Download - Blood supply of the brain
![Page 1: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/1.jpg)
NOTE:
To change
the image
on this
slide,
select the
picture
and delete
it. Then
click the
Pictures
icon in the
placeholde
r to insert
your own
image.
Amr Hassan, M.D. Associate professor of Neurology - Cairo
University
BLOOD SUPPLY OF
THE BRAIN
![Page 2: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/2.jpg)
The blood reaches brain through two systems of blood vessels:
The carotid system
The vertebral system
![Page 3: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/3.jpg)
BLOOD SUPPLY OF BRAIN
![Page 4: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/4.jpg)
The Carotid system:
![Page 5: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/5.jpg)
![Page 6: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/6.jpg)
Carotid and vertebral arteries
![Page 7: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/7.jpg)
The Carotid system:
![Page 8: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/8.jpg)
![Page 9: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/9.jpg)
The circle of Willis
![Page 10: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/10.jpg)
![Page 11: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/11.jpg)
![Page 12: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/12.jpg)
![Page 13: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/13.jpg)
![Page 14: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/14.jpg)
![Page 15: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/15.jpg)
![Page 16: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/16.jpg)
Areas supplied by MCA
![Page 17: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/17.jpg)
MC
A p
ath
way
![Page 18: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/18.jpg)
Branches of MCA:
Capsular
lenticulostriate
Cortical:
1. Frontal
2. Pareital
3. Temporal
![Page 19: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/19.jpg)
![Page 20: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/20.jpg)
Internal capsule:
![Page 21: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/21.jpg)
3/9/2017 Neurology for physiotherapist by Prof.Dr Ahmed Aboumousa
21
![Page 22: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/22.jpg)
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.
![Page 23: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/23.jpg)
Frontal branches
occlusion:
1. Facio-brachial
monoplegia
2. Motor aphasia and
agraphia in doninant
hemispheres
![Page 24: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/24.jpg)
Parietal branches occlusion:
1. Cortical sensory loss
In U.L
2. Lower quadrantic
homonymous
hemianopia
3. In dominant
hemisphere:
• Sensory aphasia
• Alexia
• Apraxia
![Page 25: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/25.jpg)
Temporal branches
occlusion:
1. Upper quadrantic
homonymous
hemianopia
2. Auditory agnosia
![Page 26: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/26.jpg)
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.
![Page 27: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/27.jpg)
Branches of ACA:
Capsular
Heubner’s artery
Cortical
1. Frontal
2. Paracentral
3. Callosal
![Page 28: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/28.jpg)
AC
A p
ath
way
![Page 29: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/29.jpg)
![Page 30: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/30.jpg)
Areas supplied by ACA
![Page 31: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/31.jpg)
Internal capsule:
![Page 32: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/32.jpg)
Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation
![Page 33: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/33.jpg)
The ant cerebral artery (ACA) occlusion
Capsular branch occlusion (Heubner Arterv):
Facio-brachial monoplegia
![Page 34: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/34.jpg)
Cortical branches occlusion
Frontal branches occlusion:
1. Severe behavior
disturbance (apathy or
“abulia,akinetic mutism)
2. Perseveration
3. Grasp reflexes, and diffuse
rigidity—“gegenhalten”)
![Page 35: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/35.jpg)
Cortical branches occlusion
Paracentral branches occlusion:
1. Contralateral hemiparesis in L.L
2. Contralateral sensory loss in L.L
3. Urinary incontinence
![Page 36: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/36.jpg)
Cortical branches occlusion
Callosal branches occlusion:
Apraxia of the left side
![Page 37: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/37.jpg)
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.
![Page 38: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/38.jpg)
Vertebrobasilar system
![Page 39: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/39.jpg)
![Page 40: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/40.jpg)
Vertebrobasilar system
Int.aud.
![Page 41: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/41.jpg)
Vertebrobasilar system
![Page 42: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/42.jpg)
Brain stem branches ( Paramedian branches) occlusion
= brain stem syndromes (revise P.53)
![Page 43: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/43.jpg)
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.
![Page 44: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/44.jpg)
Basilar artery
![Page 45: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/45.jpg)
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.
![Page 46: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/46.jpg)
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.
![Page 47: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/47.jpg)
Areas supplied by PCA
![Page 48: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/48.jpg)
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.
![Page 49: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/49.jpg)
Internal capsule:
![Page 50: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/50.jpg)
Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation
![Page 51: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/51.jpg)
![Page 52: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/52.jpg)
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.
![Page 53: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/53.jpg)
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.
![Page 54: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/54.jpg)
Walllenberg Syndrome
LEFT
Ipsi pyramidal
![Page 55: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/55.jpg)
Contra Ipsi Contra LEFT
![Page 56: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/56.jpg)
![Page 57: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/57.jpg)
Ataxia SENSORY
Contra
Ipsi
Ipsi
Ipsi
![Page 58: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/58.jpg)
Internal capsule:
![Page 59: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/59.jpg)
Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation
![Page 60: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/60.jpg)
![Page 61: Blood supply of the brain](https://reader031.vdocuments.site/reader031/viewer/2022022205/58d008021a28abad3e8b4d15/html5/thumbnails/61.jpg)
THANK YOUTHANK YOU