Blood Supply of Brain

&
Spinal Cord
Blood Supply of Spinal Cord:
-receives blood supply from 3 longitudinal
arteries channels that extend along
length of cord.
-anterior spinal arteries is present in
relation to anterior median sulcus.
-two posterior spinal arteries one on each
side run postero lateral sulcus
-in addition, piamater covering spinal cord
has arteries plexus called arteria
vasocorona.
-main source of blood supply to spinal
arteries is from vertebral arteries (from
where anterior & posterior spinal
arteries take origin)
-but blood from vertebral arteries
reach only up to cervical
segment of cord.
-spinal arteries also receives blood
through radicular arteries that
reach cord along roots of spinal
nerves
-radicular arteries arise from
spinal branches of vertebral,
ascending cervical, deep
cervical, intercostal, lumbar &
sacral arteries.
-one anterior radicular branches is
very large & called arteria
radicularis magna.
-veins of spinal cord are arranged
in form of six longitudinal
channels: anteromedian,
posteromedian, & paired
anterolateral & posterolateral
-these channel are interconnected
by plexus of veins that form
venous vasocorona
-blood from these veins is drained
by radicular veins that opens
into a venous plexus lying
between dura & vertebral canal
(epidural or internal plexus) &
through it into various
segmental veins.
Arterial Supply of Cerebrum:
-the main arteries are internal carotid,
vertebral & basilar artery.
Cerebral part of internal carotid artery:
-piercing duramater forms roof of cavernous
sinus:-gives 3 large branches:
1) Ophthalmic artery supplies orbit.
2) Anterior cerebral artery
3) Middle cerebral artery
-two smaller branches are
1) Posterior communicating artery
2) Anterior choroidal artery.
Anterior Cerebral Artery:
-arises from internal carotid
artery below ant. perforated
substance, lateral to optic
chiasm
-runs medially crossing above
optic nerve to longitudinal
fissure of two cerebral
hemisphere.
-arteries of two sides lie close
together & are united to
each other by ant.
communicating artery
-artery turns to reach genu of
corpus callosum
-winds round front of genu &
runs backwards just above
body of corpus callosum
-recurrent branch of anterior
cerebral artery(artery of
Heubner) runs laterally
backwards to enter anterior
perforated substances
Middle Cerebral Arteries:
-runs laterally in depth of stem of
lateral sulcus
-curves on to superolateral surface
& runs backwards in depth of
posterior ramus of lateral
sulcus
-its cortical area supply entire
lateral surface of hemisphere
except leg area supplied by
ACA
-central branch supply lentiform &
caudate nucleus
Posterior Communicating Artery:
-runs backward & anastamoses
with posterior cerebral artery
help to complete circle of
Willi’s.
Cranial Part of Vertebral a.:
-gives the following branches:
1)Meningeal branches: supply bone &
dura in post cranial fossa
2)Posterior spinal artery: may arise from
vertebral a. or post.inferior
cerebellar a.-supplies post 1/3rd of
spinal cord.
3)Ant. spinal a.:supplies ant 2/3rd of
spinal cord
4)Post.inf. Cerebellar artery: largest
branch supplies vermis, central
nuclei of cerebellum, part of
cerebellar hemisphere, medulla &
choroid plexus of 4th ventricle.
5)Medullary artery: small branches
supplies to medulla oblangata.
Basilar Artery & its
branches:
-formed union of left & right
vertebral arteries at lower
border of pons.
-ascends in midline ventral to
pons & ends at its upper border
by dividing right & left posterior
cerebral arteries.-Branches are
following :
1)Pontine artery: supplies pons
2)Labyrinthe artery: supplies
internal ear.
3)Ant. inf cerebellar artery:
supply ant & inf. part of
cerebellum
4)Sup. Cerebellar artery: Supplies
surface of cerebellum.- also
gives supply to pineal gland &
superior medullary velum.
Posterior Cerebral Artery:
-joined by post. communicating
artery branch of internal carotid
artery
# cortical branches: supplies
inferior & medial surface of
temporal lobe, lat & medial
surface of occipital lobe thus
supplies the visual cortex.
# central branches supplies parts
of thalamus, lentiform nucleus,
mid brain, pineal gland & MGB
# choroidal branches supplies
choroid plexus of lateral
ventricle & 3rd ventricle.
Arterial supply of
Cerebral Hemisphere:
-Anterior, middle & posterior
cerebral arteries give rise to
two sets of branches. 1)
cortical & 2) central.
Arterial supply of cerebral cortex:
-is supplied by cortical branches of
anterior, middle & posterior
cerebral arteries
-greater part of superolateral part
is supplie by middle cerebral
artery except strip about 2 cm
wide along superomedial
border extending form frontal
pole to parieto occpital sulcus
is supplied by ACA. The area
belonging to occipital lobe is
supplied by PCA. Inferior
temporal gyrus is also supplier
by PCA.
-main artery supplying medial
surface is anterior cerebral
artery(ACA) except in occipital
lobe supplies PCA
-in inferior surface, lateral part of
orbital surface is supplied by
MCA & medial part is supplied by
ACA.- also tentorial surface is
supplied by PCA but temporal
pole is supplied by MCA.
So main somatic & sensory areas is
supplied by MCA except in upper
most part leg which is supplied
by ACA and also auditory area
supplied by MCA & visual area
by PCA.
Arterial supply of other parts of
Cerebral Hemisphere
-internal capsule is supplied by
central branches of middle
cerebral artery (lenticulostriate
branches), anterior cerebral
artery(Heubner’s recurrent
branch), posterior communicating
artery & anterior choroidal artery.
-corpus striatum is chiefly by
anterolateral central branches of
middle cerebral artery & partly by
anteromedial central branches
from anterior cerebral & anterior
communicating arteries.
-thalamus is chiefly by postero
medial & posterolateral central
branch of posterior cerebral
artery & party by anteromedial
branches.
Choroid Plexuses:
-choroid plexus of lateral & third
ventricles are supplied by
anterior choroidal artery
branch of ICA. & posterior
choroidal artery branch of PCA
-choroid plexus of 4th ventricle is
supplied by branch from
posterior inferior cerebellar
artery.
Anatomical Pecularities of
Cerebral Arteries:
# circulus arteriosus (circle of willis)
#BBB formed by structures between
blood & nerve cells. Thus the BBB is
made up of vessels wall, arachnoid
layer, perivascular space, neuroglia &
ground substance of brain.- it permits
selective pasage of blood contents to
nervous tissue so toxic & harmful
substances are prevented from
reaching brain.
#central branches of cerebral arteries are
end arteries so thrombosis of any of
them will cause infarction.
Veins of the Cerebrum
Characteristics of Veins:
-walls are devoid of muscles
-no valves
-maintain patency some of them
open into cranial sinuses
against direction of blood flow
in sinus. eg. Superior cerebral
veins draining into superior
saggital sinus.
External Cerebral Veins:
-six to twelve in number-drain
superolateral surface of hemisphere
& terminate in superior saggital
sinus.
-superficial middle cerebral vein-
drains area round posterior ramus
of lateral sulcus-terminates in
cavernous sinus or sphenoparietal
sinus. –through superior & inferior
anastomotic veins communicates
with SSS & Transverse sinus. – also
communicates with deep middle
cerebral veins.
Deep median cerebral vein
-drains surface of insula &
terminates in basal vein.
Inferior cerebral veins
-several in number-divided into
orbital & tentorial veins.-orbital
veins terminate in superior
cerebral veins or in posterior
saggital sinus-tentorial veins
terminate in cavernous or any
other surrounding sinus
Anterior cerebral veins:
-small veins drain into corpus
callosusm & anterior part of
medial surface of hemisphere-
terminate into basal veins.
Internal Cerebral Veins:
-one vein on each side-formed by
union of thalamostriate &
choroidal veins at apex of tela
choroidea of 3rd ventricle
-right & left veins runs posteriorly
parallel to each other in tela
chorodea & unite together to
form great cerebral vein below
the splenium of corpus
callosum
Terminal Veins
-Great cerebral vein:- single
median vein formed by union of
two internal cerebral veins. –
terminates into straight sinus-
tributaries are basal veins &
veins from pineal body, colliculi,
cerebellum & adjoing part of
occipital lobe of cerebrum
-Basal veins:-one on each side- is
formed by union of deep middle
cerebral veins, anterior cerebral
veins & striate veins- runs
posteriorly winds round cerebral
peduncle & terminates by
joining great cerebral vein
Blood supply of
Cerebellum:
-superior surface is supplied by
superior cerebellar branches of
basilar artery
-anterior part of inferior surface is
supplied by anterior inferior
cerebellar branch of same
artery
-posterior part of inferior surface
is supplied by posterior inferior
cerebellar artery.
-venous drainage to neighbouring
venous sinuses.
Blood supply of Brain
Stem:
-is supplied by branches from
posterior cerebral arteries,
including their central branches
both posteromedial &
posterolateral.
-pons is supplied by pontine
branches of basilar artery.
-medulla is supplied by medullary
branches of vertebral artery and
branch from posterior inferior
cerebellar artery
-veins of brainstem drain into
neighbouring venous sinuses
 Clinical Anatomy
-hemiplegia-due to internal capsule lesion caused by thrombosis
of lenticulostriate branches of MCA.
-lenticulostriate branch is also most frequently ruptured and
cause cerebral hemorrhage. Lesion causes hemiplegia, deep
coma & ultimately death.
-upper monoplegia is caused by thrombosis of Heubner’s
recurrent branch of ACA.
-thrombosis of terminal cortical branch of ACA causes lower
hemiplegia.
-thrombosis of posterior inferior cerebellar artery causes lateral
medullary syndrome (Wallenberg’s syndrome) – chracterised
by severe giddiness, dsyphagia, crossed hemianesthesia,
Horner’s syndrome, cerebellar symptoms.
 Clinical Anatomy
-pontine hemorrhage is charaterized by contralateral hemiplegia, deep
coma , pinpoint pupil, hyperpyrexia.
-cerebral vascular disease is quite common in old age due to
hemorrhage, thrombosis & embolism
-hypertensive encephalopathy, elevation of diastolic pressure is form a
multiple small lesions all over cirlce of Willis..knowna as Berry
aneurysm