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Blood Supply to the Nervous System. Objectives. 1. Describe the importance of blood circulation to the brain. 2. List major arteries that transport blood to the cerebrum. 3. Describe region supplied by each major artery.

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Blood Supply to the Nervous System

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Blood supply to the nervous system l.jpg

Blood Supplyto the Nervous System


Objectives l.jpg

Objectives

  • 1. Describe the importance of blood circulation to the brain.

  • 2. List major arteries that transport blood to the cerebrum.

  • 3. Describe region supplied by each major artery.

  • 4. Discuss general blood supply for brainstem, cerebellum, and spinal cord.

  • 5. List common points of anastomoses in the vascular system.


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Objectives

  • 6. Explain significance of potential collateral circulation.

  • 7. Describe venous-sinus system.

  • 8. Discuss mechanism of cerebrovascular accidents.

  • 9. Discuss common cerebrovascular accidents.

  • 10. Describe the mechanism regulating blood flow.

  • 11. Discuss the blood-brain barrier and its clinical significance.


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Blood Supply

  • Function:

  • Total Dependence of Nerve Cells


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Oxygen Deprivation Within the Brain

  • Without Adequate Blood Supply

    • Irreversible Damage

    • Site of Lesion


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Metabolic Needs of the Brain

  • Brain’s Metabolic Needs

  • Blood Flow to the Brain


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Drainage of Blood from the Brain

  • Veins and Sinuses


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Vascular Network

  • Blood Circulation to the Brain


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Vascular Network

  • Large Arteries

  • Small arteries

  • Arterioles with small diameters

  • Capillaries


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Cerebral Arteries: Lateral Brain and Cerebellar Surface

  • Bhatnagar & Andy, 1995, Figure 17.4


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Cerebral Arteries: Midsagittal Brain Surface

  • Bhatnagar & Andy, 1995, Figure 17.3


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Vascular Network

  • Veins

  • Venules


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Cerebral Venous Sinuses

  • Bhatnagar & Andy, 1995, Figure 17.7


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Cerebral Veins: Lateral Surface

  • Bhatnagar & Andy, 1995, Figure 17.8A


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Cerebral Veins: Midsagittal Surface

  • Bhatnagar & Andy, 1995, Figure 17.8B


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Cerebrovascular Supply

  • Two Arterial Systems:


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Cerebral Arteries

  • Love & Webb, 1996, Figure 3-7


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Cerebrovascular Supply: Carotid and Vertebral Basilar Systems

  • Bhatnagar & Andy, 1995, Figure 17.1A


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Cerebrovascular Supply: Circle of Willis

  • Bhatnagar & Andy, 1995, Figure 17.1B


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Cerebrovascular Supply: Cerebral Arterial Structure at Base of Brain

  • Bhatnagar & Andy, 1995, Figure 17.2


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Cerebrovascular Supply: Carotid System

  • Carotid System


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Cerebral Arteries

  • Love & Webb, 1996, Figure 3-7


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Cerebrovascular Supply: Carotid and Vertebral Basilar Systems

  • Bhatnagar & Andy, 1995, Figure 17.1A


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Carotid System

  • External Carotid Artery and its Branches

  • Internal Carotid Artery and its Branches


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Cerebral Arteries

  • Love & Webb, 1996, Figure 3-7


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Carotid System

  • Internal Carotid


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Cerebrovascular Supply: Carotid and Vertebral Basilar Systems

  • Bhatnagar & Andy, 1995, Figure 17.1A


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Vertebral Basilar System

  • Two Vertebral Arteries


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Cerebral Arteries

  • Love & Webb, 1996, Figure 3-7


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Cerebrovascular Supply: Carotid and Vertebral Basilar Systems

  • Bhatnagar & Andy, 1995, Figure 17.1A


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Cerebrovascular Supply: Circle of Willis

  • Bhatnagar & Andy, 1995, Figure 17.1B


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Cerebrovascular Supply: Cerebral Arterial Structure at Base of Brain

  • Bhatnagar & Andy, 1995, Figure 17.2


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Vertebral Basilar System

  • Branches


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Cerebrovascular Supply: Circle of Willis

  • Bhatnagar & Andy, 1995, Figure 17.1B


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Cerebrovascular Supply: Cerebral Arterial Structure at Base of Brain

  • Bhatnagar & Andy, 1995, Figure 17.2


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Vertebral Basilar System

  • Posterior Spinal Artery

    • Function:

    • Circulatory Disorders


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Vertebral Basilar System

  • Anterior Spinal Artery

    • Pathway:

    • Function:

    • Circulatory Disorders


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CorticobulbarTract

  • Bhatnagar & Andy, 1995, Figure 14.3A


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CorticospinalTract

  • Bhatnagar & Andy, 1995, Figure 14.3B


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Vertebral Basilar System

  • Posterior Inferior Cerebellar Artery

    • Function:


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Vertebral Basilar System

  • Anterior Inferior Cerebellar Arteries


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Vertebral Basilar System

  • Pontine Level


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Cerebrovascular Supply: Circle of Willis

  • Bhatnagar & Andy, 1995, Figure 17.1B


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Vertebral Basilar System

  • Internal Auditory Artery

    • Function:


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Vertebral Basilar System

  • Superior Cerebellar Arteries

    • Pathway:

    • Function:

    • Circulatory Disorders:


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Circle of Willis

  • Shape:

  • Location:

  • Connections:


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Cerebrovascular Supply: Carotid and Vertebral Basilar Systems

  • Bhatnagar & Andy, 1995, Figure 17.1A


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Cerebrovascular Supply: Circle of Willis

  • Bhatnagar & Andy, 1995, Figure 17.1B


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Cerebrovascular Supply: Cerebral Arterial Structure at Base of Brain

  • Bhatnagar & Andy, 1995, Figure 17.2


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Circle of Willis

  • Components:

    • Communicating Arteries

      • 1.

      • 2.

    • Proximal Portions of the Cortical Arteries

      • 1.

      • 2.

      • 3.


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Circle of Willis

  • Importance:

    • Anastomotic Point


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Circle of Willis

  • Two Types of Arteries:

    • 1. Cortical (Circumferential) Arteries

    • 2. Central (Penetrating) Arteries


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Cortical Arteries

  • 1. Anterior Cerebral Artery

    • Pathway:


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Cerebral Arteries: Midsagittal Brain Surface

  • Bhatnagar & Andy, 1995, Figure 17.3


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Cortical Arteries

  • 1. Anterior Cerebral Artery

    • Vascular Supply

      • Regions:


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Cerebral Arteries of the Lateral and Medial Surfaces of the Left Cerebral Hemisphere

  • Love & Webb, 1996, Figure 3-8


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Cortical Arteries

  • 1. Anterior Cerebral Arteries

    • Vascular Supply

      • Interruption of Blood Circulation:

        • Motor Impairment:

        • Cognitive Impairments:

        • Additional Impairments:

          • Decreased spontaneity

          • Motor inaction

          • Impaired judgment

          • Limited concentration


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Cortical Arteries

  • 2. Middle Cerebral Arteries

    • Pathway:


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Cerebral Arteries: Lateral Brain and Cerebellar Surface

  • Bhatnagar & Andy, 1995, Figure 17.4


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Cortical Arteries

  • 2. Middle Cerebral Artery

    • Vascular Supply

      • Important Areas


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Cerebral Arteries of the Lateral and Medial Surfaces of the Left Cerebral Hemisphere

  • Love & Webb, 1996, Figure 3-8


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Cortical Arteries

  • 2. Middle Cerebral Arteries

    • Vascular Supply


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Cortical Arteries

  • 2. Middle Cerebral Arteries

    • Interruption of Blood Supply

      • Motor Impairment:

      • Sensory Impairment:

      • Other Symptoms:

      • Subcortical damage:


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Cortical Arteries

  • 3. Posterior Cerebral Artery

    • Pathway:


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Cortical Arteries

  • 3. Posterior Cerebral Artery

    • Vascular Supply


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Cerebral Arteries of the Lateral and Medial Surfaces of the Left Cerebral Hemisphere

  • Love & Webb, 1996, Figure 3-8


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Cortical Arteries

  • 3. Posterior Cerebral Artery

    • Interruption of Blood Supply

      • Visual Impairment:


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Central (Penetrating) Arteries

  • Pathway:


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Central (Penetrating) Arteries

  • Vascular Supply:

    • Supply the subcortical structures that include:

      • Thalamus

      • Hypothalamus

      • Caudate nucleus

      • Putamen

      • Globus pallidus

      • Basal ganglia

      • Internal capsule

      • Choroid plexus

      • Other structures


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Central (Penetrating) Arteries

  • Interruption of Blood Supply:

    • Anteromedial Arteries

    • Medial Striate Arteries

    • Anterior Choroidal Artery

    • Posteromedial Arteries

    • Posterolateral Arteries


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Collateral Circulation

  • Alternative Blood Supply:

  • Importance in Recovery:


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Cerebrovascular Supply: Carotid and Vertebral Basilar Systems

  • Bhatnagar & Andy, 1995, Figure 17.1A


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Cerebrovascular Supply: Circle of Willis

  • Bhatnagar & Andy, 1995, Figure 17.1B


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Collateral Circulation

  • Two Common Points of Collateral Circulation


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Vascular Pathologies

  • Vascular Diseases of the Brain


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Vascular Pathologies: Occlusive Vascular Pathologies

  • Atherosclerosis


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Vascular Pathologies: Occlusive Vascular Pathologies

  • Ischemia

  • Transient Ischemic Attack (TIA)


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Vascular Pathologies: Occlusive Vascular Pathologies

  • Treatment

  • Compensation for Atherosclerosis


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Cerebrovascular Disorders

  • Bhatnagar & Andy, 1995, Figure 17.6A, B, C


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Vascular Pathologies: Occlusive Vascular Pathologies

  • Embolism


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Vascular Pathologies: Occlusive Vascular Pathologies

  • Thrombosis


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Vascular Pathologies: Hemorrhage

  • Hemorrhagic Strokes


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Vascular Pathologies: Hemorrhage

  • Three Major Types:

    • 1. Intercerebral Hemorrhages

    • 2. Subdural Hematoma

    • 3. Aneurysm


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Vascular Pathologies: Arteriovenous Malformations

  • Congenital Conditions


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Venous Sinus System

  • Veins and Sinuses

    • Function:

    • Process:


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Venous Sinus System: Location of Prominent Dural Sinuses

  • Bhatnagar & Andy, 1995, Figure 2.42


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Dural Sinuses

  • Structure:

  • Function:

  • Major Dural Sinuses:

    • 1.

    • 2.

    • 3.

    • 4.


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Venous Sinus System

  • Bhatnagar & Andy, 1995, Figure 17.7


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Cerebral Veins

  • Function:

  • Two Types:

    • 1. Superficial Cerebral Veins

      • Three Large Superficial Veins

        • A.

        • B.

        • C.


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Cerebral Veins: Lateral Surface

  • Bhatnagar & Andy, 1995, Figure 17.8.A


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Cerebral Veins

  • Two Types:

    • 2. Deep Cerebral Veins

      • Function:


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Cerebral Veins: Medial Surface

  • Bhatnagar & Andy, 1995, Figure 17.8.B


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Blood-Brain Barrier

  • Important Clinical Concept


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Blood-Brain Barrier

  • Selective Membrane Permeability

  • Cortical Pathologies


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Anastomose

Aneurysm

Arteriosclerosis

Arteriovenous Malformations

Atherosclerosis

Blood-Brain Barrier

Carotid Vascular System

Cerebrovascular System

Circle of Willis

Coagulation

Collateral Circulation

Embolism

Hemorrhage

Ischemia

Metabolism

Paresthesia

Sinus

Thrombosis

Watershed Infarction

Define the Following Technical Terms:


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Review Questions

  • 1. Describe the importance of oxygen to brain cells and how long the brain can sustain blood deprivation.

  • 2. Describe vascular circulation to the brainstem and cerebellum.

  • 3. Describe the difference between cortical (circumferential) and central (penetrating) arteries.

  • 4. Describe the distribution area covered by the anterior, middle, and posterior cerebral arteries.


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Review Questions

  • 5. What important functional impairments follow interruptions with blood flow in each cortical artery?

  • 6. Discuss the importance and mechanism of collateral circulation.

  • 7. Describe common vascular pathologies.

  • 8. Describe the venous-sinus system.

  • 9. What is the blood-brain barrier and what are its clinical advantages?


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Blood Supplyof the Nervous System

Graphics


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THINGS TO DO BEFORE LECTURE

  • TERMS:

    • Perfusion

      • Act of pouring over or through, especially the passage of a fluid through the vessels of a specific organ

    • Location of Petrous Bone

    • Epicritic sensation

      • Cutaneous nerve fibers that serve the purpose of perceiving fine variations of touch or temperature

    • Watershed region

      • A ridge which directs drainage toward either side

    • Paresthesia

      • Morbid or perverted sensation

      • Abnormal sensation, as burning, prickling, formications, etc.

    • Hemianesthesia

      • Loss of feeling or sensation

      • Anesthesia affecting only one side of the body; called also unilateral anesthesia

    • Cranium

      • The skeleton of the head, variously construed as including all of the bones of the head, all of them except the mandible, or the eight bones which form the vault that lodges the brain

    • Neocortex

      • The newer, six-layered portion of the cortex cerebri showing stratification and organization characteristic of the most highly evolved type of cerebral tissue

    • Homonymous Hemianopia

      • Defective vision or blindness in half of the visual field of one or both eyes; Affecting the right halves or the left halves of the visual fields of the two eyes


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