Dr.

Chhaya Saraf

Learning Issues
Arrangement of blood vessels
Unique features of cerebral circulation
Regulation of cerebral circulation
Role of intracranial tension
Blood Brain Barrier

Circle of Willis

Enclosed within rigid structure (cranium).

Total volume of blood, CSF, and brain tissue is constant.

Cerebral veins unique features (i) no valves, (ii) thinwalled, little smooth muscles, (iii) distribution does not
correspond to distribution of arteries.
Drained mainly into internal jugular vein

Cerebral Blood Flow

Normally 50-60ml/100gm of brain tissue
750 900 ml /min (15% of CO)
No lymphatics
In choroid plexus endothelium shows the gaps but
epithelium has tight junctions
Cerebral capillaries have tight junctions, very little
vesicular transport, surrounded by end feet of Astrocytes
which help in tightening the junctions

Innervation Of Cerebral Blood Vessels

Sympathetic vasoconstrictor nerves from
cervical ganglia
Cholinergic neurons
Sensory nerves ( sensitive to pain)
Cerebral blood vessels are sensitive to
pain though brain substance has no pain
fibers

Cerebral circulation
Characteristic features:

Monro - Kellie Doctrine

contained within rigid structure
constant inflow/outflow
imbalances pressure
Cushings Reflex
Absolute requirement for
adequate flow
tissue least tolerant to
ischemia
5 sec ischemia loss of

Measurement & Regional Changes

Of Blood Flow
Positron Emission Tomography - PET
Magnetic Resonance Imaging - MRI
Injecting radioactive xenon in carotid artery,
blood flow can be measured by scintillating
detectors over the surface of cerebral cortex
By Ficks Principle
Cerebral blood flow changes 100 to 150% within
sec depending upon local activity of neurons e.g.
Reading visual cortex
Speech Wernickes area

Cerebral Microcirculation
4 times more capillaries in gray matter than
white matter
Relatively poor permeability due to tight
junctions
Less leaky as supported by glial feet
(Astrocytes), prevents overstretching during
high pressures
In hypertensives arterioles are usually
thickened & constricted preventing the
transmission of high pressure

Regulation Of Cerebral Blood Flow

Intracranial Pressure plays important role
CSF pressure is directly related with jugular
venous pressure
Regulated mainly by pCO2
pco2 VD
pO2 VC
Some anesthetics decreases blood flow
H+ concentration in blood affects cerebral
blood flow by changing pCO2
Nervous regulation play little role

Brain flow
autoregulation
Excellent between 60 and 160
mmHg
Below 60 mmHg: syncope
Above 160 mmHg: cerebral
edema

Neural regulation of brain

vessels (local
Minimal importance
mechanisms predominate)

SNS (along carotid & vertebral

arteries) - weak vasoconstriction
Intense activity like exercise
VCPrevents cerebral
hemorrhage
Parasympathetic fibers - weak
vasodilatation

Metabolic factors controlling

blood flow
Tissue Carbon dioxide in excess - VD
CO2 concentration H2CO3 H+ conc. VD
flow carries acidic substances away

O2 lack (pO2 < 30mmHg) VD

Normally 3.5ml/100gm/min of brain tissue
Tissue pO2 <20mmHg Coma

H+ concentration/any other acidic substances

affect the neuronal activity

Role Of Intracranial Pressure In cerebral

blood Flow
in venous pressure
Intracranial pressure & compresses the blood
vessels
Decreased cerebral blood flow
Decreases perfusion pressure
Prevents rupture, helps in downward acceleration
Opposite effects are obtained when venous pressure is
increased

Role Of Intracranial Pressure in

systemic blood pressure
Increased intracranial Pressure
Decreases cerebral blood flow
Stimulates VMC
Increases Blood Pressure
Restores blood flow

Cushings Reflex

Cerebral Stroke
Due to atherosclerosisblock in some small
arterieslocal cerebral ischemia
Hypertensives are more prone to cerebral
hemorrhage
Mostly in middle cerebral artery affects
midportion of brain
Posterior cerebral artery will affect the occipital
lobe
Midbrain involvement sensory & motor
abnormalities

Blood Brain Barrier

Present in choroid plexus as well as capillary level

Not present in some parts of hypothalamus,
posterior pituitary gland, adjacent median
eminence & Area Postrema
Important for homeostasis

Not well developed at birth

Factors responsible:Tight junctions leading to poor permeability

Glial cells (Astrocytes) are interposed between
neurons & capillaries

Blood Brain Barrier

Substances which can not cross
Large MW, water soluble, toxic substances
Certain drugs like dopamine

Substances which can cross

Lipid soluble substances like CO2, O2
Ab like Rh Ab
Certain drugs like L- Dopa (Parkinson disease)
Active transport Glucose (GLUT-1)

Slightly permeable to electrolytes Na+,

K+, Cl-

Study material
Guyton 11th edition, chap. 61
Ganong 21st edition, chap. 32

Thanks