Pathophysiology Blood is supplied to the brain by two major pairs of arteries: the internal carotid arteries (anterior circulation)

and the vertebral arteries (posterior circulation). The carotid arteries branch to supply most of the frontal, parietal, and temporal lobes; the basal ganglia; and part of the diencephalon (thalamus and hypothalamus). The major branches of the carotid arteries are the middle cerebral and the anterior cerebral arteries. The vertebral arteries join to form the basilar artery, which branches to supply the middle and lower parts of the temporal lobes, occipital lobes, cerebellum, brainstem, and part of the diencephalon. (Lewis, 2011) The brain requires a continuous supply of blood that will provide oxygen and glucose that neurons need in order to function. Blood flow to the brain must be maintained at 750 1000 ml/min, or 20% of the cardiac output for optimal brain functioning. If blood flow to the brain is totally interrupted , neurologic metabolism is altered in 30 seconds, metabolism stops in 2 minutes, and cellular death occurs in 5 minutes. (Lewis, 2011) The brain is normally well protected from changes in mean systemic arterial blood pressure over arrange from 50 to 150 mm Hg by a mechanism known as cerebral autoregulation. This involves changes in the diameter of the cerebral blood vessels in response to changes in pressure so that the blood flow to the brain stays constant. Cerebral autoregulation may be impaired following cerebral ischemia, and cerebral blood flow then changes directly in response to changes in BP. CO2 is a potent cerebral vasodilator, and changes in arterial CO2 levels have a increase cerebral blood flow and vice versa. Atherosclerosis is a major cause of stroke. It can led to thrombus formation and contribute to emboli. Initially there is abnormal infiltration of lipids in the intimal layer of the artery. Lewis, SL. (2011). Medical surgical nursing. St. Louis Missouri: Elsevier Mosby.

The internal carotid arteries and the vertebral arteries, are the two major pairs of arteries that supply blood to the brain. The temporal lobe, parietal, frontal, basalganlia; and the diencephalon (thalamus and hypothalamus) are supplied mainly by the carotid arteries. The anterior cerebral arteries and middle cerebral are the major branches of the carotid arteries, the basilar artery is then formed by joining the vertebral arteries which branches to supply blood to the occipital lobes, the middle and lower parts of the temporal lobes, cerebellum, part of the diencephalon, and the brainstem. ( Lewis, 2011) Neurons within the brain requires a continuous supply of oxygen and glucose in

order to function. The blood flow to the brain should be sustained between 7501000mls/min or 20% of the cardiac output for an ideal brain functioning. Once blood flow to the brain is absolutely interrupted, the persons metabolism stops in 2 minutes, neurologic metabolism is altered in 30 seconds, and cellular death occurs in 5 minutes. ( Lewis, 2011) When the arterial blood pressure is between the ranges of 50 to 150 mm hg the brain is usually well protected by a mechanism known as cerebral autoregulation. In cerebral autoregulation the cerebral blood vessels changes its diameter according to the pressure so that blood flow to the brain remains constant. Cerebral autoregulation may be impaired following cerebral ischemia, and cerebral blood flow then changes directly in response to changes in the BP. CO2 is a potent cerebral vasodilator, changes vasodilator, and changes in arterial CO2 levels have a increase cerebral blood flow and vice versa. (Lewis, 2011)