Brain vascular anatomy with MRA and MRI correlation

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Covers both Arterial and venous supply of brain .

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  • When local cerebral blood flow (LCBF) falls below 23 mL/100 mg, reversible paralysis occurs in this modelObjective – Anatomy of Vessels (location, origin branching pattern) Vascular territories
  • anterior circulationanterior choroidal arteryanterior cerebral artery (ACA)medial lenticulostriate arteriesmiddle cerebral artery (MCA)lateral lenticulostriate arteriesposterior circulationposterior cerebral artery (PCA)basilar arterysuperior cerebellar artery (SCA)anterior inferior cerebellar artery (AICA)posterior inferior cerebellar artery (PICA)
  • DSA image .. Ultravist – Iopromide (NIM) ;
  • MRA 3D v/s Diagramatic representation ..
  • 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
  • Direct branch of the vertebral arteries . As is Anterior Spinal Artery
  • Inferior to bifurcation of PCA The SCA branches off the lateral portion of the basilar artery, just inferior to its bifurcation into the posterior cerebral artery. Here, it wraps posteriorly around the pons (to which it also supplies blood) before reaching the cerebellum. The SCA supplies blood to most of the cerebellar cortex, the cerebellar nuclei, and thesuperior cerebellar peduncles
  • Just an introduction on the vascular territory of brain and water shed zones……
  • P1 peduncal arises near the intersection of the posterior communicating artery and basilar arteryBranches
  • BRANCHES --- CENTRAL + CHOROIDAL + CORTICALa group of small arteries which arise at the commencement of the posterior cerebral artery: these, with similar branches from the posterior communicating, pierce the posterior perforated substance, and supply the medial surfaces of the thalami and the walls of the third ventricle.The thalamogeniculateartery shown supplies thegeniculate bodies and theposterior two-thirds of thethalamus.Peduncular perforating or postero-lateral ganglionic branches: small arteries which arise from the posterior cerebral artery after it has turned around the cerebral peduncle
  • Anterior temporal, distributed to the uncus and the anterior part of the fusiform gyrusPosterior temporal, to the fusiform and the inferior temporal gyriMedial occipital, which branches into the:Calcarine, to the cuneus and gyruslingualis and the back part of the convex surface of the occipital lobeParieto-occipital, to the cuneus and the precuneus
  • As mentioned earlier IC and its branches form the anterior Circulation will discuss on details
  • The middle cerebral arteries supply the majority of the lateral surface of the hemisphere apart from the superior portion of the parietal lobe and the inferior portion of the temporal lobe and occipital lobe. In addition, they supply part of the internal capsule and basal ganglia.
  • Division of the MCA is variable after the horizontal segment, although most commonly, it divides into two trunks - superior and inferior :78% bifurcate into superior and inferior divisions 12% trifucate into superior, middle and inferior divisions 10% branch into many smaller branchescharcoats Supply the Corpus striatum, internal capsule, and Anterior ofthalamus.
  • # 50% in A2 44% in A1 6% from A Co A It supplies head of caudate and adjacent part of the internal capsuleCortical branches supply anterior 2/3rds of medial hemisphere . Small superior area extending over convexities
  • pericallosal artery *with the exception of the spleniumParacentral lobule – responsible for lower limb
  • Territory supplied by branches of the anterior and middle cerebral arteries is shown in red. Territorysupplied by the anterior choroidal artery is shown in green.
  • There are two patterns of border zone infarcts:1.Cortical border zone infarctions Infarctions of the cortex and adjacent subcortical white matter located at the border zone of ACA/MCA and MCA/PCA 2.Internal border zone infarctions Infarctions of the deep white matter of the centrum semiovale and corona radiata at the border zone between lenticulostriate perforators and the deep penetrating cortical branches of the MCA or at the border zone of deep white matter branches of the MCA and the ACA.
  • Just to summariz
  • Superior Sagittal SinusInfreior Sagittal Sinus Transverse sinus , sigmoid sinus Cavernous sinusws, superior and inferior petrosal sinusesFigure shows relationshi[
  • Brain vascular anatomy with MRA and MRI correlation

    1. 1. BRAIN :VASCULAR DR ARIF KHAN S
    2. 2. INTRODUCTION About 18% of the total blood volume in the body circulates in the brain, which accounts for about 2% of the body weight. loss of consciousness occurs in less than 15 seconds after blood flow to the brain has stopped, and irreparable damage to the brain tissue occurs in about 5 minutes. Blood supply = arterial supply + venous drainage
    3. 3. ARTERIAL SUPPLY Anterior circulation Posterior circulation Major vessels : Internal carotid ; Vertebral arteries
    4. 4. CIRCLE OF WILLIS The circle of Willis (after the English neuroanatomist Sir Thomas Willis Formed by Vertebro-basilar system branches Internal carotid and its branches
    5. 5. VERTEBRO BASILAR SYSTEM VERTEBRAL ARTERIES Origin: Subclavian Arteries Course: ascend through the transverse foramen of the upper six cervical vertebra. Intracranial Entry via foramen of Magnum
    6. 6. VERTEBROBASILAR SYSTEM BRANCHES 1. Anterior spinal artery 2. Posterior Inferior Cerebellar Artery (PICA) 3. Basilar Artery oAnterior Inferior Cerebellar Artery (AICA) oPontine arteries oSuperior Cerebellar Artery oPosterior Cerebral Artery
    7. 7. PICA  the largest branch of the vertebral artery arises at the caudal end of the medulla on each side  Runs a course winding between the medulla and cerebellum It supplies 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
    8. 8. AICA It arises from the basilar artery at the level of the junction between the medulla oblongata and the pons in the brainstem. It passes backward to be distributed to the anterior part of the undersurface of the cerebellum, anastomosing with the posterior inferior cerebellar branch of the vertebral artery.  It supplies a. the anterior inferior quarter of the cerebellum. b. the middle cerebellar peduncle, c. facial (CN VII) and vestibulocochlear nerves (CN VIII)
    9. 9. SUPERIOR CEREBELLAR ARTERY Branch of from lateral aspect of basilar artery It supplies a. most of the cerebellar cortex, b. the cerebellar nuclei, and c. The superior cerebellar peduncles
    10. 10. POSTERIOR CEREBRAL ARTERY P1 – pre communicating segment Posterior thalamoperforating Medial posterior choroidal P2- ambient segments Lateral posterior Choroidal Thalamogeniculate arteries Cortical branches
    11. 11. POSTERIOR CEREBRAL ARTERY 1. Central branches Thalamoperforating & thalamogeniculate supply the medial surfaces of the thalami and the walls of the third ventricle Peduncular perforating branches supply a considerable portion of the thalamus.
    12. 12. POSTERIOR CEREBRAL ARTERY 2. Choroidal branches Medial posterior choroidal branches supply the tela chorioidea of the third ventricle and the choroid plexus Lateral posterior choroidal branches small branches to the cerebral peduncle, fornix, thalamus, and the caudate nucleus
    13. 13. POSTERIOR CEREBRAL ARTERY 3. Cortical branches Anterior temporal & Posterior temporal Lateral occipital Medial occipital Splenial or the posterior pericallosal branch Supplies infero-medial part of the temporal lobe, occipital pole, visual cortex, and splenium of the corpus callosum
    14. 14. ANTERIOR CIRCULATION  Middle Cerbral artery  Anterior Cerebral artery
    15. 15. MIDDLE CEREBRAL ARTERY  arises from the Internal Carotid  continues to lateral sulcus and divides into different branches Course is divided into segments M1, M2 , M3 , M4 M1 from orgin to trifurcation M2 from bifurcation to origin of cortical branches M3 opercular branches (within sylvian fissure) M4 emerges from sylvian fissure into surface of the hemisphere
    16. 16. MCA (BRANCHES) M1•medial lenticulostriate penetrating arteries •lateral lenticulostriate penetrating arteries (Charcot’s Artery) •anterior temporal artery •polar temporal artery •uncal artery
    17. 17. MCA (BRANCHES) M2 Superior and inferior and some times to middle branch Superior terminal branch •lateral frontobasal (orbito-frontal) artery •prefrontal sulcal artery •pre-Rolandic (precentral) and Rolandic (central) sulcal arteries Inferior terminal branch •three temporal branches (anterior, middle, posterior) •branch to the angular gyrus •two parietal branches (anterior, posterior)
    18. 18. MCA(BRANCHES) M3 – opercular branches M4 - lateral branches to the surface
    19. 19. ANTERIOR CEREBRAL ARTERY  forms at the termination of the internal carotid artery  arches antro-medially to pass anterior to genu of the corpus callosum  It supplies medial aspect of the cerebral hemispheres back to the parietal lobe.  segments •A1 - origin from the ICA to the anterior communicating artery (ACOM) •A2 - from ACOM to the origin of the callosomarginal artery
    20. 20. ANTERIOR CEREBRAL ARTERY A1- medial Lenticulo striater A2 – Recurrent artery of Huebner. # orbitofrontal artey pericalossal artery  A3 – Terminal Cortical branches Orbital branches Supplies oolfactory cortex ogyrus rectus omedial orbital gyrus
    21. 21. Frontal branches supply: oCorpus callosum * ocingulate gyrus omedial frontal gyrus oparacentral lobule Parietal branches supply : oprecuneus
    22. 22. INTERNAL CAPSULE BLOOD SUPPLY INTERNAL CAROTID  Ant. Choroidal artery Supply lower part of posterior limb & retro-lentiform part inferolateral part of the lateral geniculate body. ACA  Medial striate branch (Heubner’s) the lower part of the anterior limb and genu of the internal capsule MCA Lateral striate (lenticulostriate) Supplies to the anterior limb, genu, and posterior limb of the internal capsule
    23. 23. WATERSHED ZONES Area where the blood supply of cortical vessels overlap. These overlapping vessels are Terminal branches Watershed Infarct: An area of necrosis in the brain caused by an insufficiency of blood where the distributions of
    24. 24. WATER SHED INFARCTS
    25. 25. TERITORIAL SUPPLY (CROSS SECTIONS)
    26. 26. ACA TERITORIES
    27. 27. MCA TERITORIES
    28. 28. PCA TERITORIES
    29. 29. Superior frontal gyrus Middle frontal gyrus Postcentral gyrus Occipital lobe
    30. 30. Corona radiata Lateral ventricles Occipital lobe
    31. 31. Lateral horn Thalamus Internal Capsule Superior sagittal sinus
    32. 32. VENOUS DRAINAGE
    33. 33. EXTERNAL Veins Superior Cerbral vein Superficial & Deep middle Cerebral veins INTERNAL Thalamostriate veins Choroidal veins OTHERS Veins draining from midbrain, pons, medulla, cerebellum DURAL VENOUS SINUSES
    34. 34. EXTERNAL CEREBRAL VEINS
    35. 35. INTERNAL CEREBRAL VEINS
    36. 36. DURAL VENOUS SINUSES
    37. 37. DURAL VENOUS SINUSES
    38. 38. Structure: The walls of the dural venous sinuses are composed of dura mater lined with endothelium Name Inferior sagittal sinus Superior sagittal sinus Drains to Straight sinus Typically becomes right transverse sinus or confluence of sinuses Straight sinus Typically becomes left transverse sinus or confluence of sinuses Occipital sinus Confluence of sinuses Confluence of sinuses Sphenoparietal sinuses Right and Left transverse sinuses Cavernous sinuses Cavernous sinuses Superior and inferior petrosal sinuses Superior petrosal sinus Transverse sinuses
    39. 39. CAVERNOUS SINUS Lateral to body of sphenoid bone 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
    40. 40. THANK YOU Dr. Arif khan S
    41. 41. REFERENCE Netter’s anatomy Atlas Osborn MRI Anatomy of Brain Pubmed webMD Radiograpics.rsna.org

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