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Blood supply of the brain

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Pons Anatomy
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Blood supply of the brain

  2. 2. -15% of the cardiac output -25% of the total oxygen. -Cerebral blood flow is approximately 50 ml/g/min. -Supplied by two internal carotid arteries and two vertebral arteries.
  3. 3. AORTIC ARCH 1.Innominate artery (IA) / Brachiocephalic trunk -Rt subclavian artery (SCA)- Right vertebral artery -Rt common carotid artery (CCA) 2.Left Common Carotid Artery (CCA) 3.Left Subclavian Artery (SCA)- Left Vertebral Artery (VA)
  5. 5. INTERNAL CAROTID ARTERY • Four segments: – Cervical – Petrous – Cavernous – Cerebral / Supraclinoid • Branches – Meningohypophyseal trunk – Ophthalmic artery (OA) – Superior hypophyseal artery – Posterior communicating artery (PComA) – Anterior choroidal artery (AChA) – Anterior cerebral artery (ACA) – Middle cerebral artery (MCA) (continuation of the ICA)
  6. 6. – Cervical segment – From the bifurcation of CCA – Extends to the entrance into the carotid foramen of the petrous temporal bone – No branches
  7. 7. -Petrous Segment -Extends from base of skull to the petrous apex -Ascending , Genu, Horizontal -Enters cranial vault via foramen lacerum. -Branches - Carotico tympanic A & A of pterygoid canal
  8. 8. Cavernous Segment -Passes through cavernous sinus with Abducens Nerve -Cavernous branches-trigeminal ganglion -Branches supply posterior pituitary (Meningohypophyseal Artery)
  9. 9. - Cerebral part Begins after penetration of dura, continues until bifurcation into ACA & MCA 3 Branches: 1.Ophthalmic A 2.Posterior Communicating A 3.Anterior Choroidal A- -ends in the choroid plexus. -crus cerebri, the lateral geniculate body, the optic tract, and the internal capsule).
  10. 10. Ophthalmic artery  1st intradural branch of ICA  Supplies globe, orbit,frontal and ethmoidal sinuses, & frontal scalp  Central retinal A, Long & Short posterior ciliary branches  Branches of Ophthalmic A anastamose with Maxillary A branches - potential for collateral flow in cases of proximal carotid occlusion
  11. 11. Vertebral artery • V1: (extraosseous-origin to c6): Segmental cervical muscular and spinal branches - • V2( foraminal- C6 TO C1): : meningeal/muscular/spinal branches • V3 (extraspinal-C1- dura): Posterior meningeal artery • V4: (intradural) – Anterior and sometimes posterior spinal arteries – Perforating branches to medulla – PICA: gives off perforating medullary, choroid, tonsillar, cerebellar branches
  12. 12. BASILAR ARTERY 1.The pontine arteries 2. The labyrinthine -the internal ear. - often arises as a branch of the anterior inferior cerebellar artery. 3. The anterior inferior cerebellar artery the anterior and inferior parts of the cerebellum . A few branches pass to the pons and the upper part of the medulla oblongata. 4. The superior cerebellar artery arises close to the termination of the basilar artery the superior surface of the cerebellum, pons, the pineal gland, and the superior medullary velum, tela chorde of third ventricle. 5.The posterior cerebral (in interpeduncular cistern)
  13. 13. CIRCLE OF WILLIS -In the interpeduncular fossa at the base of the brain. - It is formed by the anastomosis between the two internal carotid arteries and the two vertebral arteries
  14. 14. perforating arteries from the circle of Willis or from vessels near • four principal groups 1.anteromedial group-the optic chiasma; lamina terminalis; anteriorpreoptic and supraoptic areas of the hypothalamus; septum pellucidum; paraolfactory areas; anterior columns of the fornix; cingulate gyrus; rostrum of the corpus callosum; anterior part of the putamen and head of the caudate nucleus.
  15. 15. 2-The posteromedial group-the hypothalamus and pituitary and the anterior and medial parts of the thalamus via thalamoperforating arteries ,the mammillary bodies, subthalamus, lateral wall of the third ventricle, the medial thalamus, and globus pallidus. 3-The anterolateral group (lenticulostriate arteries)-posterior striatum, lateral globus pallidus and internal capsule. 4-The posterolateral -the cerebral peduncle, colliculi, pineal gland and posterior thalamus and medial geniculate body.
  16. 16. Anterior cerebral Artery Three segments:  A1 –Pre communicating segment  Medial lenticulostriate branches  A2-Post communicating segment  Recurrent artery of Heubner  Orbitofrontal  Frontopolar  A3- distal ACA / cortical branches  Pericallosal  Callosomarginal
  17. 17. ACA Supply The cortical branches. -Two or three orbital branches supply the olfactory cortex, gyrus rectus and medial orbital gyrus. -Frontal branches supply the corpus callosum, cingulate gyrus, medial frontal gyrus and paracentral lobule. - Parietal branches supply the precuneus - the frontal and parietal supply a strip of territory on the superolateral surface that represent the lower limb. CENTRAL BRANCHES: -they supply the rostrum of the corpus callosum, the septum pellucidum, the anterior part of the putamen, the head of the caudate nucleus and adjacent parts of the internal capsule
  18. 18. Middle cerebral Artery Four segments: • M1- horizontal / sphenoidal segment: The stem of MCA  5-15 lenticulostriate branches • M2- insular segment: Runs deep in sylvian fissure and along insula ; Superior & Inferior divisions • M3- opercular segment: Follows the curvature of operculum and ends as terminal branches of MCA • M4- cortical branches: Terminal segment
  19. 19. Middle cerebral Artery •M1- Horizontal segment •Lateral Lenticulostriate •M2- Insular segment •M3- Opercular segment •Opercular segment branches •Operculofrontal artery •M4- Cortical branches •Lat Orbitofrontal •Pre rolandic •Rolandic •Ant. parietal •Post. parietal •Angular •Temporopolar •Ant temporal •Middle temporal •Post. temporal
  20. 20. MCA supply Cortical branches Frontal branches supply the precentral, middle and inferior frontal gyri. Two parietal branches are distributed to the postcentral gyrus, the lower part of the superior parietal lobule and the whole inferior parietal lobule. Two or three temporal branches supply the lateral surface of the temporal lobe. -motor and somatosensory cortices, with the exception of the lower limb, the auditory area and the insula. the lateral striate or lenticulostriate arteries - the lentiform complex and the internal capsule and the caudate nucleus
  21. 21. Posterior cerebral artery • P1 or Peduncular segment • short segment from the basilar tip to the PComA – Mesencephalic br. – Cr. Nv. Nuclei 3 - 6 – Thalamoperforating arteries - diencephalon and midbrain • P2 or ambient segment • runs in the ambient cistern from the PComA to the portion of paramesencephalic cistern – Thalamogeniculate br. – Medial posterior choroidal arteries – Lateral posterior choroidal arteries – Ant temporal • P3 or quadrigeminal segment • Runs in calcrine fissure – Hippocampal artery – middle, and posterior temporal arteries – Posterior pericallosal artery P4 –DISTAL SEGMENT – Parieto-occipital artery – Calcarine artery
  22. 22. • The artery of Percheron is a rare variant of the posterior cerebral circulation characterised by a solitary arterial trunk that supplies blood to the paramedian thalamiand the rostral midbrain bilaterally.
  23. 23. POSTERIOR CEREBRAL ARTERY SUPPLIES The cortical branches. Temporal branches-to the uncus and the parahippocampal, medial and lateral occipitotemporal gyri. Occipital branches- the cuneus, lingual gyrus and posterolateral surface of the occipital lobe. Parieto-occipital branches -cuneus and precuneus. -the visual areas of the cerebral cortex and other structures in the visual pathway. The central branches the anterior thalamus, subthalamus, globus pallidus and lateral geniculate body . the choroid plexus of the third and lateral ventricles and the fornix. supply the peduncle and the posterior thalamus, superior and inferior colliculi, pineal gland and medial geniculate body.
  24. 24. Blood supply of internal capsule • Striate branches of anterior cerebral artery. (recurrent artery of Huebner). - genu and anterior limb • Medial and lateral striate branches of the middle cerebral artery. (Charcot‘s artery of cerebral haemorrhage). -the posterior limb of the internal capsule. • Central branches of the anterior choroidal artery -sublentiform part. • Some direct branches from the internal carotid artery -genu. • Central branches of the posterior communicating artery. • Posterolateral central branches of the posterior cerebral artery -retrolentiform and sublentiform parts
  25. 25. Mid brain blood supply • Most of the blood supply is derived from branches of the basilar artery. • Posterior cerebral • Superior cerebellar • Posterior communicating • posterior choroidal
  26. 26. Pons blood supply The pons is supplied by the following arteries: • Numerous (pontine) branches from the basilar artery. • Superior cerebellar artery.
  27. 27. Medulla blood supply • The medulla is supplied by the following arteries: • Two vertebral arteries. • Anterior and posterior spinal arteries. • Anterior and posterior inferior cerebellar arteries. • Basilar artery
  28. 28. • Branches of the vertebrobasilar system and of the internal carotid artery and P2 segment of the posterior cerebral artery • Lateral choroidal arteries -the lateral and third ventricles. • Posterior inferior cerebellar arteries - choroid plexus in the fourth ventricle . • Anterior inferior cerebellar arteries- choroid plexus of the foramen of Luschka BLOOD SUPPLY OF VENTRICLES
  29. 29. Venous Drainage of The Brain features -does not follow the arterial pattern. - thin-walled due to absence of muscular tissue in their walls. -no valves. -runs in the subarachnoid space. -superficial and deep
  30. 30. sinuses of the dura mater (1) a postero-superior at the upper and back part of the skull. 1 Superior Sagittal 2 Straight sinus 3 Inferior Sagittal 4 Two Transverse. 5 Occipital (2) an antero-inferior at the base of the skull. 1 Two Cavernous 2 Two Superior Petrosal 3 Two Intercavernous 4 Two Inferior Petrosal 5 Two sphenoparietal
  31. 31. • Thalamostriate vein + Choroidal vein+Septal = Internal cerebral vein • Internal cerebral vein + Basal Vein of Rosenthal = Great vein of Galen • Great vein of Galen + ISS = Straight sinus
  32. 32. • Superior cerebral vein drain to SSS • SSS connects to superficial middle cerebral vein by Troland’s vein. • Transverse sinus to superficial middle cerebral vein by vein of Labbe’. • SSS + straight sinus + Occipital sinus = Transverse sinus • Transverse sinus later drain into sigmoid sinus and then to IJV.
  33. 33. • Inferior cerebral vein drain to superficial middle cerebral vein terminates to cavernous sinus • Transverse sinus to superficial middle cerebral vein by vein of Labbe’. • Anterior cerebral vein + Deep middle cerebral Vein + Striate veins = Basal Vein of Rosenthal • Cavernous sinus drain to transverse/sigmoid sinus via superior and inferior petrosal sinus.
  34. 34. Thank you

Editor's Notes

  • Sc-superior colliculus, mgn/lgn-geniculate nucleus, ML-medial leminiscus, cc crus cerebri, scp-superior cerebellar peduncle, SN?