV), and
• internal parietal (V) arteries.

02/13/2024 28
02/13/2024 29
 Vertebrobasilar system (posterior
circulation)
- It arises from the 1st part of subclavian artery
and ascends through the foramina
transversaria of the upper 6 cervical vertebrae
and enters the cranial cavity through foramen
magnum along side the ventrolateral aspect
of the medulla.

02/13/2024 30
 Vertebrobasilar system
• Along its course, it gives rise to a number of
branches including the anterior and posterior
spinal arteries which supply the medulla and
spinal cord.

• Its largest branch is the posterior inferior

cerebellar artery(PICA) which supplies the
inferior aspect of the cerebellum.

02/13/2024 31
 Vertebrobasilar system
• The 2 vertebral arteries unite at the junction
between medulla and pons to form the
basilar artery which runs the length of the
pons and supplies it by pontine branches.
• At the junction of pons and midbrain it
divides into 2 pairs of vessels, the superior
cerebellar arteries and the posterior cerebral
arteries.

02/13/2024 32
 Vertebrobasilar system
• N.B. The brain stem, cerebellum and occipital
lobe are supplied by the vertebrobasilar
system.

02/13/2024 33
 Branches of Basilar Artery

1. Pontine arteries.

2. Anterior inferior cerebellar artery (AICA).

It supplies the anterior and inferior portion of the
cerebellum.

3. Labyrinthine artery.
It passes into the internal acoustic meatus to supply
the inner ear.
02/13/2024 34
 Branches of Basilar Artery
4. Superior cerebellar artery
It supplies the superior aspect of the
cerebellum.

5. Posterior cerebral artery:

It curves around the midbrain to supply the
visual cortex of the occipital lobe and the
infero medial aspect of the temporal lobe.
02/13/2024 35
Vertebro-basilar system

atlas
laterally axis
upward
backward

C6

02/13/2024 36
02/13/2024 37
 Circle of Willis

• It is an arterial anastomosis in the interpeduncular

fossa at the base of the brain. This fossa is formed:
• anteriorly by optic chiasma.
• Posteriorly by the upper border of the pons.
• Anterolaterally by the 2 optic tracts.
• Posterolaterally by the 2 cerebral peduncles.
• It is formed of: Anterior cerebral; anterior
communicating; internal carotid; posterior
communicating and posterior cerebral arteries.
02/13/2024 38
 Cerebral Arterial Circle (of Willis)
Anterior Communicating

Anterior Cerebral
Internal
Carotids Middle Cerebral

Posterior Communicating

Posterior Cerebral

Basilar

Vertebral

02/13/2024 39
 perforating arteries
• Anterior and posterior perforating arteries:
• They arise from the anterior cerebral artery
and posterior communicating arteries.
• They supply basal ganglia, optic chiasma,
internal capsule, hypothalamus. And
• ventral portion of the midbrain and parts of
the subthalamus and hypothalamus
respectively.

02/13/2024 40
02/13/2024 41
 ANTERIOR CEREBRAL ARTERY

02/13/2024 42
 MIDDLE CEREBRAL ARTERY

02/13/2024 43
 POSTERIOR CEREBRAL ARTERY

02/13/2024 44
02/13/2024 45
02/13/2024 46
 Blood Supply to Cerebellum
• Superior cerebellar
artery (SCA) from
basilar artery
• Anterior inferior
cerebellar artery (AICA)
from basilar artery
• Posterior inferior
cerebellar artery (PICA)
from vertebral artery

02/13/2024 47
 oculomotor n.
PCA

SCA

BA

AICA

VA
PICA

sca: superior cerebellar

aica: anterior inferior cerebellar
02/13/2024 48
pica: posterior inferior cerebellar
 Venous drainage of the brain
• Three sorts of vessels contribute to the
venous drainage of the brain:
– deep veins,
– superficial veins and
– the dural venous sinuses.
• None of these vessels contains valves.

02/13/2024 49
 Venous drainage of the brain
• Deep cerebral veins drain the internal
structures of the forebrain.
• the thalamostriate vein and the choroidal
vein, which drain the basal ganglia, thalamus,
internal capsule, choroid plexus and
hippocampus.
• Within each cerebral hemisphere, these
vessels merge to form the internal cerebral
vein.
02/13/2024 50
 Venous drainage of the brain
• The two internal cerebral veins then unite in
the midline to form the great cerebral vein (of
Galen), which lies beneath the splenium of
the corpus callosum.
• This short vessel is continuous posteriorly with
the straight sinus, which lies in the midline of
the tentorium cerebelli.

02/13/2024 51
 Venous drainage of the brain
• Superficial veins lie within the subarachnoid
space. Superior cerebral veins primarily drain
the lateral surface of the cerebral hemispheres
and empty into the superior sagittal sinus.
• The superficial middle cerebral vein runs
along the line of the lateral fissure and
empties into the cavernous sinus.

02/13/2024 52
 Venous drainage of the brain
• In addition, two major anastomotic channels
exist, the superior (great) anastomotic vein
and the inferior anastomotic vein, which
drain into the superior sagittal sinus and the
transverse sinus, respectively.

02/13/2024 53
 Venous drainage of the brain
• The deep and superficial cerebral veins drain
into the dural venous sinuses, which are
channels formed between the two layers of
dura mater.
• Major venous sinuses are located in the
attached borders of the falx cerebri and the
tentorium cerebelli, and on the floor of the
cranial cavity.

02/13/2024 54
 Venous drainage of the brain
• Along the line where the falx cerebri attaches
to the interior of the cranium lies the superior
sagittal sinus.
• This receives blood primarily from the
superior cerebral veins, which ramify over the
lateral surface of the cerebral hemispheres.
• The free border of the falx encloses the
smaller inferior sagittal sinus, into which flow
veins on the medial aspect of the hemisphere.
02/13/2024 55
• Within the tentorium cerebelli, along the
line of its attachment to the falx, lies the large
straight sinus.
• Into this, run both the great cerebral vein,
which drains the deep structures of the
forebrain, and the inferior sagittal sinus.

02/13/2024 56
• The superior sagittal sinus and the straight
sinus converge at the confluence of the
sinuses, which lies adjacent to the internal
occipital protuberance.
• From here, blood flows laterally on either
side in the transverse sinus, which lies along
the line of attachment of the tentorium to the
occipital bone.

02/13/2024 57
• The transverse sinus is continuous with the
sigmoid sinus, which, in turn, joins the
internal jugular vein at the level of the jugular
foramen.

02/13/2024 58
• The cavernous sinus lies lateral to the body of
the sphenoid bone.
• It receives blood from the middle cerebral
vein and drains into the internal jugular vein
(via the inferior petrosal sinus) and into the
transverse sinus (via the superior petrosal
sinus).

02/13/2024 59
• The two cavernous sinuses are connected by
intercavernous sinuses that lie anterior and
posterior to the hypophysis, forming a venous
circle around it (the circular sinus).
• The dural venous sinuses are connected to
extracranial veins via emissary veins.

02/13/2024 60
02/13/2024 61
 Superior Sagittal Sinus

Sphenoparietal

Cavernous
Basilar

Superior
Petrosal Sigmoid

Straight Transverse
Confluence
02/13/2024 62
 Dural Sinuses
Superior Sagittal
Inferior Sagittal

Great Cerebral

Sup/Inf Petrosal Straight

Confluence

Occipital

Transverse
Sigmoid
02/13/2024 63
02/13/2024 64
 Arterial supply of the spinal cord
• Three longitudinal arterial vessels run the
length of the spinal cord. These are the single
anterior spinal artery and the paired posterior
spinal arteries.
• The anterior and posterior spinal arteries
alone are insufficient to supply the cord below
cervical levels and, therefore, they receive
serial reinforcement by anastomosis with
radicular arteries
02/13/2024 65
 Arterial supply of the spinal cord
• One particularly large radicular artery (the
great radicular artery, or artery of
Adamkiewicz) may arise from a lateral
intercostal or lumbar artery at any level
between T8 and L3.

02/13/2024 66
Venous drainage of the spinal cord
• The venous drainage of the cord follows a
basically similar pattern to the arterial supply.
• Six longitudinal interconnecting venous
channels exist.
• anterior and posterior spinal veins,
• anterolateral and posterolateral veins

02/13/2024 67
• All of these vessels drain via anterior and
posterior radicular veins into the internal
vertebral venous plexus (epidural venous
plexus),
• The internal venous plexus communicates
with an external vertebral venous plexus and
thence with the ascending lumbar veins, the
azygos and hemiazygos veins.

02/13/2024 68
02/13/2024 69
02/13/2024 70
 Clinical considerations

• Atherosclerosis – brain infarctions

• Subarachnoidal hemorrhage

02/13/2024 71
 Ant. cerebral artery
Weakness/paralysis of muscles and loss of
sensory functions on the lower limbs of the
contralateral side.

Middle cerebral artery

Paralysis and sensory disfunction involving
head and neck and the upper limbs of the
contralateral side. In case of damage of the
dominant hemisphere speech disorders are
also present.

Post. cerebral artery

Visual field defficiencies or blindness.

Vertebro-basillar system
Eye movement (gaze) disorders, double vision
Anisocoria (pupils are different in size)
Vertigo, loss of balance
Dysphagia and dysphonia (disorder of
swallowing and phonation)
Drowsiness or unconsciousness

02/13/2024 72
 Thank you.

02/13/2024 73