Blood supply of the brain
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Amr Hassan, M.D. Associate professor of Neurology - Cairo
University
BLOOD SUPPLY OF
THE BRAIN
The blood reaches brain through two systems of blood vessels:
The carotid system
The vertebral system
BLOOD SUPPLY OF BRAIN
The Carotid system:
Carotid and vertebral arteries
The Carotid system:
The circle of Willis
Areas supplied by MCA
MC
A p
ath
way
Branches of MCA:
Capsular
lenticulostriate
Cortical:
1. Frontal
2. Pareital
3. Temporal
Internal capsule:
3/9/2017 Neurology for physiotherapist by Prof.Dr Ahmed Aboumousa
21
The middle cerebral artery (MCA) occlusion
Capsular branch occlusion: (lenticulo striate artery)
Contralateral complete hemiplegia: affecting the upper and lower limbs to the same extent.
Contralateral hemihyposthesia
Contralateral hemianopia: may occur.
No loss of consciousness or aphasia.
Frontal branches
occlusion:
1. Facio-brachial
monoplegia
2. Motor aphasia and
agraphia in doninant
hemispheres
Parietal branches occlusion:
1. Cortical sensory loss
In U.L
2. Lower quadrantic
homonymous
hemianopia
3. In dominant
hemisphere:
• Sensory aphasia
• Alexia
• Apraxia
Temporal branches
occlusion:
1. Upper quadrantic
homonymous
hemianopia
2. Auditory agnosia
The middle cerebral artery (MCA) occlusion
Main artery occlusion( =1+2):
Coma at the onset.
Contralateral hemiplegia affecting U.L. more than L.L.
Contralateral hemihyposthesia with cortical sensory loss in U.L.
Contralateral homonymous hemianopia.
Aphasia and agraphia in left sided lesions.
Branches of ACA:
Capsular
Heubner’s artery
Cortical
1. Frontal
2. Paracentral
3. Callosal
AC
A p
ath
way
Areas supplied by ACA
Internal capsule:
Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation
The ant cerebral artery (ACA) occlusion
Capsular branch occlusion (Heubner Arterv):
Facio-brachial monoplegia
Cortical branches occlusion
Frontal branches occlusion:
1. Severe behavior
disturbance (apathy or
“abulia,akinetic mutism)
2. Perseveration
3. Grasp reflexes, and diffuse
rigidity—“gegenhalten”)
Cortical branches occlusion
Paracentral branches occlusion:
1. Contralateral hemiparesis in L.L
2. Contralateral sensory loss in L.L
3. Urinary incontinence
Cortical branches occlusion
Callosal branches occlusion:
Apraxia of the left side
The ant cerebral artery (ACA) occlusion
Main artery occlusion( =1+2):
Contralateral hemiplegia affecting L.L. more than U.L.
Contralateral cortical sensory loss in the lower limb.
Incontinence of urine.
Mentality and personality changes.
Forced grasp reflex.
Apraxia of the left side.
Vertebrobasilar system
Vertebrobasilar system
Int.aud.
Vertebrobasilar system
Brain stem branches ( Paramedian branches) occlusion
= brain stem syndromes (revise P.53)
Sup. Cerebellar A.
(SCA occlusion)
Ant. Inf. Cerebellar A.
(AICA occlusion)
Post. Inf. Cerebellar A.
(PICA occlusion)
Ipsilateral cerebellar
ataxia
√
√
√
Ipsilateral Horner's
syndrome √ √ √
Ipsilateral deafness. √ X X
Contralateral
hemihyposthesia. √ √ √
Other features X Ipsilateral 5th, 6th and 7th
cranial nerve paralysis
Bulbar palsy
Ipsilateral loss of pain and
temperature sensations over
the face.
Acute onset associated with
syncope, hiccup, vomiting and
vertigo.
Basilar artery
Partial occlusion (insufficiency) Complete occlusion (usually fatal)
- Syncope, diplopia and
ophthalmoplegia.
- Vertigo or tinnitus.
- Bulbar palsy
- Hemiparesis, hemianaesthesia
- Ataxia.
- Deep coma.
- Complete quadriplegia with
decerebrate rigidity.
- Bulbar paralysis.
- Respiratory embarrassment.
.1Basilar artery (main vessel )occlusion
Clinical features of partial and complete occlusion of basilar artery.
The posterior cerebral artery
It gives the following branches:
Capsular branch supplying the ventral half of the posterior limb of the internal capsule, the thalamus and the geniculate bodies (Thalamogeniculate artery).
Cortical branches to the occipital lobe.
Posterior communicating artery.
Areas supplied by PCA
Posterior cerebral artery occlusion
thalamoqeniculatebranch: ( Ganalionicartery) occlusion= thalamic syndrome:
Thalamic pain i.e. constant burning severe pain in the hemianaesthetic side.
Complete contralateral hemianaesthesia to all types of sensations.
Reflex dystrophy of the shoulder girdle and arm, secondary to the pain.
Choreo-athetosis or hemiballismus due to ischaemia of the basal ganglia and/or subthalamus.
Cortical branches occlusion:
Contralateral homonymous hemianopia with macular sparing.
Visual agnosia in left sided lesions.
Internal capsule:
Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation
Posterior cerebral artery occlusion
thalamoqeniculatebranch: ( Ganalionicartery) occlusion= thalamic syndrome:
Thalamic pain i.e. constant burning severe pain in the hemianaesthetic side.
Complete contralateral hemianaesthesia to all types of sensations.
Reflex dystrophy of the shoulder girdle and arm, secondary to the pain.
Choreo-athetosis or hemiballismus due to ischaemia of the basal ganglia and/or subthalamus.
Cortical branches occlusion:
Contralateral homonymous hemianopia with macular sparing.
Visual agnosia in left sided lesions.
Posterior cerebral artery occlusion
):2+1Main vessel occlusion ( =
Thalamic syndrome
Contralateral homonymous hemianopia with macular sparing as the macula has double blood supply.
Visual agnosia in left sided lesions.
Walllenberg Syndrome
LEFT
Ipsi pyramidal
Contra Ipsi Contra LEFT
Ataxia SENSORY
Contra
Ipsi
Ipsi
Ipsi
Internal capsule:
Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation
THANK YOUTHANK YOU