As the hemispheres develop they create the

flattened "C" with a short tail shape of the

lateral ventricles that is present by birth .

The lateral ventricle consists of an anterior

horn, a body, and posterior and inferior horns
The junction of the body with the posterior and inferior horns
constitutes the atrium of the lateral ventricle.
The glomus (a large clump of choroid plexus) is found in the atrium
In adults and especially in elderly persons, the glomus may contain
calcifications that are visible on CT scans
Shifts in the position of the glomus, usually accompanied by
alterations in the volume or shape of the surrounding ventricle, may
indicate some type of ongoing pathologic process or space-occupying
lesion.
 The anterior horn and body
of the lateral ventricle are
bordered:
1. Medially: by the septum
pellucidum (at rostral levels)
and the fornix (at caudal
levels)
2. Posteriorly: (superiorly) by
the corpus callosum
The inter-ventricular foramina of Monro are
located between the column of the fornix
and the rostral and medial end of the
thalamus.

There are two interventricular foramina, one

opening from each lateral ventricle into the
single midline third ventricle
The third ventricle, the cavity
of the diencephalon, is a
narrow, vertically oriented
midline space that
communicates rostrally with
the lateral ventricles and
caudally with the cerebral
aqueduct

The third ventricle has an

elaborate profile on a sagittal
view & is quite narrow in the
coronal and axial planes
The cerebral aqueduct communicates rostrally with the third ventricle
and caudally with the fourth ventricle
This midline channel is about 1.5 mm in diameter in adults and
contains no choroid plexus.
Its susceptible to occlusion (triventricular hydrocephalus). For
example, cellular debris in the ventricular system (from infections or
hemorrhage) may clog the aqueduct. Tumors in the area of the
midbrain (such as pinealoma) may compress the midbrain and
occlude the aqueduct.
The cerebral aqueduct is surrounded on all sides by a sleeve of gray
matter that contains primarily small neurons; this is the
periaqueductal gray or central gray.
The boundaries of the third ventricle are formed by the dorsal
thalamus and hypothalamus, and recesses (supraoptic, infundibular,
pineal, suprapineal).
The rostral wall of the third ventricle is formed by a short segment of
the anterior commissure and a thin membrane, the lamina terminalis,
The floor of the third ventricle is formed by the optic chiasm and
infundibulum and their corresponding recesses, plus a line extending
caudally along the rostral aspect of the midbrain to the cerebral
aqueduct.
The caudal wall is formed by the posterior commissure and the
recesses related to the pineal, whereas the roof is the tela choroidea,
from which the choroid plexus is suspended
The only openings between the ventricles of the brain
and the subarachnoid space surrounding the brain are
the foramina of Luschka and Magendie in the fourth
ventricle.
It opens into the area of the pons-medulla-cerebellum
junction, the cerebellopontine angle, through the
foramina of Luschka
The irregularly shaped foramen of Magendie is located in
the caudal sloping roof of the ventricle
LV 3 4 SAS

FM AS FL&FM

C
SULCI,
CISTERNS
& FISSURES

LV 3 4
CSF CSF CSF

BRAIN

CSF SAS
 LV 3 4 SAS

CHOROID PLEXUS
CHOROID PLEXUS
ss

Sella Turcica
mb
 A
Basilar
B Cistern

Ventricle Size Cisterns

Make sure no hydrocephalus Should be plenty of CSF
- Evans ratio (A/B) < 0.3 (Black space)
Also check temporal horns No blood/compression
LV 3 4 SAS
Brain receives 20% of the cardiac output.
Major arterial supply via:
Internal carotids:
Give off paired anterior cerebral arteries.
Give off paired middle cerebral arteries.
Vertebral arteries:
Join to form unpaired basilar artery
Arises from common carotid
artery in the neck
Enter the skull base via the
carotid canal
terminates at bifurcation
into the anterior cerebral
artery and middle cerebral
artery
extracranial segment - origin
of the ICA to the skull base
intracranial segment -divided
into petrous, cavernous,
supraclinoid portions
major branches that arise
from the internal carotid
artery
anterior and middle cerebral
arteries (anterior circulation
that supplies the forebrain)
lenticulostriate arteries -
supply the basal ganglia
and thalamus
The arrangement of the brain's arteries into
the Circle of Willis creates collaterals in the
cerebral circulation
If one part of the circle becomes blocked or
narrowed (stenosed) or one of the arteries
supplying the circle is blocked or narrowed,
blood flow from the other blood vessels can
often preserve the cerebral perfusion well
enough to avoid the symptoms of ischemia
They branch from the
subclavian arteries
Enter deep to the transverse
process of the level of the C6
Then proceed superiorly, in
the transverse foramen of
each cervical vertebra until
C1
At the C1 level, the vertebral
arteries travel across the
posterior arch of the atlas
through the suboccipital
triangle before entering the
foramen magnum
The posterior circulation of
the brain supplies the
posterior cortex, the
midbrain, and the brainstem
Comprises arterial branches
arising from the posterior
cerebral, basilar, and
vertebral arteries
Midline arteries supply
medial structures, lateral
arteries supply the lateral
brainstem, and dorsal-lateral
arteries supply dorsal-lateral
brainstem structures and the
cerebellum
Superior cerebellar
artery (SCA) from
basilar artery
Anterior inferior
cerebellar artery
(AICA) from basilar
artery
Posterior inferior
cerebellar artery
(PICA) from vertebral
artery
three longitudinal arteries :
anterior spinal artery
right posterior spinal arteries
and left posterior spinal arteries
Found within the subarachnoid space and
send branches into the spinal cord
form anastamoses via the anterior and
posterior segmental medullary arteries
Supply blood up to cervical segments
posterior and anterior radicular arteries –
supplies the lower cervical region ; run into
spinal cord alongside the dorsal and ventral
nerve roots
intercostal and lumbar radicular arteries -arise
from the aorta ; major anastomoses and act as
blood flow supplement
artery of Adamkiewicz – Largest anterior
radicular arteries ; arises between L1 and L2;
injury = spinal cord infarction and paraplegia
Branches of vertebral arteries.
To:
Dorsolateral part of medulla
Posterior choroid plexus
Posterior/inferior parts of cerebellum
Form unpaired anterior spinal artery.
Form basilar artery.
Anterior inferior cerebellar artery
To upper medulla and pons
Internal auditory artery
To part of inner ear
Pontine arteries
To pons
Superior cerebellar artery
Terminate as posterior cerebral arteries
Terminal branches of basilar artery.
To:
Medial and inferior surfaces of the temporal
and occipital lobes, posterior thalamus.
Occlusion results in thalamic syndrome:
Contralateral diminishing of general somatic
modalities in head (ventral posterior nucleus).
Threshold for pain, temperature, and tactile
sensation on contralateral side of head
raised.
Mild stimuli may produce disagreeable
sensations.
Largest branches of internal carotid arteries.
Run between temporal and frontal lobes.
To most of lateral surfaces of cerebrum.
Give off striate arteries:
To internal capsule and adjacent structures.
Stroke:
Contralateral upper motor-neuron paralysis of
face and UE/LE as well as sensory
disturbances.
Branches of internal carotid arteries.
Give off perforating arteries to
hypothalamus.
Extend rostrally and then curve upwards and
backwards around corpus callosum:
Pericallosal arteries
Occlusion:
Contralateral paresis and diminished sensitivity
in LE.
Interconnects vertebral and internal carotid
supply.
Components:
Posterior cerebral arteries
Posterior communicating arteries
Internal carotids
Anterior cerebral arteries
Anterior communicating artery
Border zones of cerebral arteries.
Decreased blood supply.
Hypoperfusion may result in:
Paralysis/sensory loss bilateral UE
Disturbed vision
Disturbed memory
Chorea
Aphasia
Cortical Areas Supplied by the MCA, ACA and PCA
MCA Infarct

MCA
PCA Infarct

PCA
ACA Infarct ACA
A = Basilar artery
B = Posterior cerebral artery
C = Thalamoperforators
D = Posterior communicating artery
E = Internal carotid artery
F = Middle cerebral artery
G = Anterior cerebral artery
H = Anterior communicating artery
symmetry
relatively easy to compare side-to-side
asymmetry is usually pathological
not all pathology gives rise to asymmetry
ventricles
ventricular enlargement may occur with
aging
hydrocephalus is enlargement
secondary to increased pressure
often caused by obstruction
downstream
parenchymal changes
change in density
hyperdense (bright): calcification or
blood
hypodense (dark): ischaemia
masses
detail
grey-white differentiation
the cortex and white-matter should be
different shades
cortex appears brighter than white matter
if this is blurred, it is suggestive of
ischaemia
extra-axial spaces
the brain should extend all the way to
the bone
the spaces between the brain and skull
is the extra-axial space
hyperdensity may represent acute blood
hypodensity may represent chronic blood
or fluid
bony defect
abnormal bone texture
fractures
use bone algorithm to see fine