Blood supply of the brain

Lectures of Neuroanatomy by Dr. Noura El Tahawy

1. Blood Supply of the Brain

By
Dr. Noura El Tahawy

2. OBJECTIVES

= Illustrate and describe the formation of the
circle of willis

= Describe the blood supply of the brain

a Arterial supply
a Venous drainage

3. Blood Supply of Blood Circulation
The Brain =

The brain receives its arterial supply f

i
bvo pairs of vessels, the vertebral and | y ¿cjjap 46K
internal carotid arteries which ate artery a

interconnected in the cranial cavity to /

produce an arterial circle (of Willis).

|__| vertebra

4. I. Vertebro-Basilar system

Dr. Noura El Tahawy

6. Middle cerebral arteries

Anterior cerebral artery

Posterior
communicating
arteries

_ Internal carotid artery
in cavernous sinus
Posterior cerebral
arterie

- Internal carotid
artery in carotid
canal of temporal

bone
Foramen magnum --

Left vertebral artery 7

—~~~~_ Internal carorid

Right vertebral artery < nero nec

se ~~ External carotid artery

Transverse process of

sixth cervical vertebra== =
~~Thyroid cartilage

Thyrocervical trunk.

Costocervical trunk

Subclavian artery

7. Anterior communicating A

Posterior comm

*\ Oculomotor N.

a
1 Posterior cerebral A

Superior cerebellar A.

Basilar A.

Vertebral A
Accessory N:

Hypoglossal N

9. Vertebral artery

Dr. Noura El Tahawy

10. Vertebral Artery

Branch of first part of subclavian A
Passes — foramen transvesarium C6 — C1

Enters through foramen magnum - perforates dura &
arachnoid mater — enters subarachnoid space

Turns upward, forward, medially — medulla oblongata
Lower border of pons — joins opposite side to form
a BASILAR artery

11. QD Anterior cerebral A.

Anterior communicating A.
Striate branch of
anterior cerebral A.

mo — Middle
cerebral A.

Gensel Posterior
communicating A.

branches

Superior
cerebellar A

Pontine

branches Basilar A

Anterior inferior =
cerebellar A. =
ay Posterior inferior

cerebellar A.

Anterior spinal A. Vertebral A.

12. Schematic-drawing-of the arrangement of arterial vessels-on-the base of the

‘Anterior cerebral artery
Anterior communicating artery

Optic nerve
Middle cerebral artery

‘Anterior choroidal artery

a itemal aol
Poster communicaag arr) IN axey
>

Oculomotor nerve

Superior cerebellar
artery

—Tigerinal nerve

Anterie inferior
cerebellar artery

Vertebral artery
Anterior spinal artery

Posterior inferior
cerebellar artery

The diagram shows the circulus arteriosus (circle of Willis).

13. Branches of vertebral artery

LAN

Labrynthine ———

Basilar
Anterior inferior.
cerebellar

Vertebral

Posterior
inferior
cerebellar

Anterior

spinal i J

14. the arterial supply (red) and venous drainage (blue) of the
spinal cord.

Posterior spinal
artery ——

Posterior spinal

vein — Posterolateral spinal

Anterior spinal
artery —

aarp
en — Posterior —

bs) V j 4 } Radicular
y AA ares

Spinal nerve Avachnoid mater

Internal vertebral
venous plexus

Dura mater

15. Basilar Artery

Dr. Noura El Tahawy

16. =Formed by the union of the two vertebral arteries at the
lower border of the pons

=Ascends on the front of the pons lodged in the basilar
groove

=Ends at the upper border of the pons by dividing into 2
Posterior cerebral arteries (PCA)

17. \ D EE per communicating artery
Mae care A x

Arlt cheecidal artery

ASAP

Oculomoior nerve

Superior carebotar artery
rochear rene —
Porting mi

Basi artery

© Elsevier Ltd 2005. Standring: Gray's Anatomy 39e - www.graysanatomyonline.com

The circulus arteriosus on the base of the brain

18. Arteries on the base of the brain injected with resin.

19. Branches of Basilar artery
Posteromedial
central

Posterior cerebral

|

Superior
cerebellar

Pontine

Labrynthing ——— Anterior inferior
cerebellar A.

Basilar

20. Arteries of the Cerebellum

ath part
vertebral

21. Posterior Cerebral Artery

Dr. Noura El Tahawy

22. Posterior, Internal carotid
communicating

Posterior
cerebral

Superior.
cerebellar
Pontine

Basilar

Labyrinthine

Anterior.
inferior
cerebellar

Posterior

inferior

cerebellar
Anterior spinal Vertebral

Arterial supply of hindbrain.

23. Posterior Cerebral artery: Course

Anterior cerebral artery
Anterior communicating artery
Medial state artery

Internal carotid artery
Anteromedial group

Middle cerebral artery
Posterior communicating artery eal asain
Anterior choroidal artery
Posteromedia group
Oculomotor nerve Posterolateral group
Posterior cerebral artery

‘Superior cerebellar artery
Trochlear nerve
Pontine rami

Basler artery

24. Orbitofrontal artery (ACA)

Posterior WR, Frontovasal (CA)
Cerebral Artery:
Course & brs.

Lateral branch (PCA)
Anterior temporal artery
_ Posterior temporal artery

7 — Occipitotemporal artery

PN medial branch (PCA)
Callosal artery
Calcarine artery

View from below the cerebral hemispheres, showing the cortical branches and territories of the three cerebral arteries.
ACA, M PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery

25. Posterior Cerebral Artery: Course

losal

Caleanne
artery.

Superior
cerabolar artery

ior inferior
artery

Posterior inferior
cerabellar artery—

Major arteries of the brain. /

A, medial aspect

marginal

Orbital
artery

Anterior

rtery

Gasilar artery

26. Posterior Cerebral artery: Course

Anterior
Precuneal artery

FAIRE Dorsal branct
\ > to corpus call

Parietooc

rtery (cut) = y 4
j Medial «

nedial striate artery Posterior temporal

ent artery of Heubner)
‘Anterior temporal branch

Dactariar cammutnicating artery

27. Posterior Cerebral Artery: Brs & Cortical Distribution

A B
Precureus— Parecen loule —Cguletegyrus — — Neal fonts
Superior ntl gs Precetval gus Poston gyus
Superior pre lobule
Mode rental gy.
nero particule

err ental gus Mode tempore gyrus
Superior temeore gus Ini te s Lingua Corpus calosum N Paraigpocampal rs

© Elsevier Ltd 2005. Standring: Gray's Anatomy 39e - www.graysanatomyonline.com

The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries.
B. The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral
arteries. In these figures the area supplied by the anterior cerebral artery is coloured blue, that by the
middle cerebral artery pink and that by the posterior cerebral artery is yellow

28. Named cortical branches of the posterior cerebral
artery

Branch

Artery

Territory

Lateral

Anterior
temporal

Anterior temporal cortex

Posterior
temporal

Posterior temporal cortex

Occipitotemporal

Posterior temporal and occipital
cortex

Calcarine

Calcarine cortex

Parietooccipital

Cuneus and precuneus

Callosal

Splenium of corpus callosum

29. Posterior Cerebral Artery: Important Areas of Cortical

Distribution

LOBE

AREA

OCCIPITAL

Visual

TEMPORAL

Olfactory

30. Posterior Cerebral Artery: Central Brs

Thalamo-

1- Posteromedial Group geniculate ————]
artery

Thalamus

pierce the posterior perforated

substance and supply: Thalamo-

perforating
artery
- The thalamoperforating
artery to the anterior one-third Optic tract
ACA

of the thalamus
- Hypothalamus
- Globus Pallidus

Yt
GB Va F
MGB
ICA
GG

Posterior

# communicating
ACA, anterior cerebral artery; ICA, PCA : artery

internal carotid artery; LGB, MGB,

lateral, medial genic

/_— Basilar artery

31. Posterior Cerebral Artery: Central Brs

2- Posterolateral Group

1. The thalamogeniculate
artery shown supplies the
geniculate bodies and the

posterior two-thirds of the
thalamus.

2. Brs. To the cerebral peduncles
& Tectum of the Midbrain Geniculate
bodies

Cerebral
peduncle

32. Posterior Cerebral Artery: Choroidal Brs

= posterior choroidal artery: from the
posterior cerebral artery to supply the choroid
plexus of the lateral ventricle .

33. | Posterior cerebral artery & posterior communicating artery

Central brs

Hypothalamus

Thalamus (ANT)

Internal
capsule
i
Cerebral peduncle A E >
a VA

Cerebral
peduncle

34. Internal Carotid System

Dr. Noura El Tahawy

36. Internal Carotid Artery

Begins — bifurcation of Common Carotid A

Enters middle cranial fossa through the carotid canal at the base of
skull

Lies beside dorsum sellae
n the cavernous sinus: Lies Horizontal

Emerge out — medial side of Ant. clinoid process — perforates dura €
arachnoid mater — enters subarachnoid space

Turns posteriorly — below optic nerve
Tums upward — lateral to optic chiasma
ow is under anterior perforated susbtance

Divides — into ANTERIOR & MIDDLE cerebral arteries

37. Anterior communicating artery Medial striate artery

Anteromedial central arteries

ACA APA Il tem — Anterolateral central arteries
é ie (lateral striate)

Posteromedial central arteries

Thalamogeniculate artery +,
PCA

Thalamoperforating artery _W Q

Posterolateral central arteries

Baslar artery

The arteries comprising the circle of Willis. The four groups of central branches are shown;
the thalamoperforating artery belongs to the posteromedial group, and the thalamogeniculate
artery belongs to the posterolateral group. ACA, MCA, PCA, anterior, middle, posterior
cerebral arteries; ICA, internal carotid artery.

38. Anterior communicating artery

Anteromedial arteries

Anterior perforated substance
‘Optic chiasm

Pituitary stalk

Posterolateral central arteries
(including thalamogeniculate artery)

Posteromedial central arteries
{including thalamopertorating artery)

Interpeduncular fossa
(floor of hypothalamus)

— Medial striate artery

ACA

Anterolateral central arteries
(lateral striate)

MCA

ICA

Posterior communicating artery
Internal capsular branches of
anterior choroidal artery
Posterior perforated substance

PCA
Choroid plexus of temporal lobe

_. Basilar artery

Brain viewed from below, showing background structures related to the circle of
Willis. Part of the left temporal lobe (to right of picture) has been removed to show
the choroid plexus in the inferior horn of the lateral ventricle

39. = Internal Carotid A

Hypophyseal arteries
Ophthalmic
Anterior communicating
Post Communicating
Anterior Choroidal
Ant Cerebral

Cortical

Central

Communicates with
a Ant. Comm. A
Middle Cerebral
= Cortical

= Central

= Vertebral A.
Meningeal

Post Spinal

Ant Spinal

Post Inf Cerebellar
Medullary

Basilar A.

a

Pontine
Labyrinthine

Ant. Inf. Cerebellar
Sup. Cerebellar
Post Cerebral

= Cortical

= Central

= Choroidal

40. Anterior Cerebral Artery

41. Anterior Cerebral artery: Course

Anterior cerebral artery
Anterior communicating artery
Medial state artery

Internal carotid artery

Middle cerebral artery
Posterior communicating arer
wg artery Lateral stale group
Anterior choroidal artery
Posteromedia group
Oculomotor nerve Posterolateral group
Posterior cerebral artery

— Superior oerebellar artery

Trochlear nerve
Pontine rami

Basar artery

42. Anterior Cerebral Artery: Course

Cakarine Paneto-ccsipital Péricallosal ———— Callosomarginal
artery — artery aetery artery

Frontopotar

Orbital
artery

— Anterior

uperie Cerebral artery

ceraballar artery

Anterior inferior a Posterior
cerebellar artery —” ‘cerebral artery

Posterior inferior
cerebellar artery— \— Basilar artery

Major arteries of the brain. A, medial aspect

43. Anterior Cerebral artery: Course

44. Anterior Cerebral artery: Course

Anterior
Precuneal artery

FAIRE Dorsal branct
\ > to corpus call

Parietooc

Cali

rtery (cut) = y 4
j Medial «

nedial striate artery Posterior temporal

ent artery of Heubner)
‘Anterior temporal branch

Dactariar cammutnicating artery

45. Anterior Cerebral Artery: Cortical brs.

Pericallosal artery
Callosal D”

Callosal branch

Callosomarginal artery
N Parietooccipital artery

1
Polar frontal artery A L

?
—Calcarine artery

Orbitofrontal artery.

an > = | a ji artery
PCA 7 | Temporal branches
Lateral branch ve Medial branch

© Elsevier. FitzGerald et al: Clinical Neuroanatomy and Neuroscience Se - www.studentconsult.com

Medial view of the right hemisphere, showing the cortical branches and territories of
the three cerebral arteries. ACA, PCA, anterior, posterior cerebral arteries.

46. Anterior Cerebral Artery: Cortical brs.

Central artery

Posa Sra Precentral artery

Parietal artery,
Prefrontral artery

Angular artery E

Upper division

Orbitofrontal artery

Middle temporal artery

Temporooccipital artery_ 4% % pe

Middle cerebral artery

Lower division
Anterior temporal artery

© Elsevier. FitzGerald et al: Clinical Neuroanatomy and Neuroscience Se - www.studentconsult.com

Lateral view of right cerebral hemisphere, showing the cortical branches and
territories of the three cerebral arteries.

47. ‚Orbitofrontal artery (ACA)

Anterior Frontobasal (MCA)
Cerebral NW x
Artery:

Cortical brs.

ACA

ICA

PCA

Lateral branch (PCA)

Er Anterior temporal artery

Posterior temporal artery

as

>— Occipitotemporal artery

Medial branch (PCA)

Callosal artery

Calcarine artery

View from below the cerebral hemispheres, showing the cortical branches and territories of the three cerebral
arteries. ACA, MCA, PCA, anterior, middle, posterior cerebral arteries; ICA, internal carotid artery

48. Named cortical branches of the anterior cerebral artery

Branch

Territory

Orbitofrontal

Orbital surface of frontal lobe

Polar frontal

Frontal pole

Callosomarginal

Cingulate and superior frontal gyri; paracentral
lobule

Pericallosal

Corpus callosum

N. B. The term cortical is conventional . Terminal is better, because these
arteries also supply the underlying white matter

49. Anterior Cerebral Artery: cortical Distribution

Superior frontal gyrus Pracantral gyrus — Poster

Middle frontal gyrus or parietal lobe

ior parietal iobule:

Arcus parieto-

Inferior frontal gyrus Middle lemporal gyrus
Superior LS Inferior temporal gyrus
‘The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In these figures

the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the
posterior cerebral artery is yellow

50. Anterior Cerebral Artery: Cortical Distribution
8

Precunsus —, Paracentral latule — — Cingulate gyrus — Medial frontal gy

al lobule

Hobule

Cuneus — — Lingual gyrus — Corpus callosum “— Parahippocampal gyrus
B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In
these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral
artery pink and that by the posterior cerebral artery is yellow

51. Anterior Cerebral Artery

important functional areas supplied by cortical brs.

LOBE AREA

FRONTAL Motor — lower limb and perineum -
LOBE pericentral lobule

PARIETAL Sensory — lower limb and perineum -
LOBE paracentral lobule

52. Anterior Cerebral Artery: Central brs.

‘Corona radiata

interna capsule
Internal capsule {retrolenticutar part)
{posterior limb}

Middle cerabral
== Anterior choroidal
artery

‘Optic radiation
Internal capsule -
{anterior limb) internal capsule
A ‘ (gen)
Anterior cerebral
artery

Putamen

Globus pallidus

Territory supplied by branches of the anterior and middle cerebral arteries is shown in red. Territory
supplied by the anterior choroidal artery is shown in green

53. Anterior Cerebral Artery: cortical brs.

Medial striate artery recurrent artery of
Heubner (pron. 'Hoibner'):

Arises close to the anterior communicating
artery

Supplies:

Ant. Part of head Caudate & Adjacent part of
internal capsule

Putamen
Septal nuclei

54. Anterior Cerebral Artery: Central brs.

|

Anterior cerebral artery, anterior communicating artery & ICA

y
Anteromedial group of central brs

distribute to the anterior of the hypothalamus

55. Middle Cerebral Artery

56. Anterior Cerebral artery: Course

Anterior cerebral artery
Anterior communicating artery
Medial sae ate

tones ———— E Internal carotid ar
Middle cerebral artery =
Posterior communicating arer

te ing artery Lateral stale group
Anterior choroidal artery
Posteromedia group
Oculomotor nerve Posterolateral group
Posterior cerebral artery

— Superior oerebellar artery
Trochlear nerve
Pontine rami

Basar artery

57. Middle Cerebral Artery: Cortical brs.

Central artery,
Postcentral artery,

Precentral artery
Parietal artery.
Prefrontral artery

Angular artery

Upper division

Temporooccipital artery

Middle temporal artery Orbitofrontal artery

‘Middle cerebral artery

Lower division
Anterior temporal artery

© Elsevier FitzGerald et al: Clinical Neuroanatomy and Neuroscience Se - www.studentconsult.com

Lateral view of right cerebral hemisphere, showing the cortical branches and
territories of the three cerebral arteries.

58. Middle
Cerebral
Artery:
Course &
Branches

Prefrontal

Middle cerebral
artery

Antedor tempor:

Middle tempor:

Vertebral
artery

Majo:

arteries of the brai

Temporo-
‘occipital artery

Postcentral
artery

Supenor
cerebellar artery

terior inferior
cerebellar artery

Posterior infer
cerebellar artery

59. Cortical branches of the middle cerebral artery

Origin

(Branch(es

Territory

Stem

Frontobasal

Anterior
temporal

Orbital surface of frontal lobe

Anterior temporal cortex

Upper division

Prefrontal
Precentral

Prefrontal cortex
Premotor areas

Central

Pre- and postcentral gyri

Postcentral

Postcentral and anterior parietal cortex

Parietal

Posterior parietal cortex

Lower division

Middle temporal
Temporooccipital

Midtemporal cortex
Temporal and occipital cortex

Angular

Angular and neighboring gyri

60. Middle Cerebral Artery: Cortical Distribution

Superior frontal gyrus Precentral gyrus — Posteentral gyrus

Superior parietal lobu

Middle frontal gyrus SRE panela WB
Inferior parietal iobule

Arcus parieto-
cocipitalis

Inferior frontal gyrus x Middig lemporal gyrus
Superior temporal gyrus ————————] Inferior temporal gyrus ©

The lateral surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries.. In these figures
the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral artery pink and that by the
posterior cerebral artery is yellow

61. Middle Cerebral Artery: Cortical Distribution
B

Precuneus —, — Paracentral lobule — —Cingulale gyrus — Medial frontal gyrus

al lobule

Hicbule

—Unous

Cuneus — Lingual gyrus ‘Corpus callosum — Parahippocampal gyrus

B, The medial surface of the left cerebral hemisphere, showing the areas supplied by the cerebral arteries. In
these figures the area supplied by the anterior cerebral artery is coloured blue, that by the middle cerebral
artery pink and that by the posterior cerebral artery is yellow

62. Middle Cerebral Artery

Important functional areas supplied by the Cortical brs

LOBE AREA

FRONTAL Motor — except for paracentral lobule
Motor speech - esp left side

PARIETAL Sensory — except for paracentral lobule

Sensory speech

TEMPORAL Auditory

63. Middle cerebral artery & anterior choroidal artery

1- Medial Striate arteries
Supply:

Lentiform nucleus

Caudate nucleus

Internal capsule (ANT
& POST)

L

64. Middle Cerebral Artery: Central brs

2- Lateral striate arteries:
Supply the Corpus striatum, internal capsule, and Anterior of

thalamus

One of this group is specially large & more susceptible to hemorrhage & called
artery of cerebral hemorrhage (Charcot’s Artery)

Occlusion of one of the lateral striate arteries is the chief cause of classic stroke ,
where damage to the pyramidal tract in the posterior limb of the internal capsule
causes hemiplegia .a term denoting paralysis of the contralateral arm, leg, and lower

part of face

65. Middle Cerebral Artery: Central brs

Lateral
striate
arteries

Left middle Right middle
cerebral artery cerebral artery

66. Anterior
Cerebral

Middle
Cerebral

Posterior
Cerebral

Begins

From int.
carotid a.

From int.
carotid a.

From basilar
artery

Sulcus
related

Callosal

Stem of lateral
Ss.

Calcarine

Branches

1- Cortical
2- Central
3- Callosal

1- Cortical
2- Central

1- Cortical
2- Central
3- Callosal
4- Choroidal

67. Choroidal Arteries

The Anterior Choroidal A.: from the Internal
Carotid A.

The Posterior Choroidal A.: from the posterior

cerebral artery to supply the choroid plexus of

the lateral ventricle .

The Choroidal Branch of posterior inferior
Cerebellar A.

68. CIRCLE OF WILLIS

Dr. Noura El Tahawy

69. Arterial Circle Of Willis

Site: at the base of the brain around interpeduncular fossa.

Function: Important anastomosis between the 2 internal carotid
arteries in front & Vertebro-basilar system behind.

Arteries forming it:
a Rt. & Lt. internal carotid artery.

1 Rt. & Lt. anterior cerebral arteries.
Rt. & Lt. posterior cerebral arteries.
Rt. & Lt. posterior communicating arteries.
Anterior communicating artery.

70. Anterior communicating artery Medial striate artery

Anteromedial central arteries

ACA APA Il tem — Anterolateral central arteries
é ie (lateral striate)

Posteromedial central arteries

Thalamogeniculate artery +,
PCA

Thalamoperforating artery _W Q

Posterolateral central arteries

Baslar artery

The arteries comprising the circle of Willis. The four groups of central branches are shown;
the thalamoperforating artery belongs to the posteromedial group, and the thalamogeniculate
artery belongs to the posterolateral group. ACA, MCA, PCA, anterior, middle, posterior
cerebral arteries; ICA, internal carotid artery.

71. fl Anterior cerebral A.

|
\ Anteri
Anterior cerebral A. U—

or communicating A.

Striate branch of
Internal carotid A anterior cerebral A.
RD cerebral A.

= ME Posterior
Banana communicating A.
branches
Superior Posterior cerebral A.
cerebellar A.

Pontine
branches

Anterior inferior
cerebellar A.
Posterior inferior
cerebellar A.

Anterior spinal A. Vertebral A.

72. Anteromedial group

Middle cerebral artery

Posterior communicating artery

Anterior choroidal artery

Oculomolor nerve

Trochlear nerve
Pontine rami

Basiar artery

Anterior cerebral artery
Anterior communicating artery
Medial striate artery

Internal carotid artery

Lateral striate group

+E Posteromedial group
Posterolateral group
Posterior cerebral artery

‘Superior cerebellar artery

73. Chorea artery

ifundeulum

yintine artery 7

Figure 17.4 The arteries on the base of the brain. The anterior part of the right temporal
lobe has been removed to display the initial course ofthe middle cerebral artery within the
lateral fissure

75. Anterior
communicating
artery

Posterior
communicating
artery

—, Anterior cerebral
artery

Internal
carotid
artery

Middle cerebral
artery

Sup cerebellar A

Ant Inf cerebellar A

Vertebral arteries

Post Inf cerebellar A

76. Blood Supply of The Cerebrum

CIRCLE OF WILLIS

NS

Rt & Lt Vertebro-
basilar terminal
branch:

a Posterior cerebral
artery

Rt & Lt Internal Carotid
& their branches:

Rt& Lt Middle cerebral As.
Rt& Lt Anterior cerebral As.
Anterior communicating A.

Rt&Lt Posterior
communicating As.

77. Summary Blood Supply of

Specific areas of the Brain

By
Dr. Noura El Tahawy

78. Horizontal section of the
internal capsule at the
level indicated, depicting
its boundaries and parts
(left) and stroke-relevant
motor contents (right). IC
internal capsule, LGB,
lateral geniculate body;
SC, superior colliculus

Head of caudate nucleus
Anterior limb IC

Putamen
Genu IC

Globus pallidus Posterior limb IC

Thalamus Retrolentiform IC

Optic radiation Tail of caudate nucleus

Superior colliculus
————— Lateral geniculate body. superior colliculus

he al
© Elsevier FitzGerald et al: Clinical Neuroanatomy and Neuroscience Se - www.studentconsult.com

79. Anatomy of the Internal Capsule

Head of caudate nucleus

Cortico-oculomotor fibers
Corticonuclear fibers

Corticopontine fibers
Globus palidas IV) Comme
___ Dentatothalamocortical fibers

Corticospinal and
corticoreticular fibers

Thalamic projection to
somatic sensory cortex

Tail of caudate nucleus 2 > E Optic radiation

Lateral geniculate body

Horizontal section of the internal capsule, depicting its parts) left (and contents) right «(
AL, anterior limb; G, genu: PL, posterior limb; RP, retrolentiform part

80. Arterial Supply of the Internal capsule

The three sources of supply are

Anterior choroidal .a direct branch of the internal carotid. The anterior choroidal
branch of the ICA supplies the lower part of the posterior limb and the retrolentiform part of the
internal capsule, and the inferolateral part of the lateral geniculate body. Some of its branches (not
shown) supply a variable amount of the temporal lobe of the brain and the choroid plexus of the

inferior horn of the lateral ventricle;

Medial striate, branch of the anterior cerebral artery (recurrent artery of Heubner)

supplies the lower part of the anterior limb and genu of the internal capsule.

Lateral striate (lenticulostriate) branches of the middle cerebral artery .The
lateral striate arteries penetrate the lentiform nucleus and give multiple branches to the anterior

limb, genu, and posterior limb of the internal capsule

81. Arterial Supply of the Internal capsule

Medial striate artery

Lateral striate arteries

Anterior choroidal artery

Anterior corebral artery

osterior cerebral artery Internal carotid artery

Middle cerebral artery

|
|
The medial striate branch of the anterior cerebral artery is the recurrent artery of Heubner.
Only two of the six lateral striate branches of the middle cerebral artery shown are labeled.

The asterisk indicates arterial supply from the anterior choroidal artery to the inferolateral part
of the lateral geniculate body

Basilar Eu Posterior communicating artery

82. Arterial Supply of the Internal capsule

‘Corona radiata

interna capsule
Internal capsule {retrolenticutar part)
{posterior limb}

Middle cerabral
== Anterior choroidal
artery

‘Optic radiation
Internal capsule -
{anterior limb) internal capsule
A ‘ (gen)
Anterior cerebral
artery

Putamen

Globus pallidus

Territory supplied by branches of the anterior and middle cerebral arteries is shown in red. Territory
supplied by the anterior choroidal artery is shown in green

83. Arteries to specific brain areas

Corpus striatum
Internal capsule
Thalamus
Midbrain

Pons

Medulla oblongata

Cerebellum

Medial & lateral Anterior & Middle
striate brs cerebral arteries

P Com. A, basilar, PCA
PCA, sup Cerebellar A, basilar

Pontine brs. of Basilar, Ant. Inf. cerebellar,
sup. Cerebellar A.

Vertebral, Posterior inf. Cerebellar,
Anterior Inferior Cerebellar A, basilar

Sup. Cerebellar, AICA, PICA

84. Venous Drainage of the Brain

85. VENOUS DRAINAGE of THE BRAIN

= INTERNAL
a Thalamo
striate

a choroidal

e SPECIFIC

Midbrain
Pons
Medulla
oblongata
cerebellum

86. External Cerebral Veins

VEIN

DRAINS INTO

Superior cerebral
veins

Superficial middle
cerebral

Inferior cerebral veins

Sup. Anastomotic V

Inf. anastomotic V

Lateral surface of
cerebral
hemisphere

Superior Sagittal sinus

Cavernous sinus

Superficial middle cerebral
V

Communicates between the
superficial middle cerebral
V & Superior Sagittal sinus
Communicates between
superficial middle cerebral
V & transverse sinus

87. External Cerebral Veins

VEIN

AREA

DRAINS INTO

Deep middle cerebral

Insula

Joined by ant. cerebral &
striate veins to form basal
vein

Anterior cerebral
Deep middle cerebral
Striate veins

The three veins unite to form
the Basal vein

Basal vein

Inferior Surface

Rt. & Lt basal veins drain
into the great cerebral vein

Great Cerebral vein

Behind splenium of CC
& formed by the union
of the 2 internal
cerebral veins

Unite with the inferior
sagittal sinus to form straight
sinus

88. External Cerebral Veins

Superticial c ns ? Superior anastomotic vein

— Superior sagtlal sinus

— Transverse sinus
Superficial middie

cerebral vain à \ Sigmoïd sinus

Inferior anastomotic vein ———— internal jugular vein

The external (superficial) cerebral veins of the left hemisphere and their relationship to the dural
venous sinuses

89. | Superior
Sagittal
sinus

Inferior
Sagittal
sinus
Internal

| cerebral

| Great
“| cerebral

| Straight
| sinus

Site of

| junction
Le") with

transverse

sinus

"= Occipital
sinus

90. VEIN

Internal Cerebral Veins

DRAINS INTO

Thalamostriate

Choroidal

Basal ganglia, thalamus,
internal capsule,Tela
choroidae of 374
ventricle, hippocampus

- Both veins (of each side)
unite to form
Internal Cerebral vein

- Rt. & Lt. Internal
cerebral veins unite to
form Great Cerebral vein

|

—The Great cerebral vein
join the Inferior Sagittal
sinus to form Straight
sinus |

DURAL VENOUS SINUS

91. Internal Cerebral Veins

Septum pelLoisum

Caudate nucaus

Thalamostiat vein

Internal cerebral vein
Chotid plows

Basal vein

Great cerebral ein

The internal (deep) cerebral veins, viewed from above after removal of the central
portion of the corpus callosum.

92. Thalamostriate Superior anastomotic vein Superior sagittal sinus
and choraxfal \ /
vein

Inferior
sagittal
sinus

- internal

Great
cerebral
vein

— Basal vein

I Straight
, sinus
Deep middie - ; e ™ Inferior
cerebral vain - E anastomotic
y ven
Transverse sinus

|
Inferior petrosal sinus Occipital
sinus

The cerebral venous system (viewed from the teft side) showing the principal superficiat and
deep veins of the brain and their relationship to the dural venous sinuses. The more deeply
placed veins are shown in blue and those inside the brain are shown in interrupted blue.

93. n: superior view

Superior F=
petrosal
sinus

Inferior
petrosal
sinus

Straight
sinus

Superiorsa
gittal sinus

~ | Jugular
— foramen

Sigmoid

Confluence of
sinus

94. Inferior
sagittal sinus

Inferior
petrosal
sinus

Superior sagittal sinus

Tentorium
cerebelli

Sigmoid
sinus

Transverse
sinus

Superior
petrosal
sinus

Confluence of
sinus

Straight

sinus

95. Veins of Specific Areas

Midbrain

Basal, great cerebral

Pons

Basal, cerebellar

Medulla oblongata

Anterior & posterior spinal

Cerebellum

Great cerebral

96. Cavernous sinus

Lateral to body of sphenoid bone
Connected to opposite — intercavernous S
Receives blood

a Middle cerebral V

Drains into

a Int Jugular V —via Inf petrosal sinus

a Transverse S — via Sup petrosal S

Dural Venous sinuses — emissary veins — extracranial V

97. Clinical Application

Stroke or cerebrovascular accident:-
a Blockage in the artery — cerebral infarction
Carotid artery
Basilar artery
a Bleeding within the brain — intracerebral haemorrhage
Aneurysm
Subarachnoid haemorrhage
Intracerebral haemorrhage - hypertension
a Damages one side of the body - contralateral

98. CVA - due to blockage

Lack of
blood flow

Blood supply
to brain

99. CVA - due to haemorrhage

Roy > ees
7 PA dp.

100. THANK YOU