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Blood Supply of theCentral Nervous System

Ma. Cristina S. Elma, MD, FPOGSDepartment of Anatomy, UERMMMC

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Objectives

Describe the origin and course of the arterialblood supply of the brain:

Internal carotid artery system

 Vertebral artery system Circle of Willis

Describe the general distribution of thedifferent branches of arteries that supply the

various regions of the brain

Describe the venous drainage of the brain

Describe the arterial supply and venous

drainage of the spinal cord

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The Brain

One of the most metabolically activeorgans of the body consuming largeamounts of oxygen and glucose  

requires continuous blood flow

 Arterial supply consists of 2 majorinterconnected systems:

Internal Carotid System

 Vertebral Artery System

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QUESTION

GIVE ONE OF THE TERMINALBRANCHES OF THE INTERNALCAROTID ARTERY.

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Internal Carotid Artery – Major Intracranial Branches

Hypophyseal arteries

Ophthalmic artery

Posterior

communicatingartery

 Anterior choroidalartery

 Anterior cerebralartery (ACA)

Middle cerebralartery (MCA)

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Middle Cerebral Artery

 “Direct communication” of the ICA  

Supplies the dorsolateral surface of thecerebral hemispheres

Branches from stem (or M1): Lateral striate arteries (part of the

lenticulostriate arteries)

Superior (upper or suprasylvian) MCAbranch

Inferior (lower or infrasylvian) MCA branch

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QUESTION

GIVE A FUNCTIONAL/BRODMANN AREASUPPLIED BY THE MIDDLE CEREBRAL

 ARTERY.

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Key Functional Areas [MCA]

Superior branches

Sensorimotor cortex (except legs)

Frontal eye fields

Broca’s area (language expression )

Inferior branches

Wernicke’s area (language comprehension )

 Auditory cortex

Optic radiations

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OCCLUSION MAY PRODUCE:

Severe contralateral hemiparesis(marked in UE and face)

Contralateral sensory loss mainly theface and the arm

Severe aphasia (if dominant hemisphereis involved)

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 Anterior Cerebral Artery

 Anterior branch of ICA supplying themedial aspect of the frontal andparietal lobes

Branches: Anterior communicating artery

Orbital branches and frontopolar artery

Callosomarginal artery Pericallosal artery

Medial striate artery (or recurrent arteryof Heubner) [part of the lenticulostriate

arteries]

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Key Functional Areas [ACA]

Septal area

Sensorimotor cortex for thelower extremities

Motor planning areas in the

medial frontal lobe

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OCCLUSION MAY PRODUCE:

Contralateral hemiparesis andhemisensory loss greatest in the lowerlimb

Inability to identify objects correctly,apathy and personality changes (frontaland parietal lobes)

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QUESTION

WHAT ARTERY GIVES RISE TO THE ANTERIOR AND POSTERIOR SPINAL ARTERY?

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 Vertebral Artery System

 Vertebral artery

Spinal arteries- 2 posterior and 1 anterior

Posterior inferior cerebellar arteries (PICA)

Medullary (bulbar) branches Basilar artery

 Anterior inferior cerebellar arteries (AICA)

Internal auditory (labyrinthine) arteries

Pontine arteries- paramedian, circumferential(short and long)

Superior cerebellar arteries

Posterior cerebral arteries (PCA)

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QUESTION

NAME THE ARTERIAL SUPPLY OF THEPRIMARY VISUAL CORTEX.

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Posterior Cerebral Artery

Terminal branch of the basilar artery

Supplies the midbrain, the inferioraspect of the cerebral hemispheres andthe occipital lobe

Branches:

Calcarine artery

Posterior choroidal arteries

Deep perforating branches

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Key Functional Areas [PCA]

Diencephalon

Midbrain

Primary visual cortex

Hippocampal formation

(memory)

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OCCLUSION MAY PRODUCE:

Contralateral homonymous hemianopsia

Bilateral occlusion: defect of memory

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Circle of Willis

 Also called “circulus arteriosus”  

Formed by the junction of the basilarartery and the 2 ICAs through thepresence of 2 posterior and 1 anteriorcommunicating arteries

Little exchange between brain halves

(functionally separate): equalize flowbut functionally inadequate

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 Arteries to Specific Brain Areas

Corpus striatum and internal capsule:lenticulostriate and anterior choroidal arteries

Thalamus: PCA, posterior communicating, and basilar

arteries Midbrain: PCA, superior cerebellar, and basilar arteries

Pons: basilar artery, superior cerebellar arteries, AICAand PICA

Medulla oblongata: vertebral, anterior and posteriorspinal, PICA, and basilar arteries

Cerebellum: superior cerebellar artery, AICA, and

PICA

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1. Anterior cerebral artery(callosomarginal and

pericallosal arteries)2. Middle cerebral artery

3. Posterior cerebral artery

4. Medial striate arteries tothe internal capsule,globus pallidus andamygdala

5. Lateral striate arteries tothe caudate nucleus,putamen and internalcapsule

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MIDDLE MENINGEAL ARTERY

Periosteal branch of theexternal carotid artery

supplies no CNS tissue

enters the cranial cavitythrough the foramenspinosum

usually ruptured byfracture of the lateralskull vault

bleeding between thedura and overlyingskull(extradural or

epidural hematoma)

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QUESTION: TRUE OR FALSE

THE CEREBRAL VEINS RUN PARALLELWITH THE CEREBRAL ARTERIES.

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 Venous Drainage of the Brain

Cerebral Veins

External cerebral veins

Superior cerebral veins

Superficial middle cerebralvein

Deep middle cerebral vein Basal veins

from anterior cerebral,striate and deep middlecerebral veins and emptyinto the great cerebral vein

Internal cerebral veins from thalamostriate, septal

and choroidal vv.

Great cerebral vein of Galen

formed by the 2 internalcerebral veins and empty

into the straight sinus

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 Venous Drainage of the Brain

Dural Venous Sinuses Superior sagittal sinus

Inferior sagittal sinus

Rectus (straight) sinus Confluence of the sinuses

Transverse sinuses

Sigmoid sinuses Cavernous sinus

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The Spinal Cord

Blood supply: perforating vessels fromnetwork of pial arteries

Spinal cord: 1 anterior and 2 posteriorspinal arteries

Nerve roots: radicular arteries

Cord and roots: radiculospinal or

segmental medullary arteries

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Great anteriorsegmental medullaryartery of Adamkiewicz

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QUESTION

THE DORSAL HORN OF THE SPINALCORD IS SUPPLIED BY WHAT ARTERY?

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HAPPY HEARTS’ DAY!!!!! 

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Quiz

Write your name, section, and

today’s date on the half sheetof paper provided.

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QUIZ

6. What is the arterial supply of Brodmannarea 4?

7. Give one artery supplying the cerebellum.

8. Give one sinus that drains into theconfluence of sinuses.

9. Give ARTERY that supplies the internalcapsule.

10. What artery supplies the ventral horn ofthe spinal cord?