BLOOD SUPPLY OF BRAIN VERTEBRAL ARTERY INTERNAL CAROTID ARTERY

1. PRESENTER: DR MOHAMMAD NAUFAL B Y
ARTERIAL SUPPLY OF
BRAIN

2. ARTERIAL SYSTEM OF BRAIN
SOURCE:
1)VERTEBRAL ARTERY
2)INTERNAL CAROTID ARTERY
FORM
CIRCLE
OF
WILLIS

3. HEART
A
O
A
right commom
carotid
Right Subclavian Left Subclavian
Brachiocephalic
Artery
Left Internal
Carotid
Left Vertebral
Artery
Right Vertebral
Artery
Right Internal
Carotid
Left Common
Carotid

5. VERTEBRAL ARTERY Origin:
 1st Branch Of 1st Part Of Subclavian Artery
 Course:
 Passes Through Transverse Foramen (C6- C1)
 Go Through Suboccipital Triangle Enter Foramen Magnam
 Perforate Duramatar And Arachnoid Matar Enter Subarachnoid Space.
 Upward, Forward And Medially (Medulla Oblongata)
 In The Lower Border Of Pons JoinsOpposite Vertebral Artery To Form Basilar
Artery.
 Parts:
 Four Parts- V1 To V4.

7. BRANCHES OF VERTEBRAL ARTERY
1. Anterior Spinal Artery.
2. Posterior Spinal Artery (75%-PICA)
3. Posterior Inferior Cerebral Artery.
4. Terminate By Forming Basilar Artery.

9. PSA
I. 25% From Vertebral
Artery
II. 75% From PICA
III.Desends On Side Of
Medulla
IV.Unite: Lower Cervical
Region
PICA
I. Largest Branch
branch Of Vertebral
Artery
II. Supply:
 Lateral Medulla,
 Posterior Part Of
Inferior Surface Of
Cerebellum
ASA
I. Desends Infront Of
Medulla
II. Unite: Level Of Foramen
Magnum
III.Supply:
 Medial Medulla
 Anterior 2/3 Spinal Cord

11. BASILAR ARTERY
 Origin:
 Formed By Union Of Two Vertebral Artery At
Lower Border Of Pons
 Course:
 Ascends Infront Of Pons In Basilar Groove
 Ends At Upper Border Of Pons By Dividing Into
Two Posterior Cerebral Artery
 Branches:
1. Anterior Inferior Cerebellar Artery
2. Pontine Arteries
3. Superior Cerebellar Artery
4. Posterior Cerebral Artery
5. Labyrinthine Artery

13. VASCULAR TERRITORIES OF
CEREBELLUM

14. Labyrinthine Artery
Origin
 15% From Basilar Artery
 85% From Aica
 Enter Internal Auditory Meatus
Supply:
 Cochlea
 Vestibular Apparatus
Superior Cerebellar Artery
Course:
 Passes Laterally Just Behind Oculomotor Nerve
Supply:
 Superior Surface Of Cerebellum
AICA
Supply:
 Anterior Part Of Inferior Surface Of
Cerebellum
Pontine Artery
Origin:
 Multiple
Supply:
 Pons

17. POSTERIOR CEREBRAL ARTERY
Origin:
Basilar Artery Gives Two Posterior Cerebral Artery
Supply
1) Midbrain
2)Thalamus
3)Posterior Limb Of Internal Capsule
4)Optic Tract
5)Choroid Plexus And Cerebral Peduncles
6)Splenium Of Corpus Callosum
7)1/3 Posterior Medial Of The Cerebral Hemispheres
8) Inferomedial Temporal Lobe 9)A
9)Large Part Of The Occipital Lobe.
 Course:
 Passes Backwards Winding
 Around Midbrain/Cerebral Peduncle
to Reach Tentorial Surface Of Cerebral
Hemisphere.
 The Posterior Cerebral Arteries End
Above The Tentorium,In The Calcarine
Sulcus

19. Course of PCA
Passes Backwards Winding Around
Midbrain/Cerebral Peduncle to Reach
Tentorial Surface Of Cerebral
Hemisphere.The Posterior Cerebral Arteries
End Above The Tentorium,In The Calcarine
Sulcus

20. PCA BRANCHES
CENTRALCORTICAL
1) Thalamoperforating and
Thalamogeniculate/ Postero-
medial Ganglionic Artery.
2)Peduncular perforating Or
Postero-lateral Ganglionic
Artery
3.) Posterior Choroidal Artery
1) Anterior Temporal Artery
2) posterior Temporal Artery
3) Lateral Occipital Artery
4) Medial Occipital Artery
5) Splenial Artery/ Posterior
Pericallosal Artery
:

23. 1.Thalamoperforating And Thalamogeniculate/ Postero-medial Ganglionic
Branches:
Supply: The Medial Surfaces Of The Thalami And The Walls Of The 3rd Ventricle.
2.Peduncular Perforating Or Postero-lateral Ganglionic Branches:
Supply: Thalamus.
3. Posterior Choroidal Artery:
1)medial Posterior Choroidal Branches:
Supply: Supply The Tela Choroidae Of The Third Ventricle And The Choroid Plexus.
2)lateral Posterior Choroidal Branches:
Supply: Small Branches To The Cerebral Peduncle, Fornix, Thalamus, Caudate Nucleus,
And Choroid Plexus Of The Lateral Ventricle
CENTRAL BRANCHES

24. 1) Anterior Temporal Artery:
Supply: Uncus And Anterior Part Of The Fusiform Gyrus.
2) Posterior Temporal Artery:
Supply: Fusiform And The Inferior Temporal Gyri.
3) Lateral Occipital Artery:
Branches: Anterior, Middle And Posterior Inferior Temporal Arteries.
4) Medial Occipital Artery:
A) Calcarine Artery:
Supply: Cuneus And Gyrus Lingualis And The Back Part Of The Convex Surface Of The Occipital Lobe.
B) Parieto-occipital Artery:
Supply: Cuneus And Precuneus.
5) Splenial Artery/ Posterior Pericallosal Artery:
CORTICAL BRANCHES

27. PCA Parts
P1 segment
• from the basilar
artery to the
posterior
communicating
artery,within
interpeduncular
cistern
• The P1 segment
passes over the
oculomotor nerve.
P4 segment
• ends in the
calcarine
fissure.(corti
cal segment)
P3 segment
• travels briefly
through the
quadrigeminal
cistern(Thus
quadrigeminal
segment)
P2 segment
• from PCOM,curves
around the midbrain to
go near the trochlear
nerve,above the
tentorium cerebelli.
• divided into P2A
(anterior) and P2P
(posterior) sub-
segments;
• P2A is within crural
cistern which then
bridges to the P2P
segement in ambient
cistern (thus ambient
segment)

30. Common carotid artery
 Origin:
Right: brachiocephalic artery
Left: arch of aorta
 Course:
Left common carotid
2parts-thoracic and cervical
Right common carotid
Has only cervical part
course
Cervical course:
similar course for both left and right common carotid..
passes obliquely upwards from behind the sternoclavicular joint to the
level of the upper border of the thyroid cartilage.
In the lower neck, they are separated from each other by trachea.
as the carotids rise in the neck, they diverge and separated by
the thyroid gland, the larynx and pharynx.
Thoracic course:
travels upwards through the
superior mediastinum to the
level of the left sternoclavicular
joint

31. C3,4

33. INTERNAL CAROTID ARTERY

40. branches

41. BRANCHES OF ICA
Mnemonic:A VIP'S COMMA
 A: anterior choroidal artery (C7)
 V: Vidian artery (C2)
 I: inferolateral trunk (C4)
 P: posterior communicating artery (C7)
 S: superior hypophyseal artery (C6)
 C: caroticotympanic artery (C2)
 O: ophthalmic artery (C6)
 M: meningohypophyseal trunk (C4)
 M: middle cerebral artery C7)
 A: anterior cerebral artery (C7)
 The last two branches in the mnemonic are the terminal branches of the internal carotid artery.
 Except for the terminal segment (C7) the odd numbered segments usually have no branches, whereas the even
numbered segments (C2, C4, C6) each have two branches.

43. ANTERIOR CEREBRAL ARTERY
 Origin-
One Of Terminal Branch Of ICA
 Segments:
 A1 (horizontal): origin from the ICA to the anterior communicating artery (ACOM),
 A2 (vertical): from ACOM to the origin of the callosomarginal artery
 A3 (callosal): distal to the origin of the callosomarginal artery
 BRANCH:
 A1
 medial lenticulostriate arteries
 recurrent artery of Heubner
 anterior communicating artery
 A2
 orbitofrontal artery
 frontopolar artery
 A3
 pericallosal artery
 callosomarginal artery
Anterior Limb Internal Capsule
Inferior Portion Of Head Of Caudate
Anterior Globus Pallidus
MEDIAL SURFACE OF CEREBRAL
HEMISPHERE AND CORPUS CALLOSUM

48. SUPPLY BT ACA
 MEDIAL SURFACE OF
CEREBRAL
CORTEX(ANTERIR
 FRONTAL POLE(BY
CORTICAL BRANCHES)
 ANTERIOR PORTION
CORPUS CALLOSUM

51. MIDDLE CEREBRAL ARTERY
ORIGIN: ANOTHER TERMIANAL
BRANCH OF INTERNAL CAROTID
ARTERY
MCA is divided into four segments:
 M1: from the origin to bifurcation/trifurcation
(the limen insulae); also known as the horizontal or
sphenoidal segment
 M2: also known as the insular segment, from the
bifurcation/trifurcation to the circular sulcus of the
insula, where it makes a hairpin bend to continue as
M3
 M3: opercular branches (those within the Sylvian
fissure); also known as the opercular segment
 M4: branches emerging from the Sylvian fissure
onto the convex surface of the hemisphere; also
known as the cortical segment

52.  M1
 medial lenticulostriate penetrating arteries
 lateral lenticulostriate penetrating arteries
 anterior temporal artery
 polar temporal artery
 uncal artery (which may branch from the anterior
choroidal artery)
 M2
 Division of the MCA is variable after the horizontal
segment, although most commonly, it divides into two
trunks, superior and inferior:
 Superior terminal branch
 lateral frontobasal artery
 prefrontal sulcal artery
 pre-Rolandic (precentral) and Rolandic (central) sulcal
arteries
 Inferior terminal branch
 three temporal branches (anterior, middle, posterior)
 branch to the angular gyrus
 two parietal branches (anterior, posterior)

55. AREA SUPPLIED:
 MOST OF LATERAL HEMISPHERE,
EXCEPT THE SUPERIOR INCH OF
THE FRONTAL AND PARIETAL
LOBE(ANTERIOR CEREBRAL
ARTERY),AND THE INFERIOR
OF TEMPORAL LOBE.
 SUPERIOR DIVISION SUPPLIES
LATEROINFERIOR FRONTAL LOBE
 INFERIOR DIVISION SUPPLIES
LATERAL TEMPORAL LOBE
 DEEP BRANCHES SUPPLY THE
BASAL GANGLIA AS WELL AS
INTERNAL CAPULE

56. ANTERIOR CHOROIDAL ARTERY
2 SEGMENTS
 cisternal segment
 optic tract
 lateral geniculate nucleus and lateral
aspect of the thalamus
 posterior limb of the internal capsule
 lateral aspect of the midbrain
 intraventricular segment
 choroid plexus of the anterior part of the
temporal horns of the lateral ventricles

58. CIRCLE OF WILLIS

59. CIRCLE OF WILLIS

60. CIRCLE OF WILLIS

63. Vascular territories of brain