1. Cerebral Vasculature Charlie Stagg November 2010 You may want to stop eating your lunch for a while….

2. The circulation as a whole

4. Internal Carotid Arteries Anterior Cerebral a. Middle Cerebral a. Internal Carotid a.

5. Vertebral Arteries Posterior Cerebral a. Basilar a

6. Circle of Willis Anterior Cerebral a. Middle Cerebral a. Internal Carotid a. Vertebral a. Posterior Cerebral a. Basilar a Communicating a.

7. Blood supply - the 3 cerebral arteries Anterior Middle Posterior From the internal carotid From the vertebral a. LATERALMEDIAL

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

9. Capillaries

10. Venous Drainage

11. You can see veins too… Sagittal sinus

12. Ischaemic Stroke (80%) Atherothromboembolism Cardioembolism Small vessel disease Arterial dissection (Rare stuff)

13. 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

14. Atherothromboembolism stenosis

15. Stroke Treatment - “Brain Attack Principle” Event-to-needle time 3h Acute CT Head Clot busting drugs

16. 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.

17. Sub-arachnoid haemorrhage Sudden onset “worst-ever headache” Young, fit people. Nasty Picture Alert