Cerebral Vasculature

Charlie StaggNovember 2010

You may want to stop eating your lunch for a while….

The circulation as a whole

Internal Carotid Arteries

Anterior Cerebral a.

Middle Cerebral a.

Internal Carotid a.

Vertebral Arteries

Posterior Cerebral a.

Basilar a

Circle of WillisAnterior Cerebral a.

Middle Cerebral a.Internal Carotid a.

Vertebral a.

Posterior Cerebral a.

Basilar a

Communicating a.

Blood supply - the 3 cerebral arteries

AnteriorMiddle

Posterior

From the internal carotid

From the vertebral a.

LATERAL MEDIAL

You can see them on MRI (whether or not you want to….)

Capillaries

Venous Drainage

You can see veins too…

Sagittal sinus

Ischaemic Stroke (80%)

• Atherothromboembolism

• Cardioembolism

• Small vessel disease

• Arterial dissection

• (Rare stuff)

Atherothromboembolism

• Athero - – Soft gruel-like deposit (cholesterol)

• - thrombo - – Blood clot

• -embolism– a mass of clotted blood or other material brought

by the blood from one vessel and forced into a smaller one, obstructing the circulation

Atherothromboembolism

stenosis

Stroke Treatment - “Brain Attack Principle”

• Event-to-needle time 3h

• Acute CT Head

• Clot busting drugs

Stroke Treatment - for the others

• Admission to a stroke unit mortality by 30%• Physiotherapy• Occupational Therapy• Good rehabilitation….

• Secondary Prevention - blood pressure, stop smoking, check for diabetes etc.

Sub-arachnoid haemorrhage

• Sudden onset “worst-ever headache”• Young, fit people.

Nasty Picture Alert