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Blood supply to the brain The cerebrospinal fluid (CSF)

Blood supply to the brain The cerebrospinal fluid (CSF). Mark Kozsurek, M.D., Ph.D. mark@kozsurek.hu. 19/09/2011, EM II.

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Blood supply to the brain The cerebrospinal fluid (CSF)

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  1. Blood supply to the brainThe cerebrospinal fluid (CSF) Mark Kozsurek, M.D., Ph.D. mark@kozsurek.hu 19/09/2011, EM II.

  2. Extremly high demand for oxygen and nutrients: human brain represents 2% of the body weight, but receives 15% of the cardiac output, 20% of total body oxygen consumption and 25% of total body glucose utilization. • Cerebrovascular deseases and stroke are among the major causes of death.

  3. Arteries supplying the brain

  4. 2 sources of blood: ICA and VA

  5. Vertebro-basilar system CTA: CT angiography atlas axis laterally upward backward C6

  6. C6 C5 C7 C4 (C3) cavernous sinus C2

  7. C7 cavernous sinus C6 C5 carotid canal C4 C3 ant. clinoid proc. C2 C1 foramen lacerum X-ray angiogram

  8. ant. cerebral middle cerebral striate ant. communicating post. communicating ophthalmic ant. choroidal inf. hypophyseal sup. hypophyseal caroticotympanic

  9. Circle of Willis

  10. Circle of Willis

  11. oculomotor n. abducens n. Circle of Willis pituitary stalk optic chiasm mamillary bodies

  12. Circle of Willis encloses the optic chiasm, pituitary stalk and mamillary bodies. • 2. Oculomotor nerve exits between the post. cerebral and sup. cerebellar arteries. • 3. Vertebral arteries of the two sides unite to form the basilar artery at the ponto-medullary junction. The root of the abducens nerve and initial segment of the ant. inf. cerebellar artery can also be found here.

  13. A2 A1

  14. parietooccipital sulcus callosomarginal br. pericallosal br. A3 A2 A1 ant. communicating recurrent artery of Heubner

  15. Heubner’s

  16. parietooccipital sulcus callosomarginal br. pericallosal br. A3 A2 A1 ant. communicating recurrent artery of Heubner

  17. M3 M3 M2 M2 M3 M3

  18. parietooccipital sulcus ACA PCA MCA

  19. PCA

  20. anterior cerebral middle cerebral posterior cerebral

  21. oculomotor n. PCA sca BA aica VA pica sca: superior cerebellar aica: anterior inferior cerebellar pica: posterior inferior cerebellar

  22. Veins drainig the brain

  23. superficial middle cerebral vein superior cerebral veins SUPERFICIAL VEINS inferior cerebral veins Similarly, there are superior and inferior celebellar veins for the cerebellum.

  24. Superior cerebral veins open into the superior sagittal sinus or into the adjacent lateral lacunae.

  25. 1. Inferior cerebral veins drain mainly into the sphenoparietal (1), cavernous (2), superior petrous (3), and transverse (4) sinuses. 2. 3. 4.

  26. superior sagittal sinus TROLARD’S VEIN LABBE’S VEIN cavernous sinus transverse sinus

  27. DEEP VEINS ant. cerebral deep middle cerebral basal (Rosenthal) great cerebral (Galen)

  28. of septum pellucidum thalamostriate * int. cerebral choroid great cerebral

  29. ant. cerebral deep middle cer. v. of septum pell. choroid thalamostriate internal cerebral basal great cerebral vein

  30. Almost the total volume of veinous blood collected from the brain leaves the skull through the jugular foramen and the internal jugular vein. • If the jugular foramen and/or the internal jugular vein is getting occluded, blodd may escape through the diploic and emissary veins connecting the dural sinuses with the veins of the scalp skin.

  31. Diploic veins (frontal, anterior and posterior temporal, occipital): form a network between the external and internal compact bony layers of the skull and connect dural sinuses with the external veins.

  32. emissary diploic Emissary veins (occipital, parietal, condylar, mastoid): pearce the skull directly and connect dural sinuses with external veins.

  33. Blood-brain barrier (BBB) • The extracellular fluid of the CNS is separated from the blood by the BBB ensuring strictly controlled and mainly carrier protein assisted transport of macromolecules. • Is formed by endothelial cells attached to one other by tight junctions, basement membrane, astrocytic endfeet. • Protects the CNS from possibly toxic agents but makes development of medicines acting on the CNS difficult (e.g. antibiotics in infections).

  34. Life outside the BBB: the circumventricular organs • „Circumventricular” = around the ventricles • Incomplet or missing BBB • Highly capillarized structure • Secretion of neurohormons or detection of hormons, glucose, ions, etc.

  35. The cerebrospinal fluid (CSF) • Provides mechanical protection for the brain and the spinal cord. • When floating in the CSF brain weights only 50g (!) according to the Archimedes’ principle.

  36. internal and external CSF spaces internal = ventricles external = subarachnoidal space

  37. Surface of a choroid plexus

  38. post. choroidal from PCA ant. choroidal from ICA or MCA choroidal a. of the 4th ventricle from pica

  39. median aperture of Magendi lateral aperture of Luschka cerebellomedullary (or great) cystern lateral pontine (or pontocerebellar) cystern

  40. Site of CSF resorption: arachnoid granulations in the superior sagittal sinus and lateral lacunae.

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