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Blood Supply I. II. III. IV. General Concepts Internal Carotid Artery Vertebral Artery Circle of Willis Fall 2012 Cerebral Blood Flow • Central nervous system • • • • 2% of body by weight 15% of all cardiac output 20% of all O2 consumed Total brain blood volume every 5-7/min • Loss of consciousness after 10 sec • Necrosis after 4-5 min of hypoxia Cerebral Blood Flow • Arterial supply to brain and much of spinal cord derived from 2 sets of arteries • Internal carotid arteries • Anterior circulation - 80% of blood supply • Vertebral arteries • Posterior circulation - 20% of blood supply • Linear extent of capillaries/Unit volume • Gray matter > White matter • Sensory, interneurons > Motor Internal Carotid Artery Common Carotid Artery • Off Brachiocephalic Trunk – Right • Off Arch of Aorta - Left Subclavian Artery Carotid Bifurcation <1% 4% 12% 30% 35% 12% 5% 1% Normally at superior border of thyroid cartilage = C4 vertebra Ophthalmic Artery Optic Nerve Ophthalmic Artery ICA ICA Branches Anterior Cerebral A. ICA Post. Comm. Artery Middle Cerebral A. Anterior Choroidal Artery ICA Branches Ophthalmic Artery ICA Anterior Cerebral Artery Middle Cerebral Artery Posterior Communicating Artery Anterior Choroidal Artery Anterior Choroidal Artery AChA = yellow Anterior Cerebral Artery Anterior Communicating Artery ACA Anterior Cerebral Artery Anterior Communicating Artery Medial Striate Artery (Recurrent A. of Heubner) ACA Anterior Cerebral Artery ACA Anterior Cerebral Artery Frontopolar branches Internal frontal branches Paracentral branches Internal parietal branches Anterior Cerebral Artery ACA = pink Middle Cerebral ArteryACA Middle Cerebral A. M1 segment Middle Cerebral Artery Subdivisions M4 M3 M2 M1 A1 Middle Cerebral Artery Medial Striate Artery Lateral Striate As. M1 ACA Middle Cerebral Artery Post. Parietal A. Ant. Parietal A. Central A. Precentral A. Frontal A. Orbital A. MCA, sup. trunk Angular A. MCA MCA, inf. trunk Temporal As. Middle Cerebral Artery MCA = green Vertebral Artery Variants • Left off arch of aorta 4% • Left dominant 60% • Right hypoplastic 10% • Left hypoplastic 5% • Left atretic, no communication with basilar 3% Subclavian Artery • Right atretic, no communication with basilar 2% Vertebral Artery C1 C2 C3 C4 C5 C6 C7 T1 1% 2% 5% 90% 2% Vertebral Artery Vertebral Artery Basilar Artery Vertebral Artery Anterior Spinal Artery PICA Vertebral Artery Basilar Artery Vertebral Artery Anterior Spinal Artery Posterior Spinal Artery (25%) Vertebral Artery Basilar Artery PICA Vertebral Artery Anterior Spinal Artery Posterior Spinal Artery (75%) Spinal Arteries Spinal Arteries Spinal Arteries Artery of Adamkiewicz PICA Basilar Artery PICA Basilar Artery - Branches Pontine Arteries Basilar Artery AICA Labyrinthine Artery Basilar Artery - Branches Posterior Communicating Artery Posterior Cerebral Artery CN III Superior Cerebellar Artery Basilar Artery - Branches Posterior Communicating Artery Posterior Cerebral Artery CN III Superior Cerebellar Artery Basilar Artery - Branches Posterior Cerebral Artery CN III Basilar Artery CN VI Superior Cerebellar Artery Cerebellar Arteries Posterior Cerebral Artery Posterior Cerebral Artery Posterior Cerebral Artery Parieto-occipital Artery Calcarine Artery PCA Posterior Cerebral Artery PCA = blue Circle of Willis Anterior Communicating Artery Anterior Cerebral Artery Internal Carotid Artery Posterior Communicating Artery Posterior Cerebral Artery Basilar Artery Circle of Willis Anterior Communicating Artery Anterior Cerebral Artery Internal Carotid Artery Posterior Communicating Artery Posterior Cerebral Artery Basilar Artery Circle of WillisAnterior Communicating Artery Superior Hypophyseal Artery Inferior Hypophyseal Artery Anterior Cerebral Artery Internal Carotid Artery Posterior Communicating Artery Posterior Cerebral Artery Circle of Willis Variations 60% complete 10% 10% 10% 10% 10% 10% Watershed Zones Venous Dural Sinuses Inferior Sagittal Superior Sagittal Sphenoparietal Straight Inferior Petrosal Confluens Occipital Transverse Sigmoid Venous Dural Sinuses Superior Sagittal Sinus Inferior Sagittal Sinus Straight Sinus Occipital Sinus Venous Dural Sinuses Superior Ophthalmic Vein Sphenoparietal Cavernous Superior Petrosal Inferior Petrosal Sigmoid Straight Superior Sagittal Transverse Medulla Blood Supplies Caudal Medulla PSA / PICA ASA / VA ASA Rostral Medulla PICA PSA / PICA ASA / VA Pons Blood Supplies Caudal Pons BA / AICA BA Rostral Pons SCA BA / SCA BA Midbrain Blood Supplies Caudal Midbrain SCA / PCA BA / SCA Rostral Midbrain PCA PCA PCoA Ant Ch A
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