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Cerebrovascular Review

Jobi Whiting, M.D.

Cerebral Blood Supply

Four vessels
Paired internal carotid

arteries Paired Vertebral Arteries

Join to form single basilar artery

Cerebral Blood supply

Dual Circulations
Anterior Bilateral internal carotid arteries

Posterior Bilateral vertebral arteries Single basilar artery

Cerebral Blood Supply

Dual Circulations
Anterior

Bilateral internal carotid arteries Bilateral vertebral arteries Single basilar artery Separated by tentorium

Posterior

Cerebral Blood Source

Heart
20% of cardiac output destined for brain

Aortic Arch
First 3 major branches go to or send branches to

intracranial space

Brachiocephalic (innominate)
First branch right common carotid artery

Left common carotid Left subclavien


First branch left vertebral artery

Internal Carotid Artery

Paired arteries Major source of anterior intracranial blood supply Common carotid artery bifurcates @ level of C3C5 in neck
Internal carotid

No extracranial branches Supplies scalp, face, dura

External carotid

Internal Carotid Artery

Internal Carotid Artery

Intracranial portion has several important branches


Opthalmic artery

Posterior communicating artery


T-junction bifurcation Anterior cerebral artery Middle cerebral artery

Opthalmic Artery

T-junction bifurcation of ICA

Anterior cereb artery

Middle Cerebral artery T-junction Bifurcation of ICA

Anterior Cerebral Artery

Smaller of T-junction bifurcation branches Courses medially to interhemispheric fissure Veers superiorly & posteriorly into interhemispheric fissure to course over medial aspect of hemisphere

Anterior Cerebral Artery

Anterior Cerebral Artery

Anterior Cerebral Artery


CM

PC A2

ACA Vascular Territory

Middle Cerebral Artery

Larger branch of T-junction ICA bifurcation Courses laterally into Sylvian Fissure Supplies lateral hemisphere Small perforating branches from horizontal portion feed deep subcortical structures
Lenticulostriate arteries

Middle Cerebral Artery

Middle Cerebral Artery

Midddle Cerebral Artery

M3 M4 M2 M1

MCA Vascular Territory

Anterior Communicating Artery

Single artery connecting right and left anterior cerebral arteries Represents major anastomotic site for anterior circulation Part of Circle of Willis

Anterior Communicating Artery

Vertebral Artery

Posterior Circulation Paired arteries Major branches


Anterior spinal artery

Single midline artery fed from bilateral vertebral arteries Paired arteries

Posterior spinal arteries

Posterior inferior cerebellar artery (PICA)

Vertebral Artery

Vertebral Arteries

Basilar Artery

Single midline artery formed from junction of bilateral vertebral arteries Courses superiorly and anteriorly over ventral aspect of pons Multiple small perforating branches supplies pons

Basilar Artery

Major branches
Anterior inferior cerebellar arteries (AICA) Superior cerebellar arteries (SCA)

Posterior cerebellar arteries Final branches from tip of basilar artery

Basilar Artery

Cerebellar arteries

Posterior Cerebral Arteries

Final branches off tip of basilar artery Bilateral Major source of blood to midbrain and occipital lobe Course laterally and posteriorly around cerebral peduncles to occipital lobe Small perforating branches near midline to thalamus
thalamoperforators

Posterior Cerebral Arteries

PCA Vascular Territory

Circle of Willis

Anastomotic system between distinct intracranial circulations Connects right and left anterior circulations
Anterior communicating artery

Connects posterior and anterior circulations bilaterally


Posterior communicating arteries

Circle of Willis

Cerebral Venous Drainage

Superficial draining veins Deep draining veins Dural sinuses

Deep Cerebral Veins

Superficial Cerebral Veins

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