Macy Magcalas 17 September 2007

CLINICAL NEUROSCIENCE - Cerebral Blood Flow

most arteries in the brain are end arteries.
Vertebral artery
from subclavian Watershed area
ascend through the transverse foramen in the cervical spine (not - areas in the brain with very little perfusion
in the thoracic because here there are ribs) - during hypotension, watershed area suffers, which may
No branch until it enters the cranium lead to cardiac arrest.

At the level of the trachea, common carotid artery bifurcates into: (REVIEW HISTOLOGY OF VESSELS!)
external carotid artery
normal vessel:
internal carotid artery penetrates dura and enter the skull
- adventitia
- external elastic lamina
- Compared to other structures, the brain has no reserve. Therefore
- muscular layer
it has to be rich in blood supply
- endothelium
- Nerve cells, through the Na+K+ATPase continually pump sodium
out for survival. For this, ATP is needed
blood vessel in the brain:
+ - adventitia
Na outside = 140 mEq
- no external lamina
Na+ inside = 5 mEq
- thin muscle
- endothelium
- 40% of glucose that the brain gets is responsible for this pumping
action
Normally:
- If large amounts of sodium gets inside the nerve cells, water goes
with it and the cell bursts. Thus, a lot of ATP is needed to pump
Artery arterioles capillaries
sodium out.
Venules vein
Fat Acetone -ketoglutaric acid
Sometimes:
-ketoglutaric acid - useless for most organs of the body but is utilized Artery Vein
by the brain when energy stores are depleted
Arteriovenous malformation may lead to aneurysm
- The brain is the only organ which can utilize ketone bodies. As
such, it needs continuous blood supply. Brain
Common site of demand for a lot of chemicals
Adult: amount of blood that goes to brain is 55ml/100g per minute Common site of disease either because blood vessels are:
- obstructed
Newborn: cerebrum not working yet because:
- ruptured
no myelin
no synapses Autoregulation of the brain
- withing a very wide range of blood pressure, the amount of blood
Thus, newborns need more blood supply the brain receives remains constant. E.g.: AT BP 120/80 or
180/100, the brain receives 3.3 ml of oxygen/100g per minute.
Newborn: amount of blood that goes to the brain is 110ml/100g per - However at 60 systolic, amount of blood decreases and it ruptures
minute. This amount goes on until about 5 years old.
- Brain has a rich venous drainage
Glucose stored in the kidney and liver in the form of glycogen, chains - Brain has no lymphatics. No lymph nodes, no Peyers patches.
of glucose attached to one another Instead it has resident cells called microglia

Amount of glucose produced by glycogenolysis: 5.5ml/100g per Microglia scattered lymphocytes which change morphology
minute. This is also the amount of glucose utilized by the brain. depending on the situation (can be round, spider-shaped, reniform?)

In the brain, there is negligible amount of glycogen (2 grams) which (REVIEW VENOUS DRAINAGE OF THE BRAIN!)
could only last for 25 minutes.
Venous drainage of the brain is very efficient.
Oxygen the brain has the most consumption of oxygen Sinuses made up of channels relative to the atmospheric pressure

Brain: 3.3 mL/100g per minute Dura matter split at some parts and become a sinus. This is where
Heart: 1.5 ml/100g per minute blood and CSF will drain and then goes to the internal jugular vein
Liver: 1.2 ml/100g per minute
- Sagittal sinus
(REVIEW THE CIRCLE OF WILLIS!) - Cavernous sinus around the sella turcica; drains the face
Circle of Willis complete in only 20% of individuals - Straight sinus

Internal carotid artery branches, gives rise to anterior carotid arteries
which are joined by the anterior communicating artery
External carotid artery gives branches to the eye and connects with
the internal carotid artery as the ophthalmic artery, a very small branch
which is the first communication between the ECA and ICA.
Van der Ecker anastomosis second communication between ECA
and ICA
BLOOD BRAIN BARRIER
Paul Ehrlich, a German pathologist, injected trypan blue into the artery
of a rat. Trypan blue was found everywhere except in the brain. Thus,
he concluded that theres a barrier in the brain.
Carbon dioxide cannot enter the brain
Bilirubin can enter the brain and may cause hyperbilirubinemia.
Usual capillary has gap junctions, which are absent in the brain. The
brain instead has astrocytes to monitor how much and what should go
in and out of the brain capillary.

However, the BBB is not absolute. Some parts of the brain has no
BBB:
- pituitary gland
- pineal gland
- choroid plexus
- area postrema in the 4th ventricle
- organum vasculosum lamina around the optic nerve

Dear classmates, these are just notes form the lecture of Dr. Ordinario.
Take some time to read the book or review our previous neuroanatomy
handouts because this is not complete