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YEAR 2 - The Nervous System > 16. Head & Neck > Flashcards

16. Head & Neck Flashcards

1
Q

What are the main arteries supplying the CNS that you need to know about?

A
  • Common carotid
  • External carotid
  • Middle meningeal
  • Internal carotid
  • Anterior, middle and posterior cerebral
  • Ophthalmic
  • Vertebral (and its subclavian origin)
  • Basilar
  • Anterior and posterior perforating
  • Striate
  • Pontine
  • Posterior inferior cerebellar
  • Anterior and posterior spinal
  • Artery of Adamkiewitz
  • Circle of Willis
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2
Q

What are the two main arteries supplying the brain?

A
  • Vertebral arteries:
    • Provide about 20% of the total supply
    • Supply the posterior part of the cerebrum and the contents of the posterior cranial fossa
  • Internal carotid arteries:
    • Provide about 80% of the total supply
    • Supply the anterior and middle parts of the cerebrum and the diencephalon.
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3
Q

How do the vertebral arteries enter the skull?

A

Through the foramen magnum, passing along the ventral side of the medulla.

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4
Q

Describe the path of the vertebral arteries and the arteries they form.

A
  • Subclavian arteries give off the vertebral arteries, which enter the skull via the foramen magnum, passing along the ventral medulla.
  • The vertebral arteries give off the posterior inferior cerebellar arteries and also give off branches that join to form the anterior spinal artery.
  • At the lower border of the pons, the vertebral arteries unite to form the basilar artery.
  • The basilar artery gives off the pontine arteries and then ends in the posterior cerebral arteries, which supply the occipital lobes.
  • The posterior cerebral arteries at the start of their course give off the posterior communicating arteries, which form part of the Circle of Willis.
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5
Q

What blood vessel is this and what is the function?

A
  • Vertebral arteries
  • Supply the upper spinal cord, cerebellum, brainstem, occipital lobes and part of the temporal lobes.
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6
Q

What blood vessel is this and what is the function?

A
  • Basilar artery
  • It supplies the cerebellum, brainstem, occipital lobes and part of the temporal lobes.
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7
Q

Draw the path of the basilar artery.

A
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8
Q

What blood vessel is this and what is the function?

A
  • Posterior cerebral arteries
  • Supply the occipital lobes and part of the temporal lobes.
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9
Q

What blood vessel is this and what is the function?

A
  • Posterior communicating arteries.
  • Provide an alternative route to the brain blood supply in case there is a blockage of the internal carotid or vertebral arteries. Also supply the internal capsule, parts of the diencephalon and third ventricle.
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10
Q

What are pontine arteries?

A

A number of small vessels which come off from either side of the basilar artery and supply the pons and adjacent parts of the brain.

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11
Q

What are the posterior inferior cerebellar arteries?

A
  • They are large branches of the vertebral arteries.
  • They supply the cerebellum.
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12
Q

What are the spinal arteries and what do they arise from?

A
  • They are the arteries that supply the spinal cord
  • There is one anterior spinal artery -> It arises from the vertebral arteries sending branches that converge
  • There are two posterior spinal arteries -> They arise from the vertebral artery in 25% of humans or the posterior inferior cerebellar artery (a branch of the vertebral artery) in 75% of humans.
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13
Q

What is the artery of Adamkiewicz?

A
  • It is a major artery that joins the the anterior spinal artery in the lower one-third of the spinal cord, providing reinforcement of supply.
  • It typically arises from a left posterior intercostal artery at the level of the 9th to 12th intercostal artery, which branches from the aorta, and supplies the lower two-thirds of the spinal cord via the anterior spinal artery.
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14
Q

How do internal carotid arteries enter the skull?

A
  • Through the carotid canal (in the petrous portion of the temporal bone).
  • They then travel along the foramen lacerum.
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15
Q

Describe the path of the internal carotid arteries and the arteries they form.

A
  • Common carotid arteries give off the internal carotid arteries, which enters the skull through the carotid canal (in the petrous portion of the temporal bone).
  • First, the internal carotid arteries give off the ophthalmic artery that supply all the structures in the orbit as well as some structures in the nose, face and meninges.
  • Then, the internal carotid arteries give off the posterior communicating arteries, which join the posterior cerebral arteries (originating from the vertebral arteries) as part of the Circle of Willis.
  • Finally, the internal carotid arteries terminate as the anterior and middle cerebral arteries.
  • Anterior cerebral arteries supply the frontal lobes and superior medial parietal lobes. They also give off the anterior communicating arteries (part of the Circle of Willis) that connect with the opposite anterior cerebral artery.
  • Middle cerebral arteries supply the lateral cerebral cortex, anterior temporal lobes and the insular cortices.
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16
Q

What blood vessel is this and what is the function?

A
  • Internal carotid arteries
  • Supply the anterior and middle parts of the cerebrum and the diencephalon.
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17
Q

What blood vessel is this and what is the function?

A
  • Middle cerebral arteries
  • Supply the lateral cerebral cortex, anterior temporal lobes and the insular cortices.
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18
Q

What blood vessel is this and what is the function?

A
  • Anterior cerebral arteries
  • Supply the frontal lobes and superior medial parietal lobes.
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19
Q

What artery is this?

A

Anterior communicating artery

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20
Q

What are the perforating arteries in the brain?

A

They are small arteries that come off the Circle of Willis, supplying the surface of the brain. They include:

  • Anterior perforating arteries
  • Posterior perforating arteries
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21
Q

Summarise the areas of the outer brain supplied by each of the cerebral arteries.

A
  • Blue = Anterior cerebral artery
  • Red = Middle cerebral artery
  • Yellow = Posterior cerebral artery
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22
Q

Summarise the areas of the sagittal cross-section of the brain supplied by each of the cerebral arteries.

A
  • Blue = Anterior cerebral artery
  • Red = Middle cerebral artery
  • Yellow = Posterior cerebral artery
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23
Q

What are striate arteries and what is their function?

A
  • Small arteries that arise from the middle cerebral artery.
  • They supply deep structures in the cerebrum, including the internal capsule, basal ganglia and reticular formation.
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24
Q

What is the Circle of Willis?

A
  • It is the joining area of several arteries at the inferior side of the brain.
  • This is due to the anterior and posterior communicating arteries linking vessels derived from the internal carotid and vertebro-basilar systems.
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25
Q

Where is the Circle of Willis found?

A

It encloses the optic chiasm.

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26
Q

Draw a summary of the blood vessels supplying the brain.

A
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27
Q

Label this.

A
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28
Q

Where do the common carotid arteries arise from?

A
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29
Q

What are the main branches of the external carotid artery?

[EXTRA?]

A
30
Q

What is the middle meningeal artery?

A
  • It is one of the branches of the maxillary artery, which is a branch of the external carotid artery.
  • It passes through the foramen spinosum to supply the dura mater.
31
Q
A
32
Q

What imaging technique is this?

A

MRI

33
Q

What imaging technique is this?

A

Contrast CT

34
Q

Label this angiogram.

A
35
Q

What is the large artery seen in this angiogram?

A

Anterior cerebral artery

36
Q

What artery is this?

A

Middle cerebral artery

37
Q

What artery is this?

A

Posterior cerebral artery

38
Q

What artery is this?

A

Anterior cerebral artery

39
Q

What are the venous structures draining the brain that you need to know about?

A
  • Superior sagittal sinus
  • Great cerebral vein
  • Transverse and cavernous sinuses
  • Sigmoid sinus
  • Internal jugular vein
40
Q

Summarise the venous drainage of the brain.

[IMPORTANT]

A
  • Superior sagittal sinus runs between the two hemispheres, receiving many smaller veins. This drains into the transverse sinus on either the left or right of the brain.
  • The great cerebral vein is formed by the confluence of multiple deep veins and it drains multiple structures posterior to the ventricles. It drains into the straight sinus, which also drains into the transverse sinus.
  • The transverse sinus on each side runs horizontally around the occipital bone.
  • It then becomes the sigmoid sinus, which curves inferiorly and medially in a deep groove on the mastoid part of the temporal bone.
  • This then drains into the internal jugular vein.
  • The cavernous sinuses lie lateral to the pituitary beside the body of the sphenoid bone, between two layers of dura. The main tributaries of each cavernous sinus are the superior and inferior ophthalmic veins, the retinal vein and the superficial middle cerebral vein. They also eventually drain into the internal jugular vein.
41
Q

What is this vein and what is its function? What does it drain into?

A
  • Superior sagittal sinus
  • Receives veins that drain the cerebral hemispheres, falx cerebri, meninges and scalp
  • Drains into the transverse sinus on either the left or right of the brain.
42
Q

What is this vein and what is its function? What does it drain into?

A
  • Great cerebral vein
  • Drains the superior cerebellum, interpeduncular fossa, inferior horn of the lateral ventricle, parahippocampal gyrus, corpus callosum, midbrain, and choroid plexuses of the third and lateral ventricles.
  • Drains into the straight sinus.
43
Q

What is this vein and what is its function? What does it drain into?

A
  • Transverse sinus
  • Drains the confluence of sinuses (superior sagittal sinus, straight sinus and occipital sinus)
  • Drains into the sigmoid sinus
44
Q

What is this vein and what is its function? What does it drain into?

A
  • Sigmoid sinus
  • Drains the transverse sinus
  • Drains into the internal jugular vein
45
Q

What is this vein and what is its function? What does it drain into?

A
  • Internal jugular vein
  • Drains the sigmoid sinus (and several other tributaries)
  • Drains into the brachiocephalic vein
46
Q

What is the dura mater?

A
  • Dense, irregular connective tissue that surrounds the brain and the spinal cord
  • Outermost layer
  • Made up of 2 layers in the skull, but these fuse into one in the vertebral column
47
Q

What is the arachnoid mater?

A
  • Middle layer that surrounds the brain and the spinal cord
  • Contains arachnoid granulations that allow for the reabsorption of CSF into the circulation
  • Has a spiderweb appearance
  • Fibrous tissue, covered in flat cells thought to be impermeable to fluid
  • Arachnoid trabeculae anchor the arachnoid mater to the pia mater
48
Q

What is the pia mater?

A
  • Innermost layer of the 3 layers/meninges covering the brain and the spinal cord
  • Made up of collagen and reticular fibres
  • Delicate, innermost layer
  • Attached directly to the basement membrane and astrocyte foot processes (fairly secure)
49
Q

How is the dura related to the skull and the vertebral canal?

A
  • Dura mater is adhered to the skull (epidural space only occurs in the skull in cases of pathology, e.g. epidural haematoma)
    • Epidural space seen in the vertebral canal, therefore dura mater is not attached to the vertebral canal
  • The meninges extend down to the layer of S2
50
Q

What are the dural folds?

A
  • Tentorium cerebelli
    • Spans in a transverse plane from the inner surface of the occipital bone
    • Separates the cerebellum from the cerebrum (separates the forebrain and the hindbrain)
    • Contains the transverse, straight and superior petrosal sinuses
  • Falx cerebelli
    • Projects from the midline of the occipital bone
    • Seperates the hemispheres of the cerebellum
    • Contains the occipital sinus
  • Falx cerebri
    • Largest of the fibrous septa
    • Extends across the midline
    • Seperates the right and left hemispheres
    • Contains the superior and inferior sagittal sinuses
  • Diaphragma sellae [EXTRA]
    • Flat membrane, surrounds the pituitary stalk and forms a roof over the hypophyseal fossa
    • Contains the anterior and posterior intercavernous sinus
51
Q

Label these dural folds.

A
52
Q

What is the relationship of the dura to blood vessels?

A
  • Blood supply mostly seen to the outer layer of the dura mater
  • Pia mater is highly vascular, using smaller vessels from the internal carotids and vertebral arteries like the underlying neural and glial tissue
  • The arachnoid mater is avascular
  • Dura mater receives vascular supply from many different branches, including:
    • Internal carotid artery
    • Maxillary artery
    • Ascending pharyngeal arteries
    • Occiptal artery
    • Vertebral artery
  • Meningeal arteries form anastomoses with cerebral arteries and supplies some regions of the brain
  • Skull has grooves/sulci to facilitate the passage of blood vessels supplying the dura
  • Dural veins accompany the arteries and are essentially a set of sinuses
53
Q

What innervates the dura?

A

Sensory innervation to the dura mater: CN V and CN X​

54
Q

What are the CSF cisterns?

A

These are compartments within the subarachnoid space that have large gaps between the pia and the arachnoid mater that allow for the accumulation of fluid. Cisterns may have vessels or cranial nerves passing through them.

55
Q

Label these cisterns.

A
56
Q

What are the bones that make up the skull and facial skeleton?

A

Skull:

  • Frontal
  • Parietal
  • Occipital
  • Sphenoid
  • Temporal
  • Ethmoid

Facial skeleton:

  • Maxilla
  • Mandible
  • Zygomatic
  • Nasal
  • Vomer
57
Q

Label this.

A
58
Q

Which bones make up the base of the skull?

A
59
Q

Show the location of the temporal bone and name the 3 main parts of the bone.

A
60
Q

How many cranial and facial bones are there?

A
  • Cranial -> 8
  • Facial -> 14

[Check this!]

61
Q

Describe the structure of the sphenoid bone and how it appears in the skull.

A
  • Greater wings -> These are the bits that can be seen on the lateral skull wall
  • Lesser wings
  • Pterygoid plates
  • Pituitary fossa (in the body) -> Where the pituitary gland is found
  • Sphenoid sinuses (in the body)
62
Q

What is the cribriform plate?

A

Part of the ethmoid bone

63
Q

What are the clinoid processes?

A

Parts of the sphenoid bone.

64
Q

What is the pituitary fossa?

A

The fossa in the sphenoid bone where the pituitary gland sits.

65
Q

What are the major fossae of the skull?

A
66
Q

How many paranasal sinuses are there? What are their names?

A

There are 2 copies of each of these 4 types:

  • Maxillary
  • Ethmoid
  • Sphenoid
  • Frontal
67
Q

What are mastoid air cells?

A

The mastoid cells (also called air cells of Lenoir or mastoid cells of Lenoir) are air-filled cavities within the mastoid process of the temporal bone of the cranium.

68
Q

What event is the Circle of Willis commonly related to?

A

Subarachnoid haemorrhage:

  • Aneurysms associated with subarachnoid hemorrhages tend to occur in a circle of arteries that supply blood to the brain.
  • These are known as the circle of Willis.
  • In some people, a congenital anomaly leads to weak and thin blood vessel walls, increasing the risk of an aneurysm.
69
Q

What event is the middle meningeal artery commonly associated with?

A

Extradural haemorrhage:

  • This tends to occur at the PTERION -> This is the point at which multiple bones join
70
Q

What artery supplies the middle ear?

A

A branch of the internal carotid artery.

71
Q

Which sinus is the internal carotid artery related to and how?

A
  • The cavernous sinus
  • The ICA passes through the cavernous sinus
72
Q

Draw the arterial pulse points you need to know.

A

YEAR 2 - The Nervous System (18 decks)

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