CNS BLOOD SUPPLY

WHAT IS THE INTERNAL CAROTID ARTERIAL SYSTEM TO THE BRAIN? WHAT ARE THE MAJOR BRANCHES & WHAT STRUCTURES DO THEY SUPPLY?
1. Ophthalmic Artery
a. Travels along the Optic Nerve (CN II)
b. Supplies eyeball & other orbital structures
2. Anterior Choroidal Artery
a. Goes to lateral ventricle
b. Supplies Choroid Plexus
c. Also supplies optic tract, some areas of
thalamus & temporal lobe
3. Posterior Communicating Artery
a. Joins posterior cerebral artery to internal
carotid artery – anastomose for Vertebral
& Internal Carotid systems
4. Middle Cerebral Artery
a. Travels laterally
b. Travels through lateral sulcus & supplies
majority of lateral aspect of brain
c. Lenticulostriate branches come off this
artery & supply deep structures (i.e. basal
ganglia & internal capsule)
d. MCA supplies most of the Motor &
Somatosensory Gyri
e. Occlusion here=contralateral motor &
somatosensory deficits around face &
upper limb
i. If L. hemisphere is involved=language deficits
5. Anterior Cerebral Artery
a. Travels through longitudinal fissure
b. Supplies medial portion of the frontal & parietal lobes
c. Supplies some motor & somatosensory gyri
d. Also supplies the corpus collosum
e. Occlusion here=contralateral motor & somatosensory deficits in lower limb
WHAT IS THE VERTEBRAL-BASILAR ARTERIAL SYSTEM TO THE BRAIN? WHAT ARE THE MAJOR BRANCHES & WHAT STRUCTURES DO THEY
SUPPLY?
Branches of Vertebral Artery
1. Anterior Spinal Artery
a. Supplies the ventral portion of vertebral
column
2. Posterior Inferior Cerebellar Artery (PICA)
a. Supplies the inferior surface of the cerebellar
hemispheres
b. Will also supply the medulla as it curves
around the brainstem
3. Posterior Spinal Artery

Branches of Basilar Artery

1. Anterior Inferior Cerebellar Artery (AICA)
a. Supplies Anterior & Inferior parts of the
cerebellum and part of Pons
b. Labyrinthe Artery=branch off AICA – supplies
inner ear
i. If occluded=vertigo & deafness
 2. Superior Cerebellar Artery
a. Supplies the superior part of the
cerebellum & parts of midbrain
b. If occluded=ataxia
3. Posterior Cerebral Arteries
a. Supplies the medial & inferior parts
of the occipital & temporal lobes
b. Branches go to rostral midbrain &
caudal diencephalon
4. Paramedian Pontine Arteries
a. Supply medial part of upper & lower
pons
b. If occluded=loss of voluntary motor to body, loss of touch & vibration to face, strabismus, & loss to pontine gaze center
5. Long Circumferential Branches
a. Supplies most of the tegmentum of the rostral & caudal
pons
i. Issues w/ gaze center & spinothalamic tract if
occluded
6. Short circumferential Branches
a. Supplies the ventrolateral pons
i. Issues w/ descending sympathetic fibers,
pontocerebellar fibers & spinothalamic tract if
occluded

HOW DOES SOMATOTROPY RELATE TO BLOOD SUPPLY OCCLUSIONS?

 The arteries that supply the portions of brain will affect the areas
related to homunculus
o i.e. if lateral portion is occluded=facial & upper limb
deficits

WHAT IS THE CIRCLE OF WILLIS? HOW DOES IT CONNECT THE INTERNAL

CAROTID & VERTEBRAL-BASILAR SYSTEMS?
 Anterior Cerebral, Internal Carotid & Posterior Cerebral arteries are connected via “Circle of Willis”
 Provides another pathway if any of the vessels become occluded

MEDIAL MEDULLARY SYNDROME

 If branches of the anterior spinal artery (@ level of medulla) are occluded on one
side=Medial Medullary Syndrome
o Also known as Inferior Alternating or Dejerine’s Syndrome
 Corticospinal Tract – loss of voluntary motor to contralateral side
 Medial Lemniscus – loss of touch & vibration on contralateral side
 Hypoglossal Nucleus – loss of voluntary motor to tongue on ipsilateral side
 If Anterior Spinal Artery is occluded @ spinal cord, will see:
o Bilateral loss of pain & temperature – Spinothalamic Tract
o Bilateral paralysis – Lateral Corticospinal Tract
o No changes in touch or vibration

LATERAL MEDULLARY SYNDROME

 Also known as Wallenberg’s Syndrome
 Occlusion of the PICA or Vertebral Artery
 Will affect:
o Inferior Cerebellar Peduncle, Vestibular Nuclei → ataxia, vertigo,
nausea, nystagmus
o Spinal Tract of V → loss of pain on ipsilateral side from face
o Spinothalamic Tract → loss of pain on contralateral side from
body
o Descending Sympathetic Fibers → Ipsilateral Horner’s Syndrome
 Ptosis, Miosis (constricted pupils), Anhydrosis
(decreased sweating)
o Nucleus Ambiguus → hoarseness, dysphagia
o Nucleus Solitarius → Ipsilateral decreased taste
o Cochlear Nuclei → Ipsilateral hearing loss
LATERAL PONTINE SYNDROME
 Occlusion of AICA
 Leads to:
o Loss of pain & temp from Ipsilateral face – Spinal Nucleus of V
o Loss of pain & temp from contralateral “body” – Spinothalamic Tract
o Ipsilateral Horner’s Syndrome – Descending Sympathetic Fibers
o Ataxia, Vertigo, Nausea – Cerebellar Peduncle & Vestibular Nuclei
o Ipsilateral hearing loss – Cochlear Nuclei
o Facial Nucleus of V & Primary Sensory Nucleus of V can be affected

SUPERIOR ALTERNATING SYNDROME

 Unilateral damage to the ventral part of the midbrain due to occlusion of
posterior cerebral artery
 Leads to:
o Superior alternating hemiplegia
 Ipsilateral oculomotor nerve palsy & contralateral
hemiplegia
o Substantia Nigra may also be compromised

Benedikt’s Syndrome
 Damage to ventral & lateral tegmental parts of the midbrain due to
occlusion of posterior cerebral arteries
 Leads to:
o Oculomotor palsy, contralateral hemiplegia & ataxia

VASCULAR DISRUPTION & WATERSHED ZONES?

 Stroke – sudden change in vasculature inside or next to brain
o Can be ischemic or hemorrhagic
o Usually caused by thrombus (clot in vessel) or embolism
(clot/plaque in bloodstream)
 Transient Ischemic Attack (TIA)
o Temporary
o Caused by small particles that occlude arteries but
are degraded
 Aneurysms
o Swelling of the arterial walls – common @
bifurcations
o Can compress brain structures or rupture
 Watershed Zones=areas of brain where 2 major vessels overlap

WHAT IS THE VENOUS DRAINAGE OF THE BRAIN? WHAT ARE THE

MAJOR SINUSES INVOLVED?
 Recall drainage of the brain
 Superior Sagittal drains to Confluence of Sinuses
 Inferior Sagittal drains to Straight Sinus, then Straight Sinus to
Confluence of Sinuses
 From Confluence to Transverse Sinus
then to Sigmoid Sinus to IJV
 Another drainage is through Cavernous
Sinus

WHAT IS THE STRUCTURE OF THE BLOOD BRAIN

BARRIER? WHY IS IT IMPORTANT?
 The BBB=membrane that controls what
passes from blood into CNS
 Made up of endothelial cells & tight
junctions of capillaries in CNS
 Astrocytes produce signals to create
BBB
 BBB helps in preventing passage of chemical compounds
o Helpful but can be detrimental
 Can keep out bad compounds but is a problem when it comes to pharmaceuticals