Blood supply to

brain
-

Account for 20% of oxygen

consumption

Arteries
-

Derived from 2 internal carotid and

vertebral art. In subarachnoid space
circle of Willis

Internal carotid art. (ant. Circulation)

-

Common carotid art. cervical

portion (X branching) temporal
petrous portion (carotid canal)
cavernous sinuses (close to CN VI &
IV) carotid groove (side body of
sphenoid) post. Communicating,
ant, mid Cerebral art + ophthalmic
ant. Communicating art.

All terminal branches of ICA will form cerebral art. Circle around
interpeduncular fossa

contain venous plexuses and carotid plexus of sympathetic nerves

Branches: central retinal, ophthalmic, ant choroid

Vertebral art.
-

Subclavian vertebral art. (left > right) cervical (transverse formina of

C1-6V), atlantic (C1V perforate dura & arachnoid foramen magnum),
intracranial (unite at caudal border of pons basilar art.)

Basilar art ascends clivus sloping from dorsum sellae foramen magnum,
pontocerebellar cistern sup border of pons 2 post. Cerebral art.
(vertebrobasilar art sys post circulation of brain)

Post cerebral art branches: labyrinthine art (vestibulocochlear symptoms),

ant inf cerebellar art (pons & parts of cerebellum), sup cerebellar (rostral
pons and cerebellum), pontine (most pons)

Branches: Post inf cerebellar art (dorsolateral of medulla [lateral medullary

syndrome]), Medullary art (most of medulla)

Cerebral art Circle (circle of Willis)

-

Important 4 art anastomosis at cranial

base (2 vertebral & 2 ICA)

Branches:
1) Ant cerebral:

supply medial & superior surface of

brain + frontal pole
2) Mid Cerebral:

supply lateral surface + temporal pole

& parts of internal capsule + basal
ganglia
3) Post cerebral:

Bifurcation of basilar art. Collateral

with Mid cerebral by post
communicating

supply inferior surface + occipital + inf post temporal pole

4) Anteromedial: hypothalamus, preoptic & supraoptic area
5) Posteromedial: pituitary hypothalamus, thalamus & midbrain
6) Posterolateral: post thalamus, geniculate body, pulvinar, lateral
nuclear group & most ventral thalamic nuclei
7) Anterolateral (striate): medial caudate nucleus head, putamen &
internal capsule; lateral caudate, putamen, globus pallidus & internal
capsule
8) Ant choroidal: choroid plexus in lateral ventricle, hippocampal formation,
globus pallidus, post limb of internal capsule, amydaliod nucleus,
caudate nucleus tail & ventrolateral thalamus
9) Post choroidal: thalamus, choroid plexus of 3rd & lateral ventricles

Relations: ant optic

below mamillary bodies

Occlusion of single
often
completely
compensated by
collateral

chiasm, post
art

Arterial Supply to Regions

Basal Ganglia & Thalamus
-

Corpus striatum & internal

capsule - medial & lateral
striate branch of mid cerebral
art

Thalamus Thalamogeniculate,
post choroidal art (post cerebral
art), ant choroidal art (ICA)

Midbrain
-

Post cerebral, sup cerebellar, basilar art

Pons
-

Basilar & ant, sup & inf cerebellar art

Medulla oblongata
-

Vertebral, ant & post spinal, post inf cerebellar & basilar

Cerebellum
-

Sup and ant&post inf cerebellar

Spinal cord
-

2 post & 1 ant spinal art,

reinforce segmentally by
radicular art

Post spinal supply post 1/3 of

spine while ant spinal supply the
rest

Segmental art, supplied by

feeder art, will form ant & post
radicular spinal art, anastomose
w spinal art.

Great ant medullary art of

Adamkiewicz, between T11L2 range, supply lower 2/3 of
spine

Ant & post radicular art form

arterial Vasocorona
(anastomoses betw ant & post
radicular spinal art)

Vein
-

Valveless, drain from arachnoid and dura meningeal layers to dural venous
sinuses IJV

Venous drainage by cerebral and cerebellar veins adjacent venous sinuses

Sup cerebral sup sagittal sinus; inf & superficial mid cerebral straight,
transverse & sup petrosal sinuses

2 internal cerebral great cerebral (Galen) at midline straight sinus w inf

sagittal sinus

Cerebellum drained by sup & inf cerebellar transverse & sigmoid sinuses

Clinical application
Anatomoses of Cerebral art. & cerebral embolism
-

Cerebral art obstructed by embolism X able to provide suffice blood to

cortex ischemia infarction necrotic area

Large emboli occlude large art. neurologic problem and death

Variations in CoW
-

Change in size of art. Or absent of certain art (Eg. Posterior communicating

art.)

Significant in emboli or arterial disease

Aneurysm deficiency of tunica media weakness & aneurysm (branching of

CoW)

Subarachnoid Haemorrhage
-

Leakage/rupture from congenital or angioma

Severe headache, neck stiff, loss conscious + blood in CSF (lumbar

puncture)

Cerebral Haemorrhage
-

Common caused by rupture of lenticulostriate art (mid cerebral art branch)

Involve corticobulbar & corticospinal fibers in capsule hemiplegia of

opposite side

Loss conscious, paralyse after regained conscious

Cerebral Artery Occlusion

Ant Cerebral Art occlusion
-

Proximal blockage (collateral circulation preserve) safer than distal

Distal occlusion will produce:

a) Contralateral hemiparesis & hemisensory loss involving leg and foot

b) Inability to identify object, apathy, personality changes

Mid Cerebral Art Occlusion

-

Occlusion will produce:

a) Contralateral hemiparesis & hemianesthesia
b) Aphasia if left hemisphere affected; anosognosia if right hemisphere
c) Homonymous hemianopia
d) Apraxia and sensory neglect

Internal Carotid Art Occlusion

-

Will have ant and mid cerebral art occlusion presentation with:
a) Loss of vision ipsilateral to site of occlusion (ophthalmic art)

b) level of conscious

Vertebral Art Occlusion

-

Will produce:
a) pain & OC sensory loss (ipsilateral face, contralateral body)
b) loss of gag reflex, dysphagia, hoarseness (lesions of nuclei of CN 9 &10)
c) Vertigo, nystagmus, nausea & vomiting)
d) Ipsilateral horners syndrome + ataxia

Basilar Art Occlusion

-

Total blockage lesion of trigeminal, abducent, facial nerve nuclei +

quadriplegia & coma (reticular formation)

Transient Ischemic Attack

-

Referred as neurologic symptoms due to ischemia

Major cerebral/vertebrobasilar stenosis longer TIA duration & distal

closure

Symptoms: staggering, dizzy, light-headed, faint, paresthesias

Risk of MI and ischemic stroke

Strokes
1) Ischemic stroke sudden focal neurologic deficit from impaired blood flow
-

Caused by embolism in major art esp CoW (gradual/sudden obstruction

insufficient anastomose function impaired to a degree/partial neurological
deficits)

Common causes: spontaneous cerebrovascular accidents. Eg thrombosis,

embolism, cerebral & subarachnoid hemorrhage

Cardinal symptoms sudden onset of neurological symptoms

2) Haemorrhagic stroke events

rupture of art or saccular
aneurysm
-

Common type is berry

aneurysm in vessels,
bifurcation of basilar, CoW or
medium art at cranial base

(HTN) weak wall of aneurysm

expands & rupture
haemorrhage into
subarachnoid severe unbearable headache & stiff neck

of

Brain Infarction
-

Atheromatous plaque at bending art

progressive stenosis severe
neurologic deficits emboli from plaque
intracranial branch blockage acute
cortical infarction (sudden insufficiency of
blood to brain)

Sequential event w duration:

Interruption of blood (initial) altered
brain metabolism (30s) neural function
lost (1-2 mins) infarction due to anoxia
(5 min)

Notes Clinical
Medial medullary syndrome,
A (Dejerine syndrome):
-

Occlude ant spinal art

& paramedian
branches affects
medial zone of medulla

Lateral Medullary Syndrome,

B (Wallenberg syndrome):
-

Thrombosis of post inf

cerebellar art affects
posterolateral medulla

General deep artery map