MR.

REDDY,
A BUSINESS MAN
60 YEARS OLD

HYPERTENSIVE

SUFFERS SEVERE LOSS

IN BUSINESS

SUDDEN WEAKNESS
CANT MOVE
CANT SPEAK
DEVIATION OF FACIAL ANGLE

ADMITTED TO ICU

STROKE DIAGNOSED
WHAT MAKES BRAIN SO PRONE TO HAEMORRHAGE?
INTERNAL CAROTID ARTERY VERTEBRAL ARTERY

ANTERIOR CIRCULATION POSTERIOR CIRCULATION

OCCIPITAL LOBE
FOREBRAIN
BRAIN STEM
Except occipital lobe
CEREBELLUM
Ascends in the neck
and enters carotid
canal of temporal bone.

It has 4 parts:
1. Cervical
2. Petrous
Arises from bifurcation 3. Cavernous
of common carotid artery. 4. Cerebral
 ACA

ICA

MCA

ANTERIOR PERFORATED SUBSTANCE: MEDIAL TO SYLVIAN FISSURE

 CEREBRAL ARTERIES

Ramifies in pia mater & forms plexus Anastomosis is superficial

But
becomes END ARTERIES as they
plunge deep
Short branches Long branches

cortical gray matter white matter

Insufficient to maintain adequate circulation

in case of sudden obstruction of a major artery
 CEREBRAL ARTERIES

Derived from circle of Willis

Supplies
1. Diencephalon,
2. Basal nuclei and
3. Internal capsule They are end arteries
ACA
ICA

MCA

POSTERIOR COMMUNICATING ARTERY

is one of the preterminal branches of internal carotid artery
ANTERIOR CIRCULATION

POSTERIOR CIRCULATION
ANTERIOR CHOROIDAL ARTERY
is another preterminal branch
of internal carotid artery
Supplies:
a. Retrolentiform part of internal capsule
b. Ventral part of posterior limb of internal capsule
c. Globus pallidus
d. Optic tract
e. Amygdaloid body
f. Uncus
g. Hippocampus
Retrolentiform part of
Internal capsule

Ventral part of
posterior limb of
Internal capsule

Globus pallidus
Right and Left ACA are connected
via anterior communicating artery
 A1 A2 A3
PRE COMMUNAL POST COMMUNAL PERICALLOSAL ARTERY
 A2

A1
A3
 Enters through
anterior perforated substance

A1 Central penetrating branches

PRE COMMUNAL
1. Anterior limb of internal capsule
2. Head of caudate nucleus
3. Anterior part of putamen
Medial striate artery 4. Amygdaloid body
(also k/a recurrent artery of HEUBNER) 5. Anterior hypothalamus
6. optic chiasma
7. Lamina terminalis & septum pellucidum
Anterior limb of
Internal capsule

Anterior part
of putamen
 A2 A3
POST COMMUNAL PERICALLOSAL ARTERY

Cortical branches
1. Corpus callosum
2. Motor area of leg
3. Sensory area of leg
4. Paracentral lobule
5. Supplementary area
1. DEFAECATION,
2. MICTURITION, 6. Cingulate gyrus
3. PERINEAL SENSATIONS
 A2 A3
POST COMMUNAL PERICALLOSAL ARTERY

Central penetrating branches Cortical branches

1. Corpus callosum
2. Motor area of leg
3. Sensory area of leg
4. Paracentral lobule
5. Supplementary area
6. Cingulate gyrus
 M1 M2 M3 M4
SPHENOIDAL INSULAR OPERATOR CORTICAL
Runs UPTO stem of lateral sulcus

SPHENOIDAL = M1
 Runs along stem of lateral sulcus

INSULAR = M2
 Runs posterosuperiorly on the insula

INSULAR = M2
 Reaches the superolateral surface along
posterior ramus of lateral sulcus

OPERATOR = M3
 Ramifies on the superolateral surface

CORTICAL = M4
 Central penetrating, or
M1 lenticulostriate branches
(enters through APS)

SPHENOIDAL

Medial striate arteries Lateral striate arteries

Caudate nucleus & Caudate nucleus

lentiform nucleus
(k/a BASAL NUCLEI)

Dorsal part of AL, GENU & PL of internal capsule

Corona radiata
Corona radiata
Posterior limb of
Internal capsule

Globus pallidus

Putamen
 M2 M3 M4
OPERATOR CORTICAL
INSULAR

Cortical branches

SUPPLIES A HUGE AREA OF

SUPEROLATERAL SURFACE OF CEREBRAL HEMISPHERE
1. Somatosensory
cortex
2. Somatomotor
cortex
3. Brocas area
4. Wernickes area
5. Visual cortex &
radiation
6. Auditory area
7. Contraversive
eye center
 Enters cranial cavity
through foramen magnum.

It ascends through the neck in the

Transverse foramen of
upper 6 cervical vertebrae

Vertebral artery is derived

from subclavian artery

SCA
The 2 VA converges medially
to form BASILAR ARTERY,
at ponto medullary junction.

VA VA
 POSTERIOR
ANTERIOR POSTERIOR
INFERIOR
SPINAL SPINAL
CEREBELLAR
ARTERY ARTERY
ARTERY
 ANTERIOR
SPINAL
ARTERY
supplies

MEDIAN ZONE OF MEDULLA

1. 12th nerve & nuclei

2. Medial leminiscus
3. Pyramid
4. MLF

SECTION OF MEDULLA
AT MID OLIVARY LEVEL
 POSTERIOR
SPINAL
ARTERY
supplies

POSTERIOR ZONE OF
LOWER MEDULLA

1. Fasciculus Gracilis
2. Fasciculus Cuneatus
3. Nucleus Gracilis
4. Nucleus Cuneatus

SECTION OF LOWER MEDULLA

POSTERIOR
INFERIOR
CEREBELLAR
ARTERY
1. LATERAL PART OF MEDULLA,
supplies DORSAL TO OLIVARY NUCLEUS

2. CEREBELLUM

1. 5,8,9,10,11
2. NTS
3. NA
4. SPINAL LEMINISCUS ON
5. ICP SECTION OF MEDULLA
AT MID OLIVARY LEVEL
PLAN OF THE ARTERIAL SUPPLY OF MEDULLA OBLONGATA
UBP
BASILLAR ARTERY EXTENDS
FROM PONTOMEDULLARY JUNCTION
TO UPPER BORDER OF PONS

PMJ
 THEN, IT DIVIDES INTO
2 POSTERIOR CEREBRAL ARTERIES

UBP

PMJ
 Arises from lower part of BA

Supplies:
a. Inferior cerebellar surface
b. Inferolateral part of pons
c. Upper medulla oblongata
Numerous pontine branches
Supplies anteromedian
and lateral zones of PONS
Arises near the distal portion of
BA, before its termination ;

Supplies:
1. Cerebellum
2. Pons
3. Pineal body
4. Superior medullary velum
3RD NERVE

4TH NERVE

B
A
S
I
L
A
R
 P1 P3
Runs in the
From basilar bifurcation to
calcarine sulcus
junction with
posterior communicating artery
P2
Upto perimesencephalic cistern
 Central perforating branches
P1 Posteromedial branches

(enters through PPS)

Supplies:
1. Hypophysis cerebri
2. Hypothalamus
3. Mamilary body
4. Subthalamus
5. Anterior thalamus
6. Medial thalamus
 Central perforating branches
P2

Posterior choroidal artery

Cortical branches
 Central perforating branches
P2 (Posterolateral branches)

Supplies:
1. Caudal part of thalamus including pulvinar
2. Geniculate bodies
3. Lateral thalamic nuclei
4. Mid brain: tegmentum & crus cerebri
P2
Posterior choroidal artery

Supplies:
1. Posterior part of thalamus
2. Tectum of mid brain
3. Fornix
Supplies: P2 P3
1. Uncus
2. Parahippocampal gyrus
3. Occipitotemporal gyrus
4. Cuneus & precuneus
5. Lingual gyrus Cortical branches

Calcarine artery,
supplies primary visual cortex
Lies in the subarachnoid space
Lies in the interpeduncular fossa
Surrounds optic chiasma
 Haemodynamics of circle is
influenced by calibre of the formative arteries
Vs
1. Vertebral artery
2. Anterior spinal artery
3. Posterior spinal artery
4. Posterior inferior cerebellar artery
5. Basilar artery
1. Basilar artery
2. Anterior inferior cerebellar artery
1. Posterior cerebral artery
2. Superior cerebellar artery
3. Basilar artery
1. Posterior inferior cerebellar artery
2. Anterior inferior cerebellar artery
3. Superior cerebellar artery
 1. Middle cerebral artery
Anterior cerebral artery 2. Posterior cerebral artery

1. Anterior choroidal artery

2. Posterior communicating artery
1. Posterior cerebral artery
2. Posterior communicating artery
1. Anterior cerebral artery
2. Middle cerebral artery
3. Anterior choroidal artery
4. Posterior choroidal artery
1. Striate arteries of:
a. Anterior cerebral artery
b. Middle cerebral artery
2. Anterior choroidal artery
 PL d

Gd
RL
ALd Gv
PLv
ALv
 PL d

Gd
RL
ALd Gv
PLv
ALv
 PL d

Gd
RL
ALd Gv
PLv
ALv
 PL d

Gd
RL
ALd Gv
PLv
ALv
If there is WILL there is a way

Courtesy: circle of Willis