BLOOD SUPPLY OF

BRAIN

BY:
DR. IBRAR AHMED HASHMI
ARTERIAL SUPPLY OF BRAIN
COMMON CAROTID ARTERY
70% blood is delivered to ICA
Carotid bifurcation is a physiological
stenosis due to inertial forces of blood flow
divert main flow stream from midvessel to a
path along vessel margin at flow divider
CCA divides lateral to upper border of
thyriod cartilage: C3-4 intervertebral disc.
ECA arises anterior and medial to ICA(95%)
CAROTID VESSELS
ARTERIAL SUPPLY OF BRAIN
 EXTERNAL CAROTID ARTERY
1. ASCENDING PHARYNGEAL ARTERY
2. SUPERIOR THYROID ARTERY
3. LINGUAL ARTERY
4. EXTERNAL MAXILLARY=FACIAL ARTERY
5. OCCIPITAL ARTERY
6. POSTERIOR AURICULAR ARTERY
7. SUPERFICIAL TEMPORAL ARTERY
8. INTERNAL MAXILLARY ARTERY
 INTERNAL CAROTID ARTERY

1. CERVICAL SEGMENT
2. PETROUS SEGMENT
3. CAVERNOUS SEGMENT
4. SUPRACLINOID SEGMENT
 INTERNAL CAROTID ARTERY

CERVICAL SEGMENT:
Ascends posterior and medial to ECA: enters carotid canal
of petrous bone;
NO BRANCHES
CAROTID BULB= CAROTID SINUS
Dilated proximal part of ICA with thinner media and
thicker adventitia containing many receptor endings of
glossopharyngeal nerve.
Baroreceptor responsive to change in arterial BP.
Hypersensitive carotid sinus: slight touch or neck
movement initiates drop in BP and SA/AV blocks.
 PETROUS SEGMENT:
Ascends briefly in carotid canal ; bends
anteromedially in horizontal course(ant to
tympanic cavity and cochlea); exits near post
portion foramen lacerum;ascends to juxtasellar
location and pierces dural layer of cavernous sinus.
BRANCHES: (rarely seen on angiograms)
1. CORTICOTYMPANIC A.
2. PTERYGOID (VIDIAN) A.(inconstant)
 CAVERNOUS SEGMENT:
Ascends to posterior clinoid process, then turns
anteriorly and superomedially through cavernous
sinus: exits medial to ant clinoid process piercing
dura.
BRANCHES:
1. Meningohypophysial trunk
2. Anterior meningeal artery
3. Cavernous rami for trigeminal ganglia, cavernous
sinus and inf. petrosal sinuses.
 SUPRACLINOID SEGMENT:
Ascends posterior + lateral b/w oculomotor
and optic nerv.
BRANCHES:
1. OPHTHALMIC A.
2. SUPERIOR HYPOPHYSEAL A. (not routinely
visualized)
3. PCOM
4. ANTERIOR CHOROIDAL A.
5. MCA
6. ACA
 CAROTID SIPHON: (3rd + 4th part of ICA)
FLOW DIRECTION: C4---C1
a) C4 SEGMENT= Before origin of
ophthalmic a.
b) C3 SEGMENT= Genu of ICA.
c) C2 SEGMENT= Supraclinoid segment
after origin of ophthalmic a.
d) C1 SEGMENT= Terminal segment of ICA
b/w pCom + ACA.
CAROTID SIPHON
ANTERIOR CEREBRAL ARTERY
1. A1 SEGMENT= HORIZONTAL
PORTION b/w origin and aCom.
Inferior branches to optic nerve and chiasma
Superior branches to ant hypothalamus, septum
pellucidum, ant commisure, fornix, columns,
medial lenticulostriate artery to anteroinferior
portion of corpus striatum.
2. A2 SEGMENT= INTERHEMISPHERIC
PORTION after the origin of aCom.
 BRANCHES:
1. Medial orbitofrontal artery.
2. Frontopolar artery.
3. Callosomarginal artery.
4. Pericallosal artery.
SUPPLY: anterior 2/3 of medial cerebral surface
and 1cm of superomedial brain over convexity.
 MIDDLE CEREBRAL ARTERY
Largest branch of ICA, arises lat to optic chiasma,
passes horizontal and lateral direction to enter in sylvian
fissure and divides into 2/3/4 branches
SUPPLY:
Lateral cerebrum
Insula
Anterior and Lateral temporal lobes
M1 SEGMENT:
Origin to MCA bifurcation
Lateral lenticulostriate
M2 SEGMENT:
Insular branches
M3 SEGMENT:
MCA branches beyond sylvian fissure
BLOOD SUPPLY OF BRAIN
INTERNAL CAROTID ARTERY
INTERNAL CAROTID ARTERY
INTERNAL CAROTID ARTERY
 VERTEBRAL ARTERY
1st branch of subclavian(95%)
Left vertebral arises directly from aortic arch
in 5%.
Left artery is dominant in 50%, in 25% co
dominant, in 25% right is dominant.
 VERTEBRAL ARTERY
A. PREVERTEBRAL SEGMENT: Enters
transverse foramina at C6, only muscular
branches.
B. CERVICAL SEGMENT: Anterior
meningeal artery.
C. ATLANTIC SEGMENT: exits through
transverse foramina of atlas till it peierces dura
to enter cranial cavity. Branch: Post.
Meningeal.
D. INTRACRANIAL SEGMENT:
 INTRACRANIAL SEGMENT
Ascends anteriorly + laterally around medulla to
reach midline at pontomedullary junction and forms
basilar artery with other vertebral a at clivus.
BRANCHES:
1. ANTERIOR + POSTERIOR SPINAL A.
2. PICA
BASILAR ARTERY BRANCHES:
1. AICA
2. INTERNAL AUDITORY A.
3. SUPERIOR CEREBELLAR A.
4. POSTERIOR CEREBRAL A.
5. MEDULLARY AND PONTINE PERFORATING
ARTERIES
 POSTERIOR CEREBRAL ARTERY
Originates from bifurcation of basilar artery, within
interpeduncular cistern (in 15% as direct continuation
of pCom) lies above occulomotor nerve and circles
midbrain above tentorium.
P1 SEGMENT:
Origin to PCOM.
Posterior thalamoperforators
P2 SEGMENT:
Distal to PCOM
Thalamogeniculate
Posterior choroidal arteries.
TERMINAL CORTICAL BRANCHES.
 ARTERIAL ANASTOMOSES OF
BRAIN
A. AT BASE OF BRAIN:
I. CIRCLE OF WILLIS
II. DEVELOPMENTAL ANOMALIES: (3
transient carotid-basilar anastomoses appear
in fetal life)
Primitive hypoglossal artery
Primitive acoustic artery
Persistent primitive trigeminal artery
 CIRCLE OF WILLIS
Complete in 25%,
incomplete in 75%.
Made by
Supraclinoid ICAs
A1 segment of ACA
ACOMs
PCOMs
P1 segment of PCAs
 ARTERIAL ANASTOMOSES OF
BRAIN
B. VIA SURFACE VESSELS:
LEPTOMENINGEAL ANASTOMOSES OF
CEREBRUM: ACA
MCA PCA
OF CEREBELLUM:
SUP CEREBELLAR AICA PICA.
C. RETE MIRABILE:
ECA MIDDLE MENINGEAL/SUP
TEMPORAL A.
LEPTOMENINGEAL ACA/MCA.
NORMAL VARIANTS OF VASCULAR
ANATOMY
ICA:
PERSISTENT EMBRYONIC ARTERIES
ABERRANT PETROUS PART ICA: Courses posterolateral
ECA:
MIDDLE MENINGEAL FROM OPHTHALMIC
VARIATION IN ORDER OF BRANCHING.
CIRCLE OF WILLIS:
HYPOPLASTIC PCOM
HYPOPLASTIC OR ABSENT A1 SEGMENT
FETAL PCA(FROM ICA) WITH ATRETIC P1
SEGMENT
HYPOPLASTIC ACOM.
ANTERIOR CEREBRAL ARTERY
MIDDLE CEREBRAL ARTERY
POSTERIOR CEREBRAL ARTERY
CEREBRAL VEINS
THANK YOU