Back Angiology & Neurology Flashcards
What are the two arteries that could supply the rhomboid muscles and Levator Scapulae M.?
Dorsal scapular A.
Deep branch of the Transverse Cervical A.
***Both would travel along medial border of scapula
What does the Subscapular A. branch into?
Circumflex Scapular A. (anastomoses in scapula)
Thoracodorsal A. (supplies Latissimus Dorsi m.)
What are the segmental branches of the Thoracic Descending Aorta, which produce Paraspinal As.?
Posterior Intercostal A.
What is the name for the segmental branch of the Thoracic Descending Aorta coming off of T12, which produces Paraspinal As.?
Subcostal A.
What are the segmental arteries for the Abdominal Descending Aorta, which produce Paraspinal As.?
Lumbar A. (with Lumbar 1-4)
What does the abdominal Descending Aorta branch into?
Common Iliac A.
The Common Iliac A. branches into what?
Internal Iliac A. (has Anterior Division and Posterior Division)
External Iliac A.
What branches off the Posterior Division of the Internal Iliac A.?
Iliolumbar A. (produce Paraspinal As.)
Lateral Sacral A. (produce Paraspinal As.)
Superior Gluteal A.
***Supplies Pelvic Viscera, Gluteal Region, and Perineum
What are the 8 arteries that produce Paraspinal As.?
Vertebral A. (from Subclavian A.)
Ascending Cervical A. (from Inferior Thyroid A.)
Deep Cervical A. (from Costocervical Trunk)
Posterior Intercostal A. (from Descending Aorta)
Subcostal A. (from Descending Aorta)
Lumbar A. (from Descending Aorta)
Iliolumbar A. (from Internal Iliac A.)
Lateral Sacral A. (from Internal Iliac A.)
***These 8 branches supply the vertebrae, spinal cord, and surrounding structures and feed directly into the Anterior and Posterior Spinal As.
This Paraspinal A. branch travels with the Posterior Ramus of the Spinal Nerve, and supplies the Spinous Processes with Periosteal and Nutrient branches.
Dorsal branch
This Paraspinal A. branch occurs at every level of the vertebral column, supplying the vertebrae.
Equatorial branch
The Spinal branches of the Paraspinal A. occur at every thoracic level of the vertebral column, traveling through the Intervertebral Foramen and producing what?
Anterior and Posterior Vertebral Canal Branches
Anterior and Posterior Radicular As. (OR) Anterior and Posterior Segmental Medullary As.
Anterior Vertebral Canal Branches produce ascending and descending branches that communicate with other Anterior Vertebral Canal Branches as well as produce __________.
Nutrient As.
These arteries supply the Marrow Cavity of the vertebral body.
Nutrient As.
The Posterior Vertebral Canal Branch supplies what?
Vertebral Arch
T/F. Segmental Medullary As. feed into the Spinal As., but Radicular As. do not interact with Spinal As.
True
These arteries occur at every level a Spinal Branch exists unless replaced by a larger Segmental Medullary A. These arteries supply the Ventral Roots and Dorsal Roots of the Spinal Nerves.
Anterior Radicular A. (supplies ventral roots)
Posterior Radicular A. (supplies dorsal roots)
This artery occurs sporadically near the Cervical and Lumbosacral enlargements of the Spinal Cord in place of Radicular As., feeding directly into the Anterior Spinal A.
Anterior Segmental Medullary A.
This artery occurs sporadically near the Cervical and Lumbosacral enlargements of the Spinal Cord in place of Radicular As., feeding directly into the Posterior Spinal A.
Posterior Segmental Medullary A.
This is the name for a much larger Anterior Segmental Medullary A. that typically branches from a Posterior Intercostal A. or a Lumbar A.
Great Anterior Segmental Medullary A. (of Adamkiewicz)
This exists anteriorly and posteriorly and empties into segmental veins (Lumbar, Subcostal, Posterior Intercostal veins). It is located on outer edge of vertebral body and by the spinous processes.
External Vertebral Venous Plexus
This exists in the vertebral canal, and drains Anterior and Posterior Medullary and Radicular Vs., which then empties into the Intervertebral Vs. or the Cranial Dural Venous Sinuses.
Internal Vertebral Venous Plexus
What does the Anterior and Posterior Medullary Vs. empty into the Internal Vertebral Venous Plexus, respectively?
Anterior Spinal V.
Posterior Spinal V.
The Intervertebral V. drains the Internal Vertebral Venous Plexus into the…
Segmental Vs. (Lumbar, Subcostal, Posterior Intercostal)
The spinal cord occupies the upper 2/3 of the Vertebral Canal from what to what?
Medulla Oblongata to the Conus Medullaris
Spinal cord injury can be the result of a number of disease states and traumas. Complete transection of the Spinal Cord results in what?
Loss of sensation and motor function below the lesion
Spinal cord transection at different levels will result in different losses of function. What happens at C1-C3?
No function below the head, respirator necessary for life
Spinal cord transection at different levels will result in different losses of function. What happens at C4-C5?
No function of limbs, respiration capable
Spinal cord transection at different levels will result in different losses of function. What happens at C6-C8?
Loss of hand and variable upper limb function, may be able to propel wheelchair
Spinal cord transection at different levels will result in different losses of function. What happens at T1-T9?
Paralysis of both lower limbs
Spinal cord transection at different levels will result in different losses of function. What happens at T10-L1?
Some thigh muscle function, may allow walking with long leg braces
Spinal cord transection at different levels will result in different losses of function. What happens at L2-L3?
Most lower limb functions present, may be able to walk with short leg braces
What are the layers of Spinal Meninges that cover the spinal cord and spinal roots?
Spinal Dura Mater (outermost tough covering)
Spinal Arachnoid Mater (thin membranous intermediate layer)
Pia Mater (thinnest innermost covering, directly against spinal cord)
What are the components of the Spinal Dura Mater?
Epidural Space Dura-Arachnoid Interface Spinal Dural Sac Dural Root Sheath Filum Terminale Externum
What are the components of the Spinal Arachnoid Mater?
Subarachnoid Space (holds CSF) Arachnoid Trabeculae (connect Arachnoid and Pia Mater) Lumbar Cistern (enlargement of Subarachnoid space)
What are the components of the Pia Mater?
Denticulate L. (Hold Spinal Cord in Dural Sac)
Filum Terminale Internum (continuation of Pia Mater)
A lumbar puncture or spinal tap is an important diagnostic procedure for evaluating a variety of CNS disorders. A needle is inserted between either _______ vertebrae or _______ vertebrae at the level of the iliac crests. This level is typically chosen to avoid the needle injuring the spinal cord. As the needle passes through the Ligamentum Flavum, it “pops” and passes into the lumbar cistern deep to the spinal dura and arachnoid mater. CSF can then be drawn out and evaluated.
L3/L4
L4/L5
Where does the cervical enlargement occur and what does it correspond with?
From C4-T1
Corresponds with Brachial Plexus and Upper Extremity
Where does the Lumbosacral enlargement occur and what does it correspond with?
From T11-S1
Corresponds with the lumbar and sacral plexuses and Lower Extremity
A Spinal Cord Segment is part of the spinal cord that produces Spinal Rootlets that converge to form Spinal Roots that converge to form a Spinal Nerve that then branches into….
Spinal Rami
How many pairs of Cervical Spinal Nerves are there?
8
What develops from the Cervical Spinal Ns. Anterior Rami?
Cervical Plexus (C1-4)
Brachial Plexus (C5-T1)
Recurrent Meningeal Branches (sensory and sympathetic fibers to the Dura Mater)
What develops from the Posterior Rami of C1?
Suboccipital N.
What develops from the Posterior Rami of C2?
Greater Occipital N.
***Below Suboccipital Triangle
What develops from the Posterior Rami of C3?
Least Occipital N.
(Back Pain) There are five categories of structures innervated by the Recurrent Meningeal N. and Posterior Rami of Spinal Nerves. What are they?
Recurrent Meningeal Ns. – Fibroskeletal structures (periosteum and ligaments) and Meninges
Posterior Rami – Synovial joints; Intrinsic Back Muscles; Spinal nerves and nerve roots
***Of these 5, most common are muscular, joint, and fibroskeletal pain
Muscular pain is often the result of _______ in the muscular tissue producing ischemia. Joint pain is usually the result of osteoarthritis or disease arthritis, and Fibroskeletal pain is usually a result of ________ and dislocation of ligamentous structures.
Spasm
Fractures
Posterior Rami for C4-8 have a Medial Branch and Lateral Branch. What do these innervate?
Medial – Skin; Muscles (Transversospinalis muscles); Zygopophyseal Joints
Lateral – Skin; Muscles (Erector Spinae and Splenius muscles)
- **See drawing
- **Thoracic Posterior Rami do the same
What branches from the Anterior Rami of the Thoracic Spinal Nerves?
Atypical Intercostal N. (T1,2 branch to Brachial Plexus and T7-11 become Thoracoabdominal N.)
Typical Intercostal N. (T3-6)
Subcostal N. (T12)
Recurrent Meningeal Branches (sensory and sympathetic fibers to the Dura Mater)
What branches from the Anterior Rami of the Lumbar Spinal Nerves?
Lumbar Plexus (L1-4)
Lumbosacral Trunk (some of L4 and all of L5; Joins with Sacral Plexus)
Recurrent Meningeal Branches (sensory and sympathetic fibers to the Dura Mater)
What branches from the Medial Branch of the Lumbar Posterior Rami?
Muscular Branch
Articular Branch
Cutaneous Branch
***Same in Thoracic and C4-8
What branches from the Lateral Branch of the Lumbar Posterior Rami?
Muscular Branch
Cutaneous Branch
Superior Cluneal N. (Lateral Branch of the Posterior Rami of L1-3)
What branches from the Anterior Rami of the Sacral Spinal Nerves?
Sacral Plexus (L4-S4) Coccygeal Plexus (some of S4 and all of S5) Recurrent Meningeal Branches
What branches from the Posterior Rami of the Sacral Spinal Nerves?
Medial Branch
Lateral Branch
What branches off the Lateral Branch of the Sacral Spinal Nerve Posterior Rami?
Middle Cluneal N. (Lateral Branch of Posterior Rami of S1-3)
This is the distal cone shaped terminal end of the Spinal Cord. Typically begins tapering off at T12 and ends at L2.
Medullary Cone (Conus Medullaris)
This is a bundle of Anterior and Posterior Roots from the Lumbosacral Enlargement and Medullary Cone. It occupies the Vertebral Canal inside the Lumbar Cistern from the level of the Medullary Cone inferiorly.
Cauda Equina
