ARTERIAL SUPPLY

OF THE CENTAL
NERVOUS SYSTEM

Arterial Supply of the Brain

internal carotid arteries

vertebral arteries

Internal Carotid Artery

begins at bifurcation of common carotid artery (upper
border of thyroid cartilage)
parts:
cervical (from origin to base of the skull)
petrous (within carotid canal in petrous part of
temporal bone)
cavernous (within cavernous sinus)
cerebral (from the point it pierces the dura mater to
its termination, where it divides into anterior and
middle cerebral arteries)
cavernous and cerebral parts together are referred to
as carotid siphon (S-shaped configuration)

Netters Plate 130

Netters Plate 98

Branches of the Internal Carotid Artery

cervical part: no branches
petrous part: small branches to tympanic cavity
cavernous part: inferior hypophysial branches
small branches supplying trigeminal ganglion,
walls of cavernous sinus (including contained
nerves) and adjacent dura mater
cerebral part: ophthalmic artery
superior hypophysial branches
anterior choroidal artery
posterior communicating artery
anterior cerebral artery
middle cerebral artery

Netters Plate 132

Posterior Communicating Artery

extends from internal carotid artery to proximal part of
posterior cerebral artery
connects anterior (carotid) and posterior (vertebro-basilar)
circulations

Anterior Choroidal Artery

runs posteriorly, inferior to optic tract
supplies choroid plexus in inferior (temporal) horn of
lateral ventricle, structures along medial aspect of temporal
lobe (uncus, hippocampus, amygdala) , tail of caudate,
globus pallidus, inferior part of internal capsule, optic tract,
lateral geniculate nucleus and cerebral peduncle

Anterior Cerebral Artery (ACA)

it is joined to homologous artery by anterior
communicating artery
anterior communicating artery divides ACA into two
segments: A1 (proximal/precommunicating) and A2
(distal/postcommunicating)
A1 segment passes anteriorly and medially, above optic
nerve
A2 segment is distributed on medial surface of cerebral
hemisphere

Anterior Cerebral Artery (ACA)

supplies (cortical branches):
medial surface of cerebral hemisphere from frontal pole
to parieto-occipital sulcus
corpus callosum
straight gyrus and olfactory bulb and tract
distal branches extend over superior border of
hemisphere and supply strip of cortex on superolateral
surface

Anterior Cerebral Artery (ACA)

medial striate artery (recurrent artery of Heubner):
originates from ACA proximal or distal (more common)
to anterior communicating artery
passes posteriorly and laterally and its branches enter
brain via anterior perforated substance
supplies inferior part of head of caudate nucleus and
adjacent parts of anterior limb of internal capsule and
putamen

Netters Plate 132

Fig. 8-9 A Haines Textbook

Middle Cerebral Artery (MCA)

runs laterally in lateral sulcus toward ventral part of insula,
where it divides into superior and inferior trunks
M1 segment: from origin to bifurcation into superior and
inferior trunks
M2 segment (insular part): trunks and their branches as
they lie on insula
M3 segment (opercular part): branches of trunks that curve
around opercula
M4 segment (cortical part): distal branches of trunks that
exit lateral fissure and serve cortical areas above and below it

Middle Cerebral Artery (MCA)

supplies (cortical branches):
lateral part of inferior (orbital) surface of frontal lobe
insula
most of lateral surface of cerebral hemisphere, except
peripheral rim (supplied by branches of anterior and
posterior cerebral arteries)
superior trunk supplies cortical areas located above
lateral sulcus (frontal lobe and anterior parietal lobe),
while inferior trunk supplies cortical areas located
below lateral sulcus (upper part of temporal lobe) and
posterior part of parietal lobe

Netters Plate 132

Fig. 8-9 A Haines Textbook

Vertebral Artery
enters cranial cavity through foramen magnum
runs superiorly and medially and at
pontomedullary junction joins homologous artery
to form basilar artery
branches:
posterior spinal artery
posterior inferior cerebellar artery
anterior spinal artery

Posterior Spinal Artery

it may be a branch of the vertebral artery (25%) or the
PICA (75%)
descends along posterolateral sulcus of spinal cord

Posterior Inferior Cerebellar Artery (PICA)

curves around medulla to reach inferior cerebellar surface
supplies posterolateral part of medulla, choroid plexus of
4th ventricle and medial parts of inferior surface of
cerebellum

Anterior Spinal Artery

the two arteries join to form a single anterior spinal artery,
which runs along anterior median fissure of medulla and
spinal cord

Fig. 11-16 B Haines Textbook

Basilar Artery
runs in basilar sulcus of pons from pontomedullary junction to
pons-midbrain junction where it terminates by dividing into 2
posterior cerebral arteries
branches:
pontine branches (paramedian, short circumferential and
long circumferential branches)
anterior inferior cerebellar artery
labyrinthine (internal auditory) artery
superior cerebellar artery
posterior cerebral artery

Anterior Inferior Cerebellar Artery (AICA)

passes lateral along inferior border of middle cerebellar peduncle
supplies lateral parts of inferior surface of cerebellum, lower pons,
upper medulla and choroid plexus of 4th ventricle

Labyrinthine (Internal Auditory) Artery

it may originate from basilar artery or AICA (more commonly)
enters internal acoustic meatus with CNs VII and VIII to supply
internal ear

Superior Cerebellar Artery

passes laterally, just inferior to oculomotor nerve
wraps around brainstem to supply upper pons, lower midbrain and
superior surface of cerebellum

Posterior Cerebral Artery (PCA)

passes laterally, just above oculomotor nerve
passes around midbrain and joins inferomedial aspect of
temporal lobe
parts:
P1 segment: from origin to posterior communicating artery
P2 segment: from posterior communicating artery to 1st
temporal branch
P3 segment: part of PCA that gives rise to temporal branches
P4 segment: distal part of artery that gives rise to branches
that supply occipital lobe (parieto-occipital and calcarine
arteries)

Posterior Cerebral Artery (PCA)

supplies:
inferior and medial surfaces of temporal and occipital
lobes
distal branches extend over superior and inferior borders
of hemisphere to supply a strip of cortex on superolateral
surface
midbrain, thalamus and choroid plexuses of 3rd and lateral
ventricles

Fig. 8-9 B Haines Textbook

Fig. 8-9 A Haines Textbook

Watershed Infarcts
border zones: areas where terminal branches of anterior,
middle and posterior cerebral arteries overlap
brain tissue in these border zones is susceptible to damage
in case of sudden systemic hypotension or when there is
hypoperfusion of distal vascular bed of a major cerebral
artery
inadequate perfusion of border zones may result in
watershed infarcts

Fig. 8-9 C Haines Textbook

Cerebral Arterial Circle (of Willis)

consists of the larger cerebral vessels and their
interconnections on the ventral surface of the brain
components: anterior communicating a.
anterior cerebral a.
internal carotid a.
posterior communicating a.
posterior cerebral a.
serves as potential vascular shunt, assisting in
development of collateral circulation if one of the proximal
vessels is occluded

Netters Plate 133

Perforating (Central) Branches

small branches that originate from the arteries of

the cerebral arterial circle and penetrate the ventral

surface of the brain
groups:
anteromedial
anterolateral
posteromedial
posterolateral

Anteromedial Arteries
originate from A1 segment of ACA and anterior

communicating artery
supply supraoptic part of hypothalamus

Anterolateral Arteries
originate from M1 segment of MCA
(lenticulostriate arteries) and a few may come from
A1 segment of ACA
enter brain via anterior perforated substance
supply most of the caudate, putamen, globus
pallidus and internal capsule
most common site of intra-cerebral hemorrhage in
hypertensive individuals

Posteromedial Arteries
originate from posterior communicating artery and
P1 segment of posterior cerebral artery
enter brain via posterior perforated substance
supply tuberal and mammillary regions of
hypothalamus, subthalamus, anterior part of
thalamus and medial parts of midbrain tegmentum
and cerebral crus

Posterolateral Arteries
originate from P2 segment of posterior cerebral
artery
supply posterior part of thalamus, including
geniculate nuclei, choroid plexus of lateral and 3rd
ventricles (posterior choroidal arteries) and
midbrain

Arterial Supply of the Spinal Cord

there are 1 anterior and 2 posterior spinal arteries
blood received by spinal arteries from vertebral arteries is
sufficient only for upper cervical segments
spinal arteries are reinforced at intervals by anterior and
posterior radicular branches that originate from segmental
arteries (vertebral, deep cervical, ascending cervical,
posterior intercostal, lumbar, sacral arteries)
largest anterior radicular artery artery of Adamkiewicz
travels with ventral root of a lower thoracic or upper
lumbar spinal nerve, most frequently on the left

Netters Plate 164

Arterial Supply of the Spinal Cord

branches of anterior spinal artery supply anterior 2/3 of
spinal cord anterior horn, intermediate zone, basal part
of posterior horn, anterior and lateral funiculi
branches of posterior spinal artery supply posterior 1/3
of spinal cord most of posterior horn and posterior
funiculus
arterial vasocorona: fine arterial plexus connecting
anterior and posterior spinal arteries supplies narrow
zone of white matter beneath pia mater

Fig. 5-6 Haines Atlas