Blood Supply

Generalitati
4 artere magistrale: 2 ACI si 2 a.vertebrale; ACI: iriga 2/3 ant.ale emisf.cerebrale; a.vertebrale+tr.bazilar: iriga 1/3 post.emisf.cerebrale, cerebelul si tr.cerebral; linia de separare intre cele 2 sist.: c.mamilari scizura parieto-occipitala int.; cele 2 sist. sunt unite la baza creierului prin poligonul Willis; a. trimit 2 tipuri de ramificatii: sist.vaselor corticale(superficial) si sist.vaselor centrale(profund); cele 2 sist. de ramificatii sunt independente si nu se suplinesc; in subst.cerebrala arterele au caracter terminal;

Sistemul arterei carotide interne

la baza craniului ACI strabate can.carotidian din int.stancii temporalului loja cavernoasa la niv.apf.clinoide ant.se angajeaza in sp.subarahnoidian al reg.valeculare la marg.lat.a chiasmei opticese termina prin bifurcare in: a.cerebrala ant.si a.cerebrala lat.;

in can.carotidian are traiect oblic ascendent; ramuri: periostice si a.carorico-timpanica;

in loja cavernoasa are traiect sinuos(S culcat)= sifon carotidian 3 seg.: C5 proximal, vertical ascendent, medial ggl.Gasser; C4 intermediar, orizontal, paralel cu planseul seii turcesti; C3 distal, vertical; ramuri: meningeene, n III, IV, VI, V, a.hipofizara inf.;

Sistemul arterei carotide interne

in reg.valeculara a sp.subarahnoidian: la niv.apf.clinoide ant.strabate dura si arahnoida si patrunde in sp.subarahnoidian(seg C1 si C2) se angaj.post.pe sub n.optic lat.si ascendent sp.perforat ant. terminare: a.cerebrale ant.si lat.; colaterale: a.hipofizara sup., a.oftalmica, a.comunicanta post.si a.choroidiana ant.; A.hipofizara sup.: se ramifica in jurul eminentei mediene a hipotalamusului si a tulpinei hipofizare; in capilarele ei se varsa fact.eliberatori hipotalamici sist.venos port hipofizar adenohipofiza;

Sistemul arterei carotide interne

A.oftalmica: patrunde prin can.optic in orbita(lat.n.optic) ramuri pt.globul ocular si anexe; r.supraorbitara, frontala int.si nazala se anast.cu r.din ACE surse imp.de suplinire intre cele 2 carotide;

Sistemul arterei carotide interne

A.comunicanta post.: se anast.cu seg.proximal(P1) al a.cerebrale post., form.marginile lat.ale poligonului Willis; ramuri: pt.chiasma optica, 1/3 ant.talamus, subtalamus si hipotalamusul lat,; A.choroidiana ant.: 2 port. cisternala(in cisterna interpedunculara) si distala(se termina in plex.choroide din CT si se anast.cu a.choroidiana post-lat); ramuri: pt uncusul parahipocampic, lobul piriform, nc.amigdalian, tract optic, p.lat.corp geniculat lat., radiatiile optice, caps.int. (genunchi, ant brat post, seg retrolenticular), coada nc.caudat, putamen, f.lat.talamus, 1/3 ant bazis peduncul cerebral, extremit.rostrala nc.rosu;

Artera cerebrala anterioara

anatomic si angiografic prez. 3 seg.:

A1 de la originefis.interemisferica; sit.in cisterna chiasmatica, initial

lat.chiasmei, incruciseaza sup.n.optic si se sit med.;

A2 patr.in fis.interemisferica si imbratiseaza genunchiul c.calos; la

jonct. A1 cu A2 cele 2 a.cerebrale ant.sunt unite prin a.comunicanta ant.;

A3 sit.pe fata med. emisfera cerebrala, deasupra c.calos =

a.pericaloasa iriga f.med.lob parietal si precuneusul;
frontala, a.fronto-polara, a.caloso-marginala;

Ramuri: centrale a.lenticulo-striate med. si corticale a.orbito-

Artera cerebrala anterioara

1. a.lenticulo-striate med.: origine seg.A1; patr.prin orif.sp.perforat
ant.si vasc.chiasma si hipotal.preoptic; imp.: a.recurenta Heubner iriga p.ant-med cap nc.caudat, p.adiacenta caps.int., putamen, aria septala; si tract.olfactiv;

2. a.orbito-frontala: origine seg.A1; iriga: p.med. lob.orbitar, bulbul

3. a.fronto-polara: origine - seg.A2; iriga: polul frontal si f.med.lob
frontal;

4. a.caloso-marginala: origine seg.A3, sit.in s.cingular; ramuri:

a.frontale int.-ant., mijl.si post. f.med.lob frontal;

Artera cerebrala anterioara

A.pericaloasa post. ramuri pt.f.med.lob parietal:
a.paracentrala, a.parietala int. sup. si a.parietala int. inf. (precuneusului); Toate r.corticale inconj.marg sup.si trec pe f.lat.a emisferei unde iriga toata z.parasagitala pe o lat.de 1-2 cm, cu exceptia lob.occipit.; Din seg A2 si A3 mai pornesc ram.pt.: girus.cingular, c.calos (except.slenius), col.fornix, septum pellucid si comis.alba ant.;

Artera cerebrala laterala(mijlocie)

4 seg.: M1 la baza creierului si se indreapata lat.spre orig.fis.lat.; M2 intra in fundul fis.lat,cu dir.post si sup,pe f.lat. l.insulei; M3 coresp.p.post.a fis., unde devine superfic.; M4 seg.terminal;

Artera cerebrala laterala(mijlocie)

Ramuri: centrale-a.lenticulo-striate lat. si corticale;

1. a.lenticulo-striate lat.: patr.prin orif.sp.perforat ant. cap

nc.caudat, putamen, pallidus lat., genunchi si dorsala brat post.caps.int., claustrum si caps.ext.;

2. a.orbito-frontala: lat.lob orbito-frontal si f.lat.lob prefrontal; 3. r.din M2: precentral, postcentral, parietal ant. si parietal post.; se
gasesc in triunghiul sylvian;

4. r.temporale: ant., mijl.si post.; r.temporo-polar; iriga f. lat. lob

temporal;

5. r.angular: ram terminal, iriga girusul angular si p.ant. lob occipital;

Sistemul vertebro-bazilar
A.vertebrale converg la marg.caudala a puntii si form.tr.bazilar; tr.bazilar sta pe mijl. f.ventrale a puntii marg.sup.a puntii se bifurca in a.cerebrale post;

Artera vertebrala
Origine: a.subclaviculara; Traiect: ascendent si medial spre foramen apf.transverse C6 urca impr.cu n.vertebral pana la niv.gaurii transverse a axisului curba spre inafara catre gaura transvera a atlasului strabate gaura atlas ocoleste masa lat atlas in sus si med si strab.mb.occipito-atloidiana si foramen magnum in craniu sp.subarahnoid.(strab.dura si arahnoida) f.lat bulb(ant. de n XII) si aj.pe f.ventrala a bulb la marg.caudala punte se uneste cu opusa si form.tr.bazilar;

Artera vertebrala
Ramuri colaterale:
Cervicale: r.musculare si rahidiene; Intracraniene: a.spinale ant.si post.; a.bulbare; a.cerebeloasa post.-inf.;

Trunchiul bazilar
sit.in cisterna prepontina, post.clivusului; la marg.sup.a puntii se bifurca in cele 2 a.cerebrale post.;

Ramuri colaterale:
A.paramedienepunte; A.cerebeloase ant-inf si sup.; A.radicularen VI, VII, VIII; A.labirinticameat auditiv int.urechea interna;

Artera cerebrala posterioara

anatomic si angiografic prez.3 seg.: P1 seg.peduncular(f.ventrala a pedunc.); tine pana la locul de implantare a a.comunic.post.; sit.in cisterna interpedunculara; P2 latero-peduncular; inconjura f.lat.mezencefal(in cisterna ambiens); se angaj.prin incizura tentoriumuluiloja supratentoriala, in dreptul colic.quadrigemeni(cisterna cerebrala sup.); P3 trece pe sub splenium si se aseaza pe f.inf-med a lob.temp.; de aici se indreapta post. si se imparte in 2 r.terminale: a.temp.post.si a.occipit.int.;

Artera cerebrala posterioara

Ramuri centrale: 3 grupuri
1. gr.post-med r.din P1; o parte vasc.hipofiza, infundibulului si reg.tuberale a hipotalam.; alta parte(r.prof.) strab.sp.perforat post. si vasc.p.ant-med talamus, subtalamusului si c.mamilari, p.med.tegment mezencefalic; 2. gr.post-lat(talamo-geniculat) r.din P2; iriga pulvinarul, f.lat-dorsala si ventrala talamus, c.geniculati, tectumul si p.lat.mezencefal; 3. gr.a.choroidiene post. 1 med si 2 lat.; A.choroid.post-med se desprind r.pt.colic.quadrigemeni si nc.dorsomed talamus; se termina in plex,choroide V III; A.choroid.post-lat ant si post; r.ant.se termina in plex.choroide CT; r.post. Iriga fornixul, pulvinarul, cgl, nc.dorso-med.talamus;

Artera cerebrala posterioara

Ramuri corticale:
3 a.temp ant, mijl.si post.f.inf.lob temp.; trec si pe f.lat.a lob.temp. si se anast. Cu r.temp.ale a.cerebrale lat.;

Ramuri terminale:
1. a.temp.post. iriga f.inf.lobi temp si occipit.; 2. a.occipit.int. 2 r. de bifurc.: r.parieto-occipit si r.calcarin; iriga f.int.lob occipit.si splenium; a.calcarina iriga cortexul vizual;

Circulatia cerebrala venoasa

Venele emisf.cerebrale:
1. v.superfic. form.o bogata retea piala; dreneaza sg.cortexului si al subst.albe subcorticale; se impart in v.ascendente si v.descendente; a) v.ascendente: dorsala f.lat.si med.se varsa sub unghi ascutit(in contracurent); toate se varsa in sinus.longit.sup.; b) v.descendente: inf.f.lat. si inf.sinus.ven.bazei; imp: v cerebrala lat.superficsinus.cavernos; afluenti: v.lui Trolard(uneste cu sinus.longit.sup.) si v.lui Labee(uneste de sinus.transvers); inf.f.medv.cerebrale prof.;

Circulatia cerebrala venoasa

Venele emisf.cerebrale:
2. v.prof. dren.sg. diencefalului, ggl.bazali, subst.albe prof., plex.choroide; de fiecare parte exista cate o v.cerebrala int.si o v.bazala; V.cerebrala int.: se form.in dreptul orif. Monro din unirea a 3 vene: v.talamo-striata(c.striat, caps.int., talamus, fornix); v.septala(septum pellucid, genunchiul c.calos); v.choroidiana(plex.choroide, hypocamp, fornix, c.calos); v.cerebrala int. se sit.init.pe f.dorsala talamus(lat.striei medulare)se dirij.post., trece lat.de epifiza(primeste v.epitalamice) si se varsa in v.cerebrala mare.

Circulatia cerebrala venoasa

Venele emisf.cerebrale:
V.bazala(Rosenthal): origine v.cerebrala ant.unita cu v.cerebrala lat.prof.,in dreptul sp.perforat ant.; v.cerebrala ant. aduna sg.de la niv.cortex.orbit., p.rostrala c.calos, girusul cingular; v.cerebrala lat.prof. aduna sg.de la niv.cortex.insular, operculului parietal, o parte a talamus., ggl.bazali; v.bazala se dirij.post.in lungul f.inf-med a lob.temp.trece prin port.lat.a fis.cerebrale transverseinconjura f.lat.mezencefalv.cerebrala mare; Afluenti: sg.de la tract optic, hipotalamus, lob temporal si mezencefal;

Circulatia cerebrala venoasa

V.cerebrala mare a lui Galien:
Origine: unirea v.cerebrale int.; iese din profunz.pe sub splenium si se varsa in sinusul drept; Afluenti: v.bazale, v.occipitale(f.med.si inf.lob occipit.), v.hypocamp., v.fornix., v.caloasa post., v.cerebeloasa vermiana sup.;

Venele cerebelului
real.o bogata retea piala, drenata de mai multe vene; V.vermiana sup. v.cerebrala mare; V.vermiana inf. confluens sinuum; 2 v.ventrale sinus.pietroase; 2 v.dorsale sinus.transverse;

Venele trunchiului cerebral

V.mezencefalului v.cerebrala mare, v.cerebrale int., v.bazale; V.puntii si sup.bulb sinus.pietroase; V. inf.bulb v.spinale, v.condiliene, plex venos rahidian.

Spinal Cord

Vascular Supply

Arterial Supply
- Spinal Arteries Anterior (1) & Posterior (2) Spinal Artery from Vertebral artery - Radicular Arteries ----- Segmental arteries from Vertebral, Ascending Cervical, Intercostal and Lumbar Artery

Venous Drainage
- Longitudinal & Radicular Veins to Intervertebral veins ---- to Internal Vertebral Venous Plexus to external vertebral venous plexus ---- to segmental veins

5. Adamkiwicz artery

anterior spinal artery

segmental arteries

Blood Supply to the Spinal Cord and Brain Stem

The brain is one of the most metabolically active organs in the body, receiving 17% of the total cardiac output and about 20% of the oxygen available in the body.

The brain receives its blood from two pairs of arteries, the carotid and vertebral. About 80% of the brains blood supply comes from the carotid, and the remaining 20% from the vertebral.

The Vertebrobasilar System

The vertebral arteries originate from the subclavian artery, and ascend through the transverse foramen of the upper six cervical vertebra. At the upper margin of the Axis (C2) it moves outward and upward to the transverse foramen of the Atlas (C1). It then moves backwards along the articular process of atlas into a deep groove, passes beneath the atlanto-occipital ligament and enters the foramen magnum. The arteries then run forward and unite at the caudal border of the pons to form the basilar artery.

Blood Supply to the Spinal Cord and Brainstem

The Spinal Cord receives its blood supply from two major sources; 1. Branches of the vertebral arteries, the major source of blood supply, via the anterior spinal and posterior spinal arteries. 2. Multiple radicular arteries, derives sporadically from segmental arteries

The Medulla, Pons and Midbrain areas receive their major sources of blood supply from several important branches of the Basilar artery

Branches of the Vertebral Artery

1. Posterior Inferior Cerebellar Artery (PICA), the largest branch of the vertebral, arises at the caudal end of the medulla on each side. Runs a course winding between the medulla and cerebellum Distribution: a. posterior part of cerebellar hemisphere b. inferior vermis c. central nuclei of cerebellum d. choroid plexus of 4th ventricle e. medullary branches to dorsolateral medulla

Branches of the Vertebral Artery

2. Anterior Spinal Artery, formed from a Yshaped union of a branch from each vertebral artery.

Runs down the ventral median fissure the length of the cord.
Distribution: a. supplies the ventral 2/3 of the spinal cord.

Branches of the Vertebral Artery

3. Posterior Spinal Arteries (2), originate from each vertebral artery or Posterior Inferior Cerebellar on each side of the Medulla. Descends along the dorsolateral sulcus. Distribution: supplies the dorsal 1/3 of the cord of each side.

Branches of the Vertebral Artery

4. Posterior meningeal, one or two branches that originate from the vertebral opposite the foramen magnum. This branch moves into the dura matter of the cranium 5. Bulbar branches, composed of several smaller arteries which originate from the vertebral and its branches. These branches head for the pons, medulla and cerebellum

Spinal Cord Blood Supply

Ventral

Dorsal

Spinal Cord Blood Supply

Anterior Spinal Artery, provides sulcal branches which penetrate the ventral median fissure and supply the ventral 2/3 of the spinal cord. Posterior Spinal Arteries, each descends along the dorsolateral surface of the spinal cord and supplies the dorsal 1/3.

Spinal Cord Blood Supply

Radicular arteries, originating from segmental arteries at various levels, which divide into anterior and posterior radicular arteries as they move along ventral and dorsal roots to reach the spinal cord. Here they reinforce spinal arteries and anastomose with their branches. From these varied sources of blood supply, a series of circumferential anastomotic channels are formed around the spinal cord, called the arterial vasocorona, from which short branches penetrate and supply the lateral parts of the cord

Spinal Cord Blood Supply

The radicular arteries provide the main blood supply to the cord at the thorasic, lumbar and sacral segments. There are a greater number on the posterior (10-23) than anterior (6-10 only) side of the cord.

One radicular artery, noticeably larger than the others, is called the artery of Adamkiewicz, or the artery of the lumbar enlargement. Usually located with the lower thorasic or upper lumbar spinal segment on the left side of the spinal cord

Spinal Cord Blood Supply

The spinal cord lacks adequate collateral supply in some areas, making these regions prone to ischemia after vascular occlusions. The upper Thorasic (T1-T4) and first lumbar segments are the most vulnerable regions of the cord.

Spinal Cord Blood Supply

There are several arteries that reinforce the spinal cord blood supply and are termed segmental arteries 1. The Vertebral arteries, spinal branches which are present in the upper cervical (~C3-C5) levels

2. Ascending Cervical arteries, present in the lower cervical areas

3. Posterior Intercostal, present in the mid-thorasic region 4. First Lumbar arteries, present in the mid-lumbar regions

Spinal Cord Blood Supply

The spinal veins arranged in an irregular pattern. The anterior spinal veins run along the midline and the ventral roots. The posterior spinal veins run along the midline and the dorsal roots. These are drained by the anterior and posterior radicular veins. These in turn empty into an epidural venous plexus which connects into an external vertebral venous plexus, the vertebral, intercostal and lumbar veins.

Spinal Cord Blood Supply

Occlusion of the anterior spinal artery may lead to the anterior cord syndrome, characterized by; 1. Loss of ipsilateral motor function, due to damage to ventral gray matter and the ventral corticospinal tract. 2. Loss of contralateral pain and temperature sensation, due to damage to the spinothalamic pathway

Spinal Cord Blood Supply

Occlusion of the posterior spinal arteries may lead to the rare posterior cord syndrome, characterized by; 1. Ipsilateral motor deficits, due to damage to corticospinal tract 2. Ipsilateral loss of tactile discrimination, position sense, vibratory sense, due to damage to the dorsal columns

Blood Supply to the Brain Stem

The brain stem (medulla, pons midbrain) receives the bulk of its blood supply from the vertebrobasilar system. Except for the labyrynthine branch, all other branches supply the brain stem and cerebellum The posterior cerebral has only a small contribution, its main target being the posterior cerebral hemispheres

Branches of the Basilar Artery

1. Anterior Inferior Cerebellar Arteries (AICA), originates near the lower border of the Pons just past the union of the vertebral arteries. Distribution: a. supplies anterior inferior surface and underlying white matter of cerebellum b. contributes to supply of central cerebellar nuclei c. also contributes to upper medulla and lower pontine areas

Branches of the Basilar Artery

2. Pontine arteries, numerous smaller branches that can be subdivided into Paramedian and Circumferential pontine arteries. The Circumferential can be further subdivided into Long and Short pontine arteries.

Distribution:
a. paramedian pontine - basal pons b. circumferential pontine - lateral pons and middle cerebellar peduncle, floor of fourth ventricle and pontine tegmentum

Branches of the Basilar Artery

3. Superior Cerebellar arteries, originates near the end of the Basilar artery, close to the Pons-Midbrain junction. Runs along dorsal surface of cerebellum Distribution: a. cerebellar cortex, white matter and central nuclei b. Additional contribution to rostral pontine tegmentum, superior cerebellar peduncle and inferior colliculus

Branches of the Basilar Artery

4. Posterior cerebral arteries, the terminal branches of the Basilar artery. They appear as a bifurcation of the Basilar, just past the Superior Cerebellar arteries and the oculomotor nerve. Curves around the midbrain and reaches the medial surface of the cerebral hemisphere beneath the splenium of the corpus callosum Distribution: a. mainly neocortex and diencephalon b. some contribution to interpeduncular plexus

Branches of the Basilar Artery

5. Labyrynthine arteries, may branch from the basilar, but variable in its origin. Supplies the region of the inner ear

Blood Supply to the Medulla

The Medulla is supplied by the;

1. Anterior spinal artery, sends blood to the paramedian region of the caudal medulla.
2. Posterior spinal artery, supplies rostral areas, including the gracile and cuneate fasiculi and nuclei, along with dorsal areas of the inferior cerebellar peduncle. 3. Vertebral artery, bulbar branches supply areas of both the caudal and rostral medulla. 4. Posterior inferior cerebellar artery, supplies lateral medullary areas.

Blood Supply to the Medulla

Blood Supply to the Medulla

Occlusion of branches of the anterior spinal artery will produce a inferior alternating hemiplegia (aka medial medullary syndrome), characterized by; 1. A contralateral hemiplegia of the limbs, due to damage to the pyramids or the corticospinal fibers 2. A contralateral loss of position sense, vibratory sense and discriminative touch, due to damage to the medial leminiscus 3. An ipsilateral deviation and paralysis of the tongue, due to damage to the hypoglossal nucleus or nerve Occasionally, these symptoms will develop after occlusion of the vertebral artery before gives off its branches to the anterior spinal artery

Blood Supply to the Medulla

The posterior spinal arteries supply the gracile and cuneate fasiculi and nuclei, spinal trigeminal tract and nucleus, portions of the inferior cerebellar peduncle

Blood Supply to the Medulla

The vertebral arteries supply the pyramids at the level of the Pons, the inferior olive complex, the medullary reticular formation, solitary motor nucleus dorsal motor nucleus of the Vagus (cranial nerve X), hypoglossal nucleus (cranial nerve XII). spinal trigeminal tract, spinothalamic tract spinocerebellar tract

Blood Supply to the Medulla

The posterior inferior cerebellar arteries (PICA) supply spinothalamic tract, spinal trigeminal nucleus and tract, fibers from the nucleus ambiguous, dorsal motor nucleus of the Vagus (cranial nerve X) inferior cerebellar peduncle

Blood Supply to the Medulla

Occlusion of the posterior inferior cerebellar artery (or contributing vertebral) will produce a lateral medullary syndrome or Wallenbergs syndrome, characterized by; 1. A contralateral loss of pain and temperature sense, due to damage to the anterolateral system (spinothalamic tract) 2. An ipsilateral loss of pain and temperature sense on the face, due to damage to the spinal trigeminal nucleus and tract 3. Vertigo, nausea and vomiting, due to damage to the vestibular nuclei

4. Hornors syndrome, (miosis [contraction of the pupil], ptosis [sinking of the eyelid], decreased sweating), due to damage to the descending hypothalamolspinal tract

Blood Supply to the Pons

The Pons is supplied by the;

1. The Basilar artery, contributions of this main artery can be further subdivided; a. paramedian branches, to medial pontine region b. short circumferential branches, supply anterolateral pons c. long circumferential branches, run laterally over the anterior surface of the Pons to anastomose with branches of the anterior inferior cerebellar artery (AICA).
2. Some reinforcing contributions by the anterior inferior cerebellar and superior cerebellar arteries

Additional branches of the Basilar artery can be found branching off within the region of the Pons; 1. Anterior Inferior Cerebellar Arteries (AICA), originates near the lower border of the Pons just past the union of the vertebral arteries.
Distribution: a. supplies anterior inferior surface and underlying white matter of cerebellum b. contributes to supply of central cerebellar nuclei c. also contributes to upper medulla and lower pontine areas

Blood Supply to the Pons

Blood Supply to the Pons

2. Superior Cerebellar arteries, originates near the end of the Basilar artery, close to the Pons-Midbrain junction. Runs along dorsal surface of cerebellum Distribution: a. cerebellar cortex, white matter and central nuclei b. Additional contribution to rostral pontine tegmentum, superior cerebellar peduncle and inferior colliculus

2. Labyrynthine arteries, may branch from the basilar, but variable in its origin. Supplies the region of the inner ear. Divides into two branches; a. anterior vestibular b. common cochlear The labyrinthine has a variable origin, according to a study done by Wende et. al., 1975, (sample size of 238) the artery originated from; 1. Basilar (16%) 2. AICA (45%) 3. Superior cerebellar (25%) 4. PICA (5%) 5. Remaining 9% were of duplicate origin

Blood Supply to the Pons

Blood Supply to the Pons

The paramedian branches of the Basilar artery supplies the paramedian regions of the Pons, this includes corticospinal fibers (basis pedunculi), the medial leminiscus, abducens nerve and nucleus (cranial nerve VI) , pontine reticular area, and periaquaductal gray areas

Blood Supply to the Pons

The paramedian branches of the Basilar artery supply corticospinal fibers, the medial leminiscus, abducens nerve and nucleus (cranial nerve VI) , pontine reticular area, periaquaductal gray areas

Blood Supply to the Pons

Obstruction of the paramedian pontine arteries will produce a middle alternating hemiplegia (also termed medial pontine syndrome) which is characterized by; 1. Hemiplegia of the contralateral arm and leg, due to damage to the corticospinal tracts 2. Contralateral loss of tactile discrimination, vibratory and position sense, due to damage to the medial leminiscus 3. Ipsilateral lateral rectus muscle paralysis, due to damage to the abducens nerve or tract (can cause diplopia double vision)

Blood Supply to the Pons

The short circumferential branches supply, pontine nuclei, pontocerebellar fibers, medial leminiscus the anterolateral system (spinothalamic fibers)

Blood Supply to the Pons

The long circumferential branches supply, along with the anterior inferior cerebellar (caudally), and superior cerebellar artery (rostrally). middle and superior cerebellar peduncles, vestibular and cochlear nerves and nuclei, facial motor nucleus (cranial nerve VII) trigeminal nucleus (cranial nerve V) spinal trigeminal nucleus and tract (cranial nerve V), hypothalamospinal fibers, the anterolateral system (spinothalamic) pontine reticular nuclei.

Blood Supply to the Pons

Occlusions of long branches circumferential branches of the basilar artery produce a lateral pontine syndrome, characterized by; 1. Ataxia, due to damage to the cerebral peduncles (middle and superior) 2. Vertigo, nausea, nystagmus, deafness, tinitus, vomiting, due to damage to vestibular and cochlear nuclei and nerves 3. Ipsilateral pain and temperature deficits from face, due to damage to the spinal trigeminal nucleus and tract 4. Contralateral loss of pain and temperature sense from the body, due to damage to the anterolateral system (spinothalamic) 5. Ipsilateral paralysis of facial muscles and masticatory muscles, due to damage to the facial and trigeminal motor nuclei (cranial nerves VII and V)

Blood Supply to the Midbrain

The major blood supply to the midbrain is derived from branches of the basilar artery;
1. Posterior cerebral artery, forms a plexus with the posterior communicating arteries in the interpeduncular fossa, branches from this plexus supply a wide area if the midbrain 2. Superior cerebellar artery, supplies dorsal areas around the central gray and inferior colliculus with support from branches of the posterior cerebral artery. 3. Quadrigeminal, (some posterior choroidal) a branch of the posterior cerebral, provides support for the tectum (superior and inferior colliculi)

4. Posterior communicating artery, derived from the internal carotid, joins the posterior cerebral to form portions of the circle of Willis (arterial circle). Contributes to the interpeduncular plexus
5. Branches of these arteries are best understood when grouped into paramedian, short circumferential and long circumferential

Blood Supply to the Midbrain

The paramedian arteries, derived from the posterior communicating and posterior cerebral, form a plexus in the interpeduncular fossa, enter the through the posterior perforated substance, this system supplies raphe region, oculomotor complex, medial longitudinal fasiculus, red nucleus substantia nigra crus cerebri

Blood Supply to the Midbrain

Occlusion of midbrain paramedian branches produces a medial midbrain or superior alternating hemiplegia (or Webers syndrome) characterized by;
1. Contralateral hemiplegia of the limbs, and contralateral face and tongue due to damage to the descending motor tracts (crus cerebri). 2. Ipsilateral deficits in eye motor activity, caused by damage to the oculomotor nerve

Blood Supply to the Midbrain

The short circumferential arteries originate from the interpeduncular plexus and portions of the posterior cerebral and superior cerebellar arteries, this system supplies crus cerebri, substantia nigra midbrain tegmentum

Blood Supply to the Midbrain

The long circumferential branches originate mainly from the posterior cerebral artery, one important branch, the quadrigeminal (collicular artery) supplies the superior and inferior colliculi.

Blood Supply to the Midbrain

The posterior choroidal arteries originate near the basilar bifurcation into the posterior cerebral arteries. In addition to providing reinforement to the midbrain short and long circumferential arteries they move forward to supply portions of the diencephalon and the choroid plexus of the third and lateral ventricles

Other Clinical Points

Substantial infarcts within the Pons are generally rapidly fatal, due to failure of central control of respiration Infarcts within the ventral portion of the Pons can produce paralysis of all movements except the eyes. Patient is conscious but can communicate only with eyes. LOCKED-IN-SYNDROME

Blood Supply of the Brain

Arterial supply of the brain is derived from 2 pairs of vessels: Internal Carotid Arteries and the Vertebral Arteries.

Arteries of the Brain

The human brain requires a constant supply of oxygen. A lack of oxygen of just a few minutes results in irreversible damage to the brain.

Blood Supply of the Brain

Arterial supply of the brain is derived from 2 pairs of vessels----Internal Carotid Arteries and the Vertebral Arteries.

Internal Carotid Artery

Supplies much of the cerebrum (telencephalon and diencephalon) **Gets blood supply from the internal carotids Gives rise to the Middle and Anterior Cerebral Arteries and to 2 smaller branches the Anterior Choroidal Artery and the Posterior Communicating Artery.

Internal Carotid Artery

The Anterior Choroidal Artery supplies a number of different structures including optic tract, choroid plexus, cerebral peduncles, internal capsule, thalamus, and hippocampus.

Internal Carotid Artery

The Middle Cerebral Artery gives rise to many very small branches that penetrate the brain called Lenticulostriate Arteries and are referred to as preforating or ganglionic branches

Arterial Supply of the CNS

MCA-lateral surfaces of the frontal,occipital, temporal and parietal lobes, and insula.

Arterial Supply of the CNS

ACA- medial surfaces of the frontal and parietal lobes, cingulate gyrus, parts of the Basal Ganglia, and corpus callosum.

Arterial Supply of the CNS

The communicating arteries communicate or link the cerebral arteries by traveling across the midlines.

Vertebral-Basilar System
Supplies the brainstem and parts of the cerebrum and spinal cord. Gets blood supply from the subclavian artery.

Basilar Artery

Vertebral Aretries

Vertebral-Basilar System
The Vertebral Arteries are responsible for supplying the spinal cord, medulla, and parts of the cerebellum. The Basilar Arteries supply the internal ears, pons, as well as cerebellum.

Vertebral-Basilar System
The Vertebral Arteries give rise to 3 branches the posterior and anterior spinal arteries and the posterior inferior communicating artery (PICA).
** PICA supplies much of the inferior surface of the cerebellum, choroid plexus of the 4th ventricle, and the lateral medulla.

Vertebral-Basilar System
The Basilar Artery gives rise to the Anterior Inferior Communicating Artery (AICA).

**AICA supplies the

more anterior portions of the inferior surface of the cerebellum (ie the flocculus) as well as the caudal pons.

Vertebral-Basilar System
The basilar arteries branches out into the posterior cerebral arteries which supply the midbrain, occipital lobe, and medial surfaces of the temporal lobe.

Circle of Willis
The Posterior Communicating Artery links the Internal Carotid System to the Vertebral-Basilar System.

****Named after Thomas Willis

Circle of Willis
Surrounds the optic chiasm, infundibulum, and mammillary bodies and is important for the mechanism for collateral circulation following occlusion of blood flow.

Venous System
Cerebral veins are divided into Superficial and Deep groups. Cerebral veins are valveless and eventually empty into the internal jugular veins and then to the right atrium of the heart.

Venous System
Superficial veins empty into the Superior Sagittal Sinus.
Has three veins that are common from one brain to another--Superficial Middle Cerebral Vein, Vein of Trolard, and the Vein of Labbe`.

Venous System
Deep veins ultimately empty into the Straight Sinus The major deep vein is the Internal Cerebral Vein.

Blood Flow
The brain is very active metabolically yet there is no way for the brain to effectively store oxygen and glucose. The brain is 2% of total body weight yet accounts for 15% of cardiac output and 25% of oxygen consumption. Without oxygen damaging effects can happen---10 secs. of brain ischemia we lose conciousness, 20 secs. electrical activity ceases, after a few minutes irreversible brain damage begins (think Terri Schiavo)!!!! Brain damage can also happen if brain goes without glucose for 10-15 minutes.

Effects of Blood Supply damage

Normal blood flow is 55ml/100g of CNS. Reduction to about 20ml/100g causes neurons to stop generating electrical signals. Reduction to about 10ml/100g results in necrosis in brain tissue called an infaract and eventually a stroke.

Types of Strokes
Ischemic stroke- (those caused by vascular insufficiencies) are most commonly caused by a thrombus (a blood clot formed within the vessel) or an embolus (a bit of foreign matter such as a plaque that is carried along in the bloodstream).

Types of Strokes
Transient Ischemic attack- is like an ischemic attack but only last a few minutes to a few hours and usually has a complete recovery. Hemorrhage-results from the rupture of the small perforating arteries (lenticulostriate arteries). Greatly increased through hypertension. Aneurysms-balloon-like swellings of the arterial walls. Can cause damage by compressing brain structures and by rupturing the subarachnoid space.

Good Luck !