Back Angiology and Neurology Flashcards
What arteries branch off the arch of the aorta
Brachiocephalic trunk (R. subclavian, R. common carotid)
Left common carotid
Left subclavian
Axillary
Branches of the left subclavian artery include
Vertebral Internal thoracic Thyrocervical trunk Costocervical trunk Dorsal scapular (if this branch arises from transverse cervical, it is known as the deep branch of the transverse cervical artery)
Branches of the vertebral artery include
Anterior/posterior spinal arteries
Anterior spinal produces sulcal artery which supplies anterior 2/3 of spinal cord
Posterior spinal are paired arteries and may arise from posterior inferior cerebellar artery
Branches of thyrocervical trunk include
Inferior thyroid->ascending cervical (produces paraspinal arteries)
Suprascapular
Transverse cervical–>superficial branch, deep branch (if deep branch is present, it replaces dorsal scapular)
Explain the path of the vertebral artery
Travels superiorly in the transverse foramina of cervical vertebrae C6-1, exits transverse foramina of atlas, crosses over posterior arch of atlas, passes through floor of suboccipital triangle, sends branches anterior/posteriorly to form ant/post spinal arteries, then enters posterior cranial fossa through foramen magnum and meets up with contralateral vertebral artery to form basilar artery which produces paraspinal arteries
Branches of costocervical trunk include
Deep cervical
Supreme intercostal
Branches of axillary artery include
Superior thoracic Thoracoacromial trunk Lateral thoracic Subscapular->circumflex scapular, thoracodorsal Anterior/posterior circumflex humeral
Branches of the thoracic (descending) aorta
Posterior intercostal
Subcostal
Branches of abdominal (descending) aorta
Lumbar
Common iliac–>
-Internal iliac
-External iliac
Explain internal iliac artery
It is a branch of the common iliac, and has two branches
- Anterior division
- Posterior division–> iliolumbar, lateral sacral, superior gluteal
Which arteries produce paraspinal arteries
Vertebral (from subclavian) Ascending cervical (from inferior thyroid) Deep cervical (from costocervical) Posterior intercostal (from descending aorta) Subcostal (from descending aorta) Lumbar (from descending aorta) Iliolumbar (from internal iliac) Lateral sacral (from internal iliac)
Paraspinal arteries feed directly into what
Anterior and posterior spinal arteries
Branches of paraspinal arteries
Dorsal branches-travel with posterior ramus, supply spinous process
Equatorial branches-supply vertebrae
Periosteal branches- supply periosteum
Spinal branches
Describe the spinal branches of the paraspinal arteries
Produces anterior/posterior vertebral canal branches, and either anterior/posterior radicular arteries, or anterior/posterior segmental medullary arteries
Anterior/posterior vertebral canal branches supply
Anterior- produces nutrient artery which supplies marrow cavity
Posterior- supplies vertebral arch
Anterior posterior radicular arteries supply
Anterior- Supply ventral roots of spinal nerves
Posterior- Supply dorsal roots of spinal nerves
Spinal veins main branches
External/internal vertebral venous plexus
External vertebral venous plexus
Drain basivertebral veins, empty into segmental veins, communicates with internal vertebral venous plexus
Internal vertebral venous plexus
Drains anterior/posterior medullary and radicular veins, also drains basivertebral veins, empties into intervertebral veins or cranial dural venous sinuses
Intervertebral veins
Drain internal/external vertebral venous plexus, empties into segmental veins
C1-3 injury
No function below head, respirator necessary to live
C4-5 injury
No function of limbs, capable of respiration
C6-8 injury
Loss of hand and variable upper limb function, may be able to propel wheelchair
T1-9 injury
Paralysis of both lower limbs
T10-L1 injury
Some thigh muscle function, may allow walking with leg braces
L2-3 injury
Most lower limb functions present, may be able to walk with short leg braces
Dura mater layers
Epidural space
Dura-arachnoid interface
Spinal dural sac-lines vertebral canal
Dural root sheeth- surround ant/post roots
Filum terminale externum- inserts on coccyx
Spinal arachnoid mater layers
Subarachnoid space- CSF
Arachnoid trabeculae
Lumbar cistern- enlargement of subarachnoid space inferior to conus medullaris, contains cauda equina
Pia mater layers
Denticulate ligament- suspend spinal cord in dural sac
Filum terminale internum- becomes filum terminale externum
Cervical enlargement
Swelling of spinal cord from C4-T1, corresponds with brachial plexus
Lumbosacral enlargement
Swelling of spinal cord from T11-S1, corresponds with lumbar/sacral plexuses
Spinal cord segment
Part of spinal cord that produces spinal rootlets that converge to form spinal root which converge to form spinal nerve and eventually spinal rami
Anterior root
Projections from neuronal cell bodies in anterior horn, converge with posterior root to form spinal nerve
Posterior root
Projections from neuronal cell bodies in spinal ganglion, converge with anterior root
Cervical plexus and brachial plexus are which vertebrae levels?
Cervical- C1-4
Brachial C5-T1
Recurrent meningeal branches of cervical spinal nerves supply what
Sensory and sympathetic fibers to dura mater
Fibroskeletal structures and meninges are innervated by
Recurrent meningeal nerves
Synovial joints, intrinsic back muscles, spinal nerves and nerve roots are innervated by
Posterior rami
Branches of posterior rami of cervical spinal nerves
Suboccipital nerve- Posterior ramus of C1
Great occipital nerve- C2
Least occipital nerve- C3
C4-C8- Cutaneous and muscular innervation
Branches of C4-C8 posterior rami
Medial branch- muscular (transversospinalis muscles), articular (zygopophyseal joints) and cutaneous branches
Lateral branch- muscular (erector spinae and splenius muscles) and cutaneous branches
Thoracic spinal nerve anterior rami branches
Atypical intercostal nerve-
T1,2- send branches to brachial plexus
T7-11 become thoracoabdominal nerve as they travel over abdomen
Typical intercostal nerve T3-6
Subcostal nerve T12
Recurrent meningeal branches- sensory/sympathetic to dura mater
Thoracic spinal nerve posterior rami branches
Medial branch: -Muscular to transversospinalis and longissimus thoracis -Articular to zygopophyseal joint -Cutaneous Lateral branch: -Muscular to erector spinae group -Cutaneous
Lumbar spinal nerves anterior rami branches
Lumbar plexus L1-4
Lumbosacral trunk- Some L4, all of L5, join with sacral plexus
Recurrent meningeal- sensory/sympathetic to dura mater
Lumbar spinal nerves posterior rami branches
Medial branch: -Muscular to transversospinalis, interspinalis and intertransversarii muscles -Articular to zygopophyseal joint -Cutaneous Lateral branch -Muscular to erector spinae group -Cutaneous -Superior cluneal nerve L1-3
Sacral spinal nerve anterior rami branches
Sacral plexus- L4-S4
Coccygeal plexus- some S4 all S5
Recurrent meningeal branches
Sacral spinal nerve posterior rami branches
Medial
Lateral:
-Middle cluneal nerve S1-3
List the 5 groups of spinal nerves and how many pairs each has
Cervical-8 Thoracic-12 Lumbar-5 Sacral-5 Coccygeal-1
Medullary cone
Distal cone shaped terminal end of the spinal cord, typically begins tapering off at T12 and ends at L2
Cauda equina
Bundle of anterior and posterior roots from the lumbosacral enlargement and medullary cone
Occupies the vertebral canal inside the lumbar cistern from the level of the medullary cone inferiorly
