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Blood Supply of the Brain
By
Dr. Noura El Tahawy
OBJECTIVES
Illustrate and describe the formation of the
circle of willis
Describe the blood supply of the brain
Arterial supply
Venous drainage
Blood Supply of
The Brain
The brain receives its arterial supply from
two pairs of vessels, the vertebral and
internal carotid arteries which are
interconnected in the cranial cavity to
produce an arterial circle (of Willis).
I. Vertebro-Basilar system
Dr. Noura El Tahawy
Blood supply of the brain
Blood supply of the brain
Blood supply of the brain
Blood supply of the brain
Vertebral artery
Dr. Noura El Tahawy
Vertebral Artery
Branch of first part of subclavian A
Passes – foramen transvesarium C6 – C1
Enters through foramen magnum – perforates dura &
arachnoid mater – enters subarachnoid space
Turns upward, forward, medially – medulla oblongata
Lower border of pons – joins opposite side to form
BASILAR artery
Blood supply of the brain
The diagram shows the circulus arteriosus (circle of Willis).
Schematic drawing of the arrangement of arterial vessels on the base of the
brain.
Branches of vertebral artery
the arterial supply (red) and venous drainage (blue) of the
spinal cord.
Basilar Artery
Dr. Noura El Tahawy
Formed by the union of the two vertebral arteries at the
lower border of the pons
Ascends on the front of the pons lodged in the basilar
groove
Ends at the upper border of the pons by dividing into 2
Posterior cerebral arteries (PCA)
The circulus arteriosus on the base of the brain
Arteries on the base of the brain injected with resin.
Branches of Basilar artery
Anterior inferior
cerebellar A.
Arteries of the Cerebellum
Posterior Cerebral Artery
Dr. Noura El Tahawy
Arterial supply of hindbrain.
Posterior Cerebral artery: Course
View from below the cerebral hemispheres, showing the cortical branches and territories of the three cerebral arteries.
ACA, MCA, PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery.
Posterior
Cerebral Artery:
Course & brs.
Major arteries of the brain. A, medial aspect
Posterior Cerebral Artery: Course
Posterior Cerebral artery: Course
The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries.
B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral
arteries. In these figures the area supplied by the anterior cerebral artery is coloured blue, that by the
middle cerebral artery pink and that by the posterior cerebral artery is yellow.
Posterior Cerebral Artery: Brs & Cortical Distribution
Named cortical branches of the posterior cerebral
artery
t
h
e
p
o
s
t
e
r
i
o
r
c
e
r
e
b
r
a
l
a
r
Splenium of corpus callosumCallosal
Cuneus and precuneusParietooccipital
Calcarine cortexCalcarineMedial
Posterior temporal and occipital
cortex
Occipitotemporal
Posterior temporal cortexPosterior
temporal
Anterior temporal cortexAnterior
temporal
Lateral
TerritoryArteryBranch
Posterior Cerebral Artery: Important Areas of Cortical
Distribution
- The thalamoperforating
artery to the anterior one-third
of the thalamus
- Hypothalamus
- Globus Pallidus
ACA, anterior cerebral artery; ICA,
internal carotid artery; LGB, MGB,
lateral, medial geniculate bodies .
Posterior Cerebral Artery: Central Brs
1- Posteromedial Group
pierce the posterior perforated
substance and supply:
thalamusthalamus
Cerebral
peduncle
Cerebral
peduncle
Geniculate
bodies
Geniculate
bodies
Posterior Cerebral Artery: Central Brs
1.The thalamogeniculate
artery shown supplies the
geniculate bodies and the
posterior two-thirds of the
thalamus.
2. Brs. To the cerebral peduncles
& Tectum of the Midbrain
2- Posterolateral Group
posterior choroidal artery: from the
posterior cerebral artery to supply the choroid
plexus of the lateral ventricle .
Posterior Cerebral Artery: Choroidal Brs
thalamusthalamus
Cerebral
peduncle
Cerebral
peduncle
Internal
capsule
Internal
capsule
Posterior cerebral artery & posterior communicating arteryPosterior cerebral artery & posterior communicating artery
Central brs
Internal Carotid System
Dr. Noura El Tahawy
Blood supply of the brain
Internal Carotid Artery
Begins – bifurcation of Common Carotid A
Enters middle cranial fossa through the carotid canal at the base of
skull
Lies beside dorsum sellae
In the cavernous sinus: Lies Horizontal
Emerge out – medial side of Ant. clinoid process – perforates dura &
arachnoid mater – enters subarachnoid space
Turns posteriorly – below optic nerve
Turns upward – lateral to optic chiasma
Now is under anterior perforated susbtance
Divides – into ANTERIOR & MIDDLE cerebral arteries
The arteries comprising the circle of Willis. The four groups of central branches are shown;
the thalamoperforating artery belongs to the posteromedial group, and the thalamogeniculate
artery belongs to the posterolateral group. ACA, MCA, PCA, anterior, middle, posterior
cerebral arteries; ICA, internal carotid artery.
Brain viewed from below, showing background structures related to the circle of
Willis. Part of the left temporal lobe (to right of picture) has been removed to show
the choroid plexus in the inferior horn of the lateral ventricle
Internal Carotid A
Hypophyseal arteries
Ophthalmic
Anterior communicating
Post Communicating
Anterior Choroidal
Ant Cerebral
Cortical
Central
Communicates with
Ant. Comm. A.
Middle Cerebral
Cortical
Central
Vertebral A.
Meningeal
Post Spinal
Ant Spinal
Post Inf Cerebellar
Medullary
Basilar A.
Pontine
Labyrinthine
Ant. Inf. Cerebellar
Sup. Cerebellar
Post Cerebral
Cortical
Central
Choroidal
Anterior Cerebral Artery
Anterior Cerebral artery: Course
Major arteries of the brain. A, medial aspect
Anterior Cerebral Artery: Course
Anterior Cerebral artery: Course
Anterior Cerebral artery: Course
Medial view of the right hemisphere, showing the cortical branches and territories of
the three cerebral arteries. ACA, PCA, anterior, posterior cerebral arteries.
Anterior Cerebral Artery: Cortical brs.
Lateral view of right cerebral hemisphere, showing the cortical branches and
territories of the three cerebral arteries.
Anterior Cerebral Artery: Cortical brs.
View from below the cerebral hemispheres, showing the cortical branches and territories of the three cerebral
arteries. ACA, MCA, PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery.
Anterior
Cerebral
Artery:
Cortical brs.
Corpus callosumPericallosal
Cingulate and superior frontal gyri; paracentral
lobule
Callosomarginal
Frontal polePolar frontal
Orbital surface of frontal lobeOrbitofrontal
TerritoryBranch
Named cortical branches of the anterior cerebral artery
N. B. The term cortical is conventional .Terminal is better, because these
arteries also supply the underlying white matter .
The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries.. In these figures
the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the
posterior cerebral artery is yellow.
Anterior Cerebral Artery: cortical Distribution
Anterior Cerebral Artery: Cortical Distribution
B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In
these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral
artery pink and that by the posterior cerebral artery is yellow.
Anterior Cerebral Artery
important functional areas supplied by cortical brs.
Territory supplied by branches of the anterior and middle cerebral arteries is shown in red. Territory
supplied by the anterior choroidal artery is shown in green.
Anterior Cerebral Artery: Central brs.
Medial striate artery recurrent artery of
Heubner (pron. 'Hoibner'):
Arises close to the anterior communicating
artery
Supplies:
1. Ant. Part of head Caudate & Adjacent part of
internal capsule
2. Putamen
3. Septal nuclei
Anterior Cerebral Artery: cortical brs.
Anterior cerebral artery , anterior communicating artery & ICAAnterior cerebral artery , anterior communicating artery & ICA
:
distribute to the anterior of the hypothalamus
Anterior Cerebral Artery: Central brs.
Anteromedial group of central brs
Middle Cerebral Artery
Anterior Cerebral artery: Course
Lateral view of right cerebral hemisphere, showing the cortical branches and
territories of the three cerebral arteries.
Middle Cerebral Artery: Cortical brs.
Major arteries of the brain. B, lateral aspect.
Middle
Cerebral
Artery:
Course &
Branches
Cortical branches of the middle cerebral artery
i
d
d
l
e
c
e
r
e
b
r
a
l
a
r
t
e
r
y
Angular and neighboring gyriAngular
Midtemporal cortex
Temporal and occipital cortex
Middle temporal
Temporooccipital
Lower division
Posterior parietal cortexParietal
Postcentral and anterior parietal cortexPostcentral
Pre- and postcentral gyriCentral
Prefrontal cortex
Premotor areas
Prefrontal
Precentral
Upper division
Anterior temporal cortexAnterior
temporal
Orbital surface of frontal lobeFrontobasalStem
TerritoryBranch(es(Origin
The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries.. In these figures
the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the
posterior cerebral artery is yellow.
Middle Cerebral Artery: Cortical Distribution
Middle Cerebral Artery: Cortical Distribution
B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In
these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral
artery pink and that by the posterior cerebral artery is yellow.
Middle Cerebral Artery
Important functional areas supplied by the Cortical brs
Middle cerebral artery & anterior choroidal artery
1- Medial Striate arteries
Supply:
Supply the Corpus striatum, internal capsule, and Anterior of
thalamus.
One of this group is specially large & more susceptible to hemorrhage & called
artery of cerebral hemorrhage (Charcot’s Artery)
Occlusion of one of the lateral striate arteries is the chief cause of classic stroke ,
where damage to the pyramidal tract in the posterior limb of the internal capsule
causes hemiplegia ,a term denoting paralysis of the contralateral arm, leg, and lower
part of face .
Middle Cerebral Artery: Central brs
2- Lateral striate arteries:
Left middle
cerebral artery
Left middle
cerebral artery
Right middle
cerebral artery
Right middle
cerebral artery
Lateral
striate
arteries
Lateral
striate
arteries
Middle Cerebral Artery: Central brs
Comparison between cerebral arteries
1- Cortical
2- Central
3- Callosal
4- Choroidal
1- Cortical
2- Central
1- Cortical
2- Central
3- Callosal
Branches
CalcarineStem of lateral
s.
CallosalSulcus
related
From basilar
artery
From int.
carotid a.
From int.
carotid a.
Begins
Posterior
Cerebral
Middle
Cerebral
Anterior
Cerebral
Choroidal Arteries
The Anterior Choroidal A.: from the Internal
Carotid A.
The Posterior Choroidal A.: from the posterior
cerebral artery to supply the choroid plexus of
the lateral ventricle .
The Choroidal Branch of posterior inferior
Cerebellar A.
CIRCLE OF WILLIS
Dr. Noura El Tahawy
Arterial Circle Of Willis
Site: at the base of the brain around interpeduncular fossa.
Function: Important anastomosis between the 2 internal carotid
arteries in front & Vertebro-basilar system behind.
Arteries forming it:
Rt. & Lt. internal carotid artery.
Rt. & Lt. anterior cerebral arteries.
Rt. & Lt. posterior cerebral arteries.
Rt. & Lt. posterior communicating arteries.
Anterior communicating artery.
The arteries comprising the circle of Willis. The four groups of central branches are shown;
the thalamoperforating artery belongs to the posteromedial group, and the thalamogeniculate
artery belongs to the posterolateral group. ACA, MCA, PCA, anterior, middle, posterior
cerebral arteries; ICA, internal carotid artery.
Blood supply of the brain
Blood supply of the brain
Figure 17.4 The arteries on the base of the brain. The anterior part of the right temporal
lobe has been removed to display the initial course of the middle cerebral artery within the
lateral fissure.
Blood supply of the brain
Vertebral arteries
Basilar A
Posterior cerebral
artery
Posterior
communicating
artery
Posterior
communicating
artery
Internal
carotid
artery
Internal
carotid
artery
Middle cerebral
artery
Middle cerebral
artery
Anterior cerebral
artery
Anterior cerebral
artery
Anterior
communicating
artery
Anterior
communicating
artery
Post Inf cerebellar A
Sup cerebellar A
Ant Inf cerebellar A
Blood Supply of The Cerebrum
Rt & Lt Vertebro-
basilar terminal
branch:
Posterior cerebral
artery
Rt & Lt Vertebro-
basilar terminal
branch:
Posterior cerebral
artery
Rt & Lt Internal Carotid
& their branches:
Rt& Lt Middle cerebral As.
Rt& Lt Anterior cerebral As.
Anterior communicating A.
Rt&Lt Posterior
communicating As.
Rt & Lt Internal Carotid
& their branches:
Rt& Lt Middle cerebral As.
Rt& Lt Anterior cerebral As.
Anterior communicating A.
Rt&Lt Posterior
communicating As.
CIRCLE OF WILLIS
Summary Blood Supply of
Specific areas of the Brain
By
Dr. Noura El Tahawy
Horizontal section of the
internal capsule at the
level indicated, depicting
its boundaries and parts
(left) and stroke-relevant
motor contents (right). IC
internal capsule; LGB,
lateral geniculate body;
SC, superior colliculus .
Horizontal section of the internal capsule, depicting its parts) left (and contents) right .(
AL, anterior limb; G, genu: PL, posterior limb; RP, retrolentiform part .
Anatomy of the Internal Capsule
Arterial Supply of the Internal capsule
The three sources of supply are:
Anterior choroidal ,a direct branch of the internal carotid. The anterior choroidal
branch of the ICA supplies the lower part of the posterior limb and the retrolentiform part of the
internal capsule, and the inferolateral part of the lateral geniculate body. Some of its branches (not
shown) supply a variable amount of the temporal lobe of the brain and the choroid plexus of the
inferior horn of the lateral ventricle;
Medial striate, branch of the anterior cerebral artery (recurrent artery of Heubner)
supplies the lower part of the anterior limb and genu of the internal capsule.
Lateral striate (lenticulostriate) branches of the middle cerebral artery .The
lateral striate arteries penetrate the lentiform nucleus and give multiple branches to the anterior
limb, genu, and posterior limb of the internal capsule
..
The medial striate branch of the anterior cerebral artery is the recurrent artery of Heubner.
Only two of the six lateral striate branches of the middle cerebral artery shown are labeled.
The asterisk indicates arterial supply from the anterior choroidal artery to the inferolateral part
of the lateral geniculate body .
Arterial Supply of the Internal capsule
Territory supplied by branches of the anterior and middle cerebral arteries is shown in red. Territory
supplied by the anterior choroidal artery is shown in green.
Arterial Supply of the Internal capsule
Corpus striatum
Medial & lateral
striate brs
Anterior & Middle
cerebral arteriesInternal capsule
Thalamus P Com. A, basilar, PCA
Midbrain PCA, sup Cerebellar A, basilar
Pons Pontine brs. of Basilar, Ant. Inf. cerebellar,
sup. Cerebellar A.
Medulla oblongata Vertebral, Posterior inf. Cerebellar,
Anterior Inferior Cerebellar A, basilar
Cerebellum Sup. Cerebellar, AICA, PICA
Arteries to specific brain areas
Venous Drainage of the Brain
VENOUS DRAINAGE of THE BRAIN
EXTERNAL
Superior
cerebral
Superficial
middle
cerebral
Deep middle
cerebral
EXTERNAL
Superior
cerebral
Superficial
middle
cerebral
Deep middle
cerebral
INTERNAL
Thalamo
striate
choroidal
INTERNAL
Thalamo
striate
choroidal
• SPECIFIC
– Midbrain
– Pons
– Medulla
oblongata
– cerebellum
• SPECIFIC
– Midbrain
– Pons
– Medulla
oblongata
– cerebellum
External Cerebral Veins
Communicates between
superficial middle cerebral
V & transverse sinus
Inf. anastomotic V
Communicates between the
superficial middle cerebral
V & Superior Sagittal sinus
Sup. Anastomotic V
Inferior cerebral veins
Superficial middle cerebral
V
VEIN AREA DRAINS INTO
Superior cerebral
veins
Lateral surface of
cerebral
hemisphere
Superior Sagittal sinus
Superficial middle
cerebral
Cavernous sinus
Unite with the inferior
sagittal sinus to form straight
sinus
Behind splenium of CC
& formed by the union
of the 2 internal
cerebral veins
Great Cerebral vein
Rt. & Lt basal veins drain
into the great cerebral vein
Inferior SurfaceBasal vein
The three veins unite to form
the Basal vein
• Anterior cerebral
• Deep middle cerebral
• Striate veins
Joined by ant. cerebral &
striate veins to form basal
vein
InsulaDeep middle cerebral
DRAINS INTOAREAVEIN
External Cerebral Veins
The external (superficial) cerebral veins of the left hemisphere and their relationship to the dural
venous sinuses.
External Cerebral Veins
basalbasal
Superior
Sagittal
sinus
Superior
Sagittal
sinus
Inferior
Sagittal
sinus
Inferior
Sagittal
sinus
Great
cerebral
Great
cerebral
Internal
cerebral
Internal
cerebral
Straight
sinus
Straight
sinus
Occipital
sinus
Occipital
sinus
Site of
junction
with
transverse
sinus
Site of
junction
with
transverse
sinus
Internal Cerebral Veins
VEIN AREA DRAINS INTO
Thalamostriate
Basal ganglia, thalamus,
internal capsule,Tela
choroidae of 3rd
ventricle, hippocampus
- Both veins (of each side)
unite to form
Internal Cerebral vein
- Rt. & Lt. Internal
cerebral veins unite to
form Great Cerebral vein
–The Great cerebral vein
join the Inferior Sagittal
sinus to form Straight
sinus
DURAL VENOUS SINUS
Choroidal
The internal (deep) cerebral veins, viewed from above after removal of the central
portion of the corpus callosum.
Internal Cerebral Veins
The cerebral venous system (viewed from the left side) showing the principal superficial and
deep veins of the brain and their relationship to the dural venous sinuses. The more deeply
placed veins are shown in blue and those inside the brain are shown in interrupted blue.
Straight
sinus
Straight
sinus Transverse
sinus
Transverse
sinus
Sigmoid
sinus
Sigmoid
sinus
Confluence of
sinus
Confluence of
sinus
Jugular
foramen
Jugular
foramen
Cavernous sinus
Superior
petrosal
sinus
Superior
petrosal
sinus
Inferior
petrosal
sinus
Inferior
petrosal
sinus
Superiorsa
gittal sinus
Superiorsa
gittal sinus
Falx cerebriFalx cerebriSuperior sagittal sinusSuperior sagittal sinusInferior
sagittal sinus
Inferior
sagittal sinus
Straight
sinus
Straight
sinus
Tentorium
cerebelli
Tentorium
cerebelli
*
Superior
petrosal
sinus
Superior
petrosal
sinus
Inferior
petrosal
sinus
Inferior
petrosal
sinus
Sigmoid
sinus
Sigmoid
sinus
Confluence of
sinus
Confluence of
sinus
Transverse
sinus
Transverse
sinus
Veins of Specific Areas
Cavernous sinus
Lateral to body of sphenoid bone
Connected to opposite – intercavernous S
Receives blood
Middle cerebral V
Drains into
Int Jugular V –via Inf petrosal sinus
Transverse S – via Sup petrosal S
Dural Venous sinuses – emissary veins – extracranial V
Stroke or cerebrovascular accident:-
Blockage in the artery – cerebral infarction
Carotid artery
Basilar artery
Bleeding within the brain – intracerebral haemorrhage
Aneurysm
Subarachnoid haemorrhage
Intracerebral haemorrhage - hypertension
Damages one side of the body - contralateral
Clinical Application
CVA – due to blockage
CVA – due to haemorrhage
THANK YOU

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Blood supply of the brain

  • 1. Blood Supply of the Brain By Dr. Noura El Tahawy
  • 2. OBJECTIVES Illustrate and describe the formation of the circle of willis Describe the blood supply of the brain Arterial supply Venous drainage
  • 3. Blood Supply of The Brain The brain receives its arterial supply from two pairs of vessels, the vertebral and internal carotid arteries which are interconnected in the cranial cavity to produce an arterial circle (of Willis).
  • 10. Vertebral Artery Branch of first part of subclavian A Passes – foramen transvesarium C6 – C1 Enters through foramen magnum – perforates dura & arachnoid mater – enters subarachnoid space Turns upward, forward, medially – medulla oblongata Lower border of pons – joins opposite side to form BASILAR artery
  • 12. The diagram shows the circulus arteriosus (circle of Willis). Schematic drawing of the arrangement of arterial vessels on the base of the brain.
  • 14. the arterial supply (red) and venous drainage (blue) of the spinal cord.
  • 16. Formed by the union of the two vertebral arteries at the lower border of the pons Ascends on the front of the pons lodged in the basilar groove Ends at the upper border of the pons by dividing into 2 Posterior cerebral arteries (PCA)
  • 17. The circulus arteriosus on the base of the brain
  • 18. Arteries on the base of the brain injected with resin.
  • 19. Branches of Basilar artery Anterior inferior cerebellar A.
  • 20. Arteries of the Cerebellum
  • 21. Posterior Cerebral Artery Dr. Noura El Tahawy
  • 22. Arterial supply of hindbrain.
  • 24. View from below the cerebral hemispheres, showing the cortical branches and territories of the three cerebral arteries. ACA, MCA, PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery. Posterior Cerebral Artery: Course & brs.
  • 25. Major arteries of the brain. A, medial aspect Posterior Cerebral Artery: Course
  • 27. The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the posterior cerebral artery is yellow. Posterior Cerebral Artery: Brs & Cortical Distribution
  • 28. Named cortical branches of the posterior cerebral artery t h e p o s t e r i o r c e r e b r a l a r Splenium of corpus callosumCallosal Cuneus and precuneusParietooccipital Calcarine cortexCalcarineMedial Posterior temporal and occipital cortex Occipitotemporal Posterior temporal cortexPosterior temporal Anterior temporal cortexAnterior temporal Lateral TerritoryArteryBranch
  • 29. Posterior Cerebral Artery: Important Areas of Cortical Distribution
  • 30. - The thalamoperforating artery to the anterior one-third of the thalamus - Hypothalamus - Globus Pallidus ACA, anterior cerebral artery; ICA, internal carotid artery; LGB, MGB, lateral, medial geniculate bodies . Posterior Cerebral Artery: Central Brs 1- Posteromedial Group pierce the posterior perforated substance and supply:
  • 31. thalamusthalamus Cerebral peduncle Cerebral peduncle Geniculate bodies Geniculate bodies Posterior Cerebral Artery: Central Brs 1.The thalamogeniculate artery shown supplies the geniculate bodies and the posterior two-thirds of the thalamus. 2. Brs. To the cerebral peduncles & Tectum of the Midbrain 2- Posterolateral Group
  • 32. posterior choroidal artery: from the posterior cerebral artery to supply the choroid plexus of the lateral ventricle . Posterior Cerebral Artery: Choroidal Brs
  • 33. thalamusthalamus Cerebral peduncle Cerebral peduncle Internal capsule Internal capsule Posterior cerebral artery & posterior communicating arteryPosterior cerebral artery & posterior communicating artery Central brs
  • 34. Internal Carotid System Dr. Noura El Tahawy
  • 36. Internal Carotid Artery Begins – bifurcation of Common Carotid A Enters middle cranial fossa through the carotid canal at the base of skull Lies beside dorsum sellae In the cavernous sinus: Lies Horizontal Emerge out – medial side of Ant. clinoid process – perforates dura & arachnoid mater – enters subarachnoid space Turns posteriorly – below optic nerve Turns upward – lateral to optic chiasma Now is under anterior perforated susbtance Divides – into ANTERIOR & MIDDLE cerebral arteries
  • 37. The arteries comprising the circle of Willis. The four groups of central branches are shown; the thalamoperforating artery belongs to the posteromedial group, and the thalamogeniculate artery belongs to the posterolateral group. ACA, MCA, PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery.
  • 38. Brain viewed from below, showing background structures related to the circle of Willis. Part of the left temporal lobe (to right of picture) has been removed to show the choroid plexus in the inferior horn of the lateral ventricle
  • 39. Internal Carotid A Hypophyseal arteries Ophthalmic Anterior communicating Post Communicating Anterior Choroidal Ant Cerebral Cortical Central Communicates with Ant. Comm. A. Middle Cerebral Cortical Central Vertebral A. Meningeal Post Spinal Ant Spinal Post Inf Cerebellar Medullary Basilar A. Pontine Labyrinthine Ant. Inf. Cerebellar Sup. Cerebellar Post Cerebral Cortical Central Choroidal
  • 42. Major arteries of the brain. A, medial aspect Anterior Cerebral Artery: Course
  • 45. Medial view of the right hemisphere, showing the cortical branches and territories of the three cerebral arteries. ACA, PCA, anterior, posterior cerebral arteries. Anterior Cerebral Artery: Cortical brs.
  • 46. Lateral view of right cerebral hemisphere, showing the cortical branches and territories of the three cerebral arteries. Anterior Cerebral Artery: Cortical brs.
  • 47. View from below the cerebral hemispheres, showing the cortical branches and territories of the three cerebral arteries. ACA, MCA, PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery. Anterior Cerebral Artery: Cortical brs.
  • 48. Corpus callosumPericallosal Cingulate and superior frontal gyri; paracentral lobule Callosomarginal Frontal polePolar frontal Orbital surface of frontal lobeOrbitofrontal TerritoryBranch Named cortical branches of the anterior cerebral artery N. B. The term cortical is conventional .Terminal is better, because these arteries also supply the underlying white matter .
  • 49. The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries.. In these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the posterior cerebral artery is yellow. Anterior Cerebral Artery: cortical Distribution
  • 50. Anterior Cerebral Artery: Cortical Distribution B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the posterior cerebral artery is yellow.
  • 51. Anterior Cerebral Artery important functional areas supplied by cortical brs.
  • 52. Territory supplied by branches of the anterior and middle cerebral arteries is shown in red. Territory supplied by the anterior choroidal artery is shown in green. Anterior Cerebral Artery: Central brs.
  • 53. Medial striate artery recurrent artery of Heubner (pron. 'Hoibner'): Arises close to the anterior communicating artery Supplies: 1. Ant. Part of head Caudate & Adjacent part of internal capsule 2. Putamen 3. Septal nuclei Anterior Cerebral Artery: cortical brs.
  • 54. Anterior cerebral artery , anterior communicating artery & ICAAnterior cerebral artery , anterior communicating artery & ICA : distribute to the anterior of the hypothalamus Anterior Cerebral Artery: Central brs. Anteromedial group of central brs
  • 57. Lateral view of right cerebral hemisphere, showing the cortical branches and territories of the three cerebral arteries. Middle Cerebral Artery: Cortical brs.
  • 58. Major arteries of the brain. B, lateral aspect. Middle Cerebral Artery: Course & Branches
  • 59. Cortical branches of the middle cerebral artery i d d l e c e r e b r a l a r t e r y Angular and neighboring gyriAngular Midtemporal cortex Temporal and occipital cortex Middle temporal Temporooccipital Lower division Posterior parietal cortexParietal Postcentral and anterior parietal cortexPostcentral Pre- and postcentral gyriCentral Prefrontal cortex Premotor areas Prefrontal Precentral Upper division Anterior temporal cortexAnterior temporal Orbital surface of frontal lobeFrontobasalStem TerritoryBranch(es(Origin
  • 60. The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries.. In these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the posterior cerebral artery is yellow. Middle Cerebral Artery: Cortical Distribution
  • 61. Middle Cerebral Artery: Cortical Distribution B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the posterior cerebral artery is yellow.
  • 62. Middle Cerebral Artery Important functional areas supplied by the Cortical brs
  • 63. Middle cerebral artery & anterior choroidal artery 1- Medial Striate arteries Supply:
  • 64. Supply the Corpus striatum, internal capsule, and Anterior of thalamus. One of this group is specially large & more susceptible to hemorrhage & called artery of cerebral hemorrhage (Charcot’s Artery) Occlusion of one of the lateral striate arteries is the chief cause of classic stroke , where damage to the pyramidal tract in the posterior limb of the internal capsule causes hemiplegia ,a term denoting paralysis of the contralateral arm, leg, and lower part of face . Middle Cerebral Artery: Central brs 2- Lateral striate arteries:
  • 65. Left middle cerebral artery Left middle cerebral artery Right middle cerebral artery Right middle cerebral artery Lateral striate arteries Lateral striate arteries Middle Cerebral Artery: Central brs
  • 66. Comparison between cerebral arteries 1- Cortical 2- Central 3- Callosal 4- Choroidal 1- Cortical 2- Central 1- Cortical 2- Central 3- Callosal Branches CalcarineStem of lateral s. CallosalSulcus related From basilar artery From int. carotid a. From int. carotid a. Begins Posterior Cerebral Middle Cerebral Anterior Cerebral
  • 67. Choroidal Arteries The Anterior Choroidal A.: from the Internal Carotid A. The Posterior Choroidal A.: from the posterior cerebral artery to supply the choroid plexus of the lateral ventricle . The Choroidal Branch of posterior inferior Cerebellar A.
  • 68. CIRCLE OF WILLIS Dr. Noura El Tahawy
  • 69. Arterial Circle Of Willis Site: at the base of the brain around interpeduncular fossa. Function: Important anastomosis between the 2 internal carotid arteries in front & Vertebro-basilar system behind. Arteries forming it: Rt. & Lt. internal carotid artery. Rt. & Lt. anterior cerebral arteries. Rt. & Lt. posterior cerebral arteries. Rt. & Lt. posterior communicating arteries. Anterior communicating artery.
  • 70. The arteries comprising the circle of Willis. The four groups of central branches are shown; the thalamoperforating artery belongs to the posteromedial group, and the thalamogeniculate artery belongs to the posterolateral group. ACA, MCA, PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery.
  • 73. Figure 17.4 The arteries on the base of the brain. The anterior part of the right temporal lobe has been removed to display the initial course of the middle cerebral artery within the lateral fissure.
  • 75. Vertebral arteries Basilar A Posterior cerebral artery Posterior communicating artery Posterior communicating artery Internal carotid artery Internal carotid artery Middle cerebral artery Middle cerebral artery Anterior cerebral artery Anterior cerebral artery Anterior communicating artery Anterior communicating artery Post Inf cerebellar A Sup cerebellar A Ant Inf cerebellar A
  • 76. Blood Supply of The Cerebrum Rt & Lt Vertebro- basilar terminal branch: Posterior cerebral artery Rt & Lt Vertebro- basilar terminal branch: Posterior cerebral artery Rt & Lt Internal Carotid & their branches: Rt& Lt Middle cerebral As. Rt& Lt Anterior cerebral As. Anterior communicating A. Rt&Lt Posterior communicating As. Rt & Lt Internal Carotid & their branches: Rt& Lt Middle cerebral As. Rt& Lt Anterior cerebral As. Anterior communicating A. Rt&Lt Posterior communicating As. CIRCLE OF WILLIS
  • 77. Summary Blood Supply of Specific areas of the Brain By Dr. Noura El Tahawy
  • 78. Horizontal section of the internal capsule at the level indicated, depicting its boundaries and parts (left) and stroke-relevant motor contents (right). IC internal capsule; LGB, lateral geniculate body; SC, superior colliculus .
  • 79. Horizontal section of the internal capsule, depicting its parts) left (and contents) right .( AL, anterior limb; G, genu: PL, posterior limb; RP, retrolentiform part . Anatomy of the Internal Capsule
  • 80. Arterial Supply of the Internal capsule The three sources of supply are: Anterior choroidal ,a direct branch of the internal carotid. The anterior choroidal branch of the ICA supplies the lower part of the posterior limb and the retrolentiform part of the internal capsule, and the inferolateral part of the lateral geniculate body. Some of its branches (not shown) supply a variable amount of the temporal lobe of the brain and the choroid plexus of the inferior horn of the lateral ventricle; Medial striate, branch of the anterior cerebral artery (recurrent artery of Heubner) supplies the lower part of the anterior limb and genu of the internal capsule. Lateral striate (lenticulostriate) branches of the middle cerebral artery .The lateral striate arteries penetrate the lentiform nucleus and give multiple branches to the anterior limb, genu, and posterior limb of the internal capsule ..
  • 81. The medial striate branch of the anterior cerebral artery is the recurrent artery of Heubner. Only two of the six lateral striate branches of the middle cerebral artery shown are labeled. The asterisk indicates arterial supply from the anterior choroidal artery to the inferolateral part of the lateral geniculate body . Arterial Supply of the Internal capsule
  • 82. Territory supplied by branches of the anterior and middle cerebral arteries is shown in red. Territory supplied by the anterior choroidal artery is shown in green. Arterial Supply of the Internal capsule
  • 83. Corpus striatum Medial & lateral striate brs Anterior & Middle cerebral arteriesInternal capsule Thalamus P Com. A, basilar, PCA Midbrain PCA, sup Cerebellar A, basilar Pons Pontine brs. of Basilar, Ant. Inf. cerebellar, sup. Cerebellar A. Medulla oblongata Vertebral, Posterior inf. Cerebellar, Anterior Inferior Cerebellar A, basilar Cerebellum Sup. Cerebellar, AICA, PICA Arteries to specific brain areas
  • 84. Venous Drainage of the Brain
  • 85. VENOUS DRAINAGE of THE BRAIN EXTERNAL Superior cerebral Superficial middle cerebral Deep middle cerebral EXTERNAL Superior cerebral Superficial middle cerebral Deep middle cerebral INTERNAL Thalamo striate choroidal INTERNAL Thalamo striate choroidal • SPECIFIC – Midbrain – Pons – Medulla oblongata – cerebellum • SPECIFIC – Midbrain – Pons – Medulla oblongata – cerebellum
  • 86. External Cerebral Veins Communicates between superficial middle cerebral V & transverse sinus Inf. anastomotic V Communicates between the superficial middle cerebral V & Superior Sagittal sinus Sup. Anastomotic V Inferior cerebral veins Superficial middle cerebral V VEIN AREA DRAINS INTO Superior cerebral veins Lateral surface of cerebral hemisphere Superior Sagittal sinus Superficial middle cerebral Cavernous sinus
  • 87. Unite with the inferior sagittal sinus to form straight sinus Behind splenium of CC & formed by the union of the 2 internal cerebral veins Great Cerebral vein Rt. & Lt basal veins drain into the great cerebral vein Inferior SurfaceBasal vein The three veins unite to form the Basal vein • Anterior cerebral • Deep middle cerebral • Striate veins Joined by ant. cerebral & striate veins to form basal vein InsulaDeep middle cerebral DRAINS INTOAREAVEIN External Cerebral Veins
  • 88. The external (superficial) cerebral veins of the left hemisphere and their relationship to the dural venous sinuses. External Cerebral Veins
  • 90. Internal Cerebral Veins VEIN AREA DRAINS INTO Thalamostriate Basal ganglia, thalamus, internal capsule,Tela choroidae of 3rd ventricle, hippocampus - Both veins (of each side) unite to form Internal Cerebral vein - Rt. & Lt. Internal cerebral veins unite to form Great Cerebral vein –The Great cerebral vein join the Inferior Sagittal sinus to form Straight sinus DURAL VENOUS SINUS Choroidal
  • 91. The internal (deep) cerebral veins, viewed from above after removal of the central portion of the corpus callosum. Internal Cerebral Veins
  • 92. The cerebral venous system (viewed from the left side) showing the principal superficial and deep veins of the brain and their relationship to the dural venous sinuses. The more deeply placed veins are shown in blue and those inside the brain are shown in interrupted blue.
  • 93. Straight sinus Straight sinus Transverse sinus Transverse sinus Sigmoid sinus Sigmoid sinus Confluence of sinus Confluence of sinus Jugular foramen Jugular foramen Cavernous sinus Superior petrosal sinus Superior petrosal sinus Inferior petrosal sinus Inferior petrosal sinus Superiorsa gittal sinus Superiorsa gittal sinus
  • 94. Falx cerebriFalx cerebriSuperior sagittal sinusSuperior sagittal sinusInferior sagittal sinus Inferior sagittal sinus Straight sinus Straight sinus Tentorium cerebelli Tentorium cerebelli * Superior petrosal sinus Superior petrosal sinus Inferior petrosal sinus Inferior petrosal sinus Sigmoid sinus Sigmoid sinus Confluence of sinus Confluence of sinus Transverse sinus Transverse sinus
  • 96. Cavernous sinus Lateral to body of sphenoid bone Connected to opposite – intercavernous S Receives blood Middle cerebral V Drains into Int Jugular V –via Inf petrosal sinus Transverse S – via Sup petrosal S Dural Venous sinuses – emissary veins – extracranial V
  • 97. Stroke or cerebrovascular accident:- Blockage in the artery – cerebral infarction Carotid artery Basilar artery Bleeding within the brain – intracerebral haemorrhage Aneurysm Subarachnoid haemorrhage Intracerebral haemorrhage - hypertension Damages one side of the body - contralateral Clinical Application
  • 98. CVA – due to blockage
  • 99. CVA – due to haemorrhage