I. The carotid system. II. The vertebral system. 1) The ophthalmic artery. 2) The anterior choroidal artery. 3) The posterior communicating artery II. The Vertebro-Basilar System VOS brain stem syndromes

1. Amr Hassan, M.D.
Associate professor of Neurology - Cairo
University
BLOOD SUPPLY OF
THE BRAIN

2. The blood reaches brain
through two systems of
blood vessels:
The carotid system
The vertebral system

3. BLOOD SUPPLY OF BRAIN

4. The Carotid system:

6. Carotid and vertebral arteries

7. The Carotid system:

9. The circle of Willis

16. Areas supplied by MCA

17. MCApathway

18. Branches of MCA:
 Capsular
lenticulostriate
 Cortical:
1. Frontal
2. Pareital
3. Temporal

20. Internal capsule:

21. 3/9/2017 Neurology for physiotherapist by Prof.Dr Ahmed
Aboumousa
21

22. 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.

23. Frontal branches
occlusion:
1. Facio-brachial
monoplegia
2. Motor aphasia and
agraphia in doninant
hemispheres

24. Parietal branches occlusion:
1. Cortical sensory loss
In U.L
2. Lower quadrantic
homonymous
hemianopia
3. In dominant
hemisphere:
• Sensory aphasia
• Alexia
• Apraxia

25. Temporal branches
occlusion:
1. Upper quadrantic
homonymous
hemianopia
2. Auditory agnosia

26. 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.

27. Branches of ACA:
 Capsular
Heubner’s artery
 Cortical
1. Frontal
2. Paracentral
3. Callosal

28. ACApathway

30. Areas supplied by ACA

31. Internal capsule:

32. Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation

33. The ant cerebral artery (ACA) occlusion
Capsular branch occlusion (Heubner Arterv):
Facio-brachial monoplegia

34. Cortical branches occlusion
 Frontal branches
occlusion:
1. Severe behavior
disturbance (apathy or
“abulia,akinetic mutism)
2. Perseveration
3. Grasp reflexes, and diffuse
rigidity—“gegenhalten”)

35. Cortical branches occlusion
 Paracentral branches
occlusion:
1. Contralateral
hemiparesis in L.L
2. Contralateral sensory
loss in L.L
3. Urinary incontinence

36. Cortical branches occlusion
 Callosal branches
occlusion:
Apraxia of the left side

37. 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.

38. Vertebrobasilar system

40. Vertebrobasilar system
Int.aud.

41. Vertebrobasilar system

42. Brain stem branches ( Paramedian branches)
occlusion
= brain stem syndromes (revise P.53)

43. 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.

44. Basilar artery

45. 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.

46. 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.

47. Areas supplied by PCA

48. Posterior cerebral artery occlusion
thalamoqeniculatebranch: (Ganalionic
artery) 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.

49. Internal capsule:

50. Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation

52. Posterior cerebral artery occlusion
thalamoqeniculatebranch: (Ganalionic
artery) 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.

53. 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.

54. Walllenberg Syndrome
LEFT
Ipsi
pyramidal

55. Contra IpsiContra
LEFT

57. Ataxia
SENSORY
Contra
Ipsi
Ipsi
Ipsi

58. Internal capsule:

59. Association fibres
Pyramidal fibres
Sensory fibres
Auditory radiation
Visual radiation

61. THANK YOUTHANK YOU