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SCRUBS Neuroanatomy Workshop Blood Supply to the Brain Jake Ahmed [email protected] Introduction • Anatomy overview • Intracerebral supply – Anterior Circulation – Posterior circulation – Territories of supply • Strokes • Classification • Presenting features • Summary R Subclavian A. R O A T A L Internal Carotid A. R Internal Carotid A. L V e r t e b r a l A. R Common Carotid A. L Common Carotid A. Anterior Circulation R V e r t e b r a l A. Anatomy Overview Posterior Circulation Circle of Willis Anterior Cerebral A. anterior communication a. Middle Cerebral A. Anterior Circulation Origin posterior communication a. Superior Cerebellar A. Pontine a. Anterior-Inferior Cerebellar A. Posterior-Inferior Cerebellar A. Posterior Circulation Origin Circle of Willis (Double thumbs-up of Ahmed) Anterior Cerebral A. = ACA Middle Cerebral A. = MCA L-MCA Posterior Cerebral A. = PCA R-MCA Superior Cerebelllar A. = SCeA Anterior-Inferior Cerebellar A. = AICeA L-VA Posterior-Inferior Cerebellar A. = PICeA Vertebral A. = VA R-VA Arterial Territories Striate & Choroidal Striate Medial – from ACA Lateral – from MCA Choroidal Anterior – from ICA Posterior – from PCA ANTERIOR CIRCULATION SUPPLY ACA MCA PCA SCeA AICeA PICea POSTERIOR CIRCULATION SUPPLY Overview of blood supplies & territories Lobes of the brain Strokes The outcome of compromised blood supply to the brain Clinical Definition Deficit: Focal neurological Onset: Sudden Origin: Vascular Duration: >24 hours TIAs = Strokes that last <24hours Bamford Classification of Strokes TACS = PACS = LACS = POCS = Total Anterior Circulation Syndrome Partial Anterior Circulation Syndrome Lacunar Syndrome Posterior Circulation Syndrome Also classified on compromised factor Ischaemic Stroke 80% Thromboembolic Atherosclerotic Haemorrhagic Stroke 20% Worse outcome (usually) MCA occlusion Hemispheric haematoma TACS PACS HEMIPARESIS 2/3 of criteria For TACS HOMONOMOUS HEMIANOPIA DYSPHASIA/INATTENTION LACS 4 classical syndromes OR any of these 3 Isolated cortical dysfunction Loss of proprioception in 1 limb Monoplegia Distal MCA occlusion Distal ACA occlusion POCS Isolated visual field deficit Cortical perforation Vessels (from MCA) 1. Pure motor hemiparesis 2. Pure hemisensory loss 3. 1+2 together 4. Ataxic hemiparesis (ipsilateral corticospmal and cerebellar- like dysfunction due to supratentorial and brainstem lesions) Opthalmoplegia Cerebellar signs (PIGHAND) Cranial nerve palsy + contralateral motor/sensory deficit Cortical perforation Vessels (from MCA) Meningeal Bleeds Extradural Meningeal arteries Pterion = anatomical weak-spot Hx of trauma / LoC / Lucid period Sub-dural Bridging veins across subdural space Acute/Subacute(3-7/7)/Chronic(2-3/52) At risk groups Infants Alcoholics Elderly Pts on Anticoagulants Subarachnoid Cerebral arteries Berry aneurysm rupture/burst THUNDER CLAP HEADACHE Xanthochromic CSF 12h later Linked to ADPKD Summary • Anatomy overview of Blood supply to the brain • Circle of Willis (Double thumbs-up of Ahmed) • Territories of different arteries • Strokes – Definition – Classifications – Presenting features to clinically distinguish types • Meningeal Bleeds
