The vascular supply to the central nervous system represents one of the most critical and elegantly organized systems in human anatomy. This chapter provides a comprehensive overview of cerebral and spinal vascularization, emphasizing the clinical relevance for medical practice. The brain’s arterial supply derives primarily from the internal carotid and vertebrobasilar systems, which anastomose through the Circle of Willis to provide collateral circulation. Understanding the territorial distribution of major cerebral arteries—including the anterior, middle, and posterior cerebral arteries—is essential for recognizing stroke syndromes and localizing vascular lesions. The chapter explores the unique features of cerebrovascular physiology, including autoregulation mechanisms and the blood-brain barrier, which maintain a stable neuronal environment despite systemic fluctuations. Special attention is given to the spinal cord’s vascular anatomy, highlighting the watershed zones vulnerable to ischemia. Clinical correlations throughout the chapter connect anatomical knowledge with common neurological presentations, including stroke syndromes affecting specific arterial territories, venous sinus thrombosis, and spinal cord infarction patterns. This integrated approach prepares medical students and residents to apply neurovascular anatomy in clinical decision-making and radiological interpretation.