Q 1.36. Cerebral Circulation: An Overview. Examination methods.

Cerebral circulation refers to the blood flow within the brain, which is crucial for maintaining normal brain function. It ensures the delivery of oxygen and nutrients to brain cells while removing waste products. Understanding cerebral circulation is essential for diagnosing and managing various brain disorders.


Cerebral Circulation: Arteries and Branches

The cerebral circulation is divided into two parts: the anterior and posterior circulations. The anterior circulation is formed by the internal carotid arteries, which bifurcate into the middle cerebral arteries (MCAs) and the anterior cerebral arteries (ACAs). The ACAs are connected by the anterior communicating artery. The MCAs supply the lateral part of the cerebral hemispheres.

The posterior circulation involves the vertebrobasilar system, which includes the vertebral arteries and the basilar artery. The basilar artery gives rise to the posterior cerebral arteries (PCAs), which supply the occipital lobes and the bottom of the temporal lobes.


Circle of Willis

The Circle of Willis is an anastomotic ring of arteries located at the base of the brain. It connects the anterior and posterior circulations and consists of the ACAs, MCAs, PCAs, the anterior communicating artery, and the posterior communicating arteries. This structure allows for collateral circulation in the event of arterial blockage.


Anatomical Pathways

The arteries of the brain are linked via the anterior and posterior communicating arteries. They branch and bifurcate to supply the cerebrum, with the internal carotid arteries contributing to the anterior circulation and the vertebral arteries to the posterior circulation.


Venous System of the Brain

The venous system of the brain includes a network of valveless veins that drain deoxygenated blood from the brain into the dural venous sinuses, which then drain into the internal jugular veins. The veins can be categorized into superficial and deep groups. The superficial veins primarily drain the cerebral cortex, whereas the deep veins drain the deep structures within the hemispheres.


Key Parameters in Cerebral Circulation:

  1. Cerebral Blood Flow (CBF): The volume of blood flowing through the brain per unit of time.
  2. Cerebral Perfusion Pressure (CPP): The pressure gradient driving blood flow to the brain.
  3. Cerebrovascular Resistance (CVR): The resistance encountered by blood vessels in the brain.
  4. Intracranial Pressure (ICP): The pressure within the cranial cavity.


Examination Methods for Cerebral Circulation:

The evaluation of cerebral circulation pathologies involves a variety of diagnostic methods, each with its own indications and applications:


Imaging Techniques

  • Magnetic Resonance Imaging (MRI): Provides detailed images of brain structures and can be enhanced with contrast agents.
  • Computed Tomography (CT): Useful for quickly assessing hemorrhagic strokes, infarctions, and other structural abnormalities.
  • Xenon CT: Measures cerebral blood flow and can detect areas of reduced perfusion.
  • Single-Photon Emission Computed Tomography (SPECT): Offers metabolic and blood flow information, particularly useful in assessing chronic conditions.
  • Positron Emission Tomography (PET): Allows for the measurement of metabolic processes and is often used in research settings.
  • Arterial Spin Labeling (ASL) MRI: A non-invasive method that uses water in blood as an intrinsic tracer to measure cerebral blood flow.

Ultrasound-Based Assessments

  • Transcranial Doppler (TCD): Measures blood flow velocity in the major brain arteries and can detect stenosis or vasospasm.
  • Carotid Ultrasound: Evaluates the carotid arteries for atherosclerotic disease, which can affect cerebral circulation.



  • Digital Subtraction Angiography (DSA): Considered the gold standard for visualizing cerebral vessels, it can identify blockages or malformations.


Functional Assessments

  • Cerebrovascular Reserve Testing: Assesses the capacity of cerebral blood vessels to dilate in response to increased demand or stress.
  • Baroreceptor Sensitivity: Evaluates the response of blood pressure regulation mechanisms to changes in arterial pressure.


Clinical Significance:

Understanding cerebral circulation aids in diagnosing conditions such as stroke, hemorrhage, head trauma, and carotid artery disease. By combining direct and indirect methods, clinicians can comprehensively evaluate cerebral blood flow and make informed decisions.

Remember, as medical students, mastering these techniques will empower you to contribute to better patient care and neurological research. 



1 intechopen.com

2 ccforum.biomedcentral.com

3 oxfordmedicaleducation.com

4 link.springer.com

Verified by Dr. Petya Stefanova