Blood Supply, Hemorrhage, and Herniation Flashcards by Kristina Assaf

Q

Blood Supply to the Brain:
?
• Cervical part
     - Bifurcation to ?
     - Anterior to transverse processes of ?

• Petrous part

 - Carotid canal in petrous part of temporal
 - Upward and medially above ?

• Cavernous part

 - In the cavernous sinus
 - Surrounded by sympathetic plexus, CN ?

• Cerebral part

A

Internal Carotid
• Cervical part
- Bifurcation to CAROTID CANAL
- Anterior to transverse processes of UPPER 3 VERTEBRAE

• Petrous part

  - Carotid canal in petrous part of temporal
  - Upward and medially above FORAMEN LACERUM

• Cavernous part
- In the cavernous sinus
- Surrounded by sympathetic plexus, CN III, IV, VI,
and V1

• Cerebral part

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Q

Blood Supply to the Brain:
?
• Cervical part
- Transverse foramina of ?

• Atlantic part

 - Perforates the ? and ?
 - Pass through ?

• Intracranial part

 - In the cranium
 - Unite at the caudal border of pons to form ?

A

Vertebral Artery

• Cervical part
- Transverse foramina of FIRST 6 CERVICAL VERTEBRAE

• Atlantic part

 - Perforates the DURA and ARACHNOID
 - Pass through FORAMEN MAGNUM

• Intracranial part
- In the cranium
- Unite at the caudal border of pons to form BASILAR
ARTERY

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Q

• A ring of 9 arteries supplying blood to the
cerebral hemispheres (6 large arteries
anastomose via 3 small communicating arteries)

A

Circle of Willis
• 2-Anterior Cerebral a. (branch of internal
carotid)
• 2-Internal Carotid a.
• 2-Posterior Cerebral a. (branch of Basilar)
• Anterior Communicating a.
• 2-Posterior Communicating a.

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Q

CN near ICA and Anterior communicating

a. ?

A

CN II

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Q

CN near posterior cerebral a., superior

cerebellar a., and posterior communicating a. ?

A

CN III

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Q

CN near labyrinthine and AICA?

A

CN IV

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Q

Supplies most of the medial and superior surface of the frontal and parietal lobes

A

Anterior Cerebral A. (ACA)

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Q

Supplies lateral surface of frontal and parietal lobes and the superior part of temporal lobe

A

Middle Cerebral A. (MCA)

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Q

Supplies the occipital lobe and the inferior temporal lobe

A

Posterior Cerebral A. (PCA)

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Q

Border zones: area between arteries

* Susceptible to damage under conditions of sudden systemic hypotension or hypoperfusion

A

Cerebral Arteries

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Q

Anterior Cerebral A. Segments:

- ICA to anterior communicating a.

A

A1: (Precommunicating segment)

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Q

Anterior Cerebral A. Segments:

- anterior communicating a. to where rostrum and genu of corpus callosum meet

A

A2: (Infracallosal segment)

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Q

Anterior Cerebral A. Segments:

- arches around the genu of corpus callosum, ends when vessels turn caudal

A

A3: (Precallosal segment)

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Q

Anterior Cerebral A. Segments:

- superior to corpus callosum

A

A4: (Supracallosal)

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Q

Anterior Cerebral A. Segments:

- caudal to corpus callosum

A

A5: (Postcallosal)

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Q

Middle Cerebral A. Segments:

- ICA to the bifurcation at insula

A

M1: (Sphenoidal or horizontal segment)

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Q

Middle Cerebral A. Segments:

- bifurcation at insula to circular sulcus of insula (right angle turn)

A

M2: (Insular segment)

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Q

Middle Cerebral A. Segments:

- Circular sulcus of insula to external surface of Lateral Fissure

A

M3: (Opercular segment)

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Q

Middle Cerebral A. Segments:

- On the cortex

A

M4: (Cortical segment)

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Q

Posterior Cerebral A. Segments:

- Basilar bifurcation to posterior communicating a.

A

P1

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Q

Posterior Cerebral A. Segments:

- Posterior communicating a. to around the midbrain

A

P2

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Q

Posterior Cerebral A. Segments:

- segment within the quadrigeminal cistern

A

P3: (Quadrigeminal segment)

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Q

Posterior Cerebral A. Segments:

- (Cortical segment)

A

P4

Q

Potential space

* Between cranium and periosteal dura

A

Epidural (extradural)

* Potential space | * Between dura and arachnoid

Subdural (dura-arachnoid interface)

* Real space * Between arachnoid and pia * Contains CSF, arteries (Circle of Willis) and veins

Subarachnoid

Herniation Syndromes: | Causes ?

* Hemorrhage * Mass/tumor * Trauma * Abscess * Infection * Metabolic conditions

Herniation Syndromes: - Divisions: • Supratentorial compartment – above the ? and divided into right and left by the ? • Infratentorial compartment – below the ? • Tentorial notch – continuation of the ? and ?

* Supratentorial compartment – above the TENTORIUM and divided into right and left by the FALX CEREBRI * Infratentorial compartment – below the TENTORIUM CEREBELLI * Tentorial notch – continuation of the SUPRA and INFRATENTORIAL COMPARTMENT

``` Subfalcine Herniation • Also called a ? or ? or ? herniation • ? compartment - Displaces brain tissue under the ? • May compress ? - Frontal lobe - Parietal lobe • May evolve into a ? ```

• Also called a CINGULATE or FALCINE or FALX herniation • SUPRATENTORIAL compartment - Displaces brain tissue under the FALX CEREBRI • May compress ACA - Frontal lobe - Parietal lobe • May evolve into a TRANSTENTORIAL HERNIATION

``` Transtentorial Herniation • Also called ? • Brain displaced downward toward the ? • Compromises the ? brainstem, CN ? and possibly even ? • May compress ? and ? • Decorticate rigidity • Decerebrate rigidity ```

• Also called CENTRAL HERNIATION • Brain displaced downward toward the TENTORIAL NOTCH • Compromises the UPPER brainstem, CN III and possibly even LOWER STRUCTURES • May compress BASILAR ARTERY and POSTERIOR CEREBRAL ARTERIES • Decorticate rigidity • Decerebrate rigidity

Uncal Herniation • ? and frequently portions of the ? are extruded over the edge of tentorium cerebelli and through the tentorial notch • Impinge on ?

• UNCUS and frequently portions of the PARAHIPPOCAMPAL GYRUS are extruded over the edge of tentorium cerebelli and through the tentorial notch • Impinge on MIDBRAIN

Tonsillar Herniation • Cerebellar tonsils through ? • Compression of the ? and ?

Tonsillar Herniation • Cerebellar tonsils through FORAMEN MAGNUM • Compression of the MEDULLA and UPPER CERVICAL SPINAL CORD

Blood Supply to Medulla: - What supplies the medial medulla? - get anterior medial syndrome

Anterior Spinal A.

Blood Supply to Medulla: - What supplies the lower levels of the medulla, does fascicule cuneatus and gracilis, does cuneate nucleus

Posterior Spinal A.

Blood Supply to Medulla: - What supplies the lateral medulla? - Get lateral medullary syndrome

Posterior Inferior Cerebellar A.

Blood Supply to Medulla: - Does cochlear nuclei (dorsal and ventral cochlear)

Anterior Inferior Cerebellar A.

Blood Supply to Pons: - What supplies the medial aspects of the pons

Paramedian branches of basilar A.

Blood Supply to Pons: - What supplies the lateral pontine and gives lateral pontine syndrome?

Long Circumferential branches of Basilar A and branches of AICA

Blood Supply to the Midbrain: - What supplies the medial portions of the midbrain? - Get Weber's Syndrome

Anteriomedial (paramedian ) branches of basilar bifurcation and P1 segment

Blood Supply to the Midbrain: - What supplies the inferior and superior colliculus of the midbrain?

Quadrigeminal and superior cerebellar arteries (level of inferior colliculus), quadrigeminal and posterior medial choroidal arteries (level of superior colliculus)

Blood Supply to the Forebrain: - Supplies the thalamus; medial and lateral geniculate nuclei/bodies?

Thalamogeniculate branches of posterior cerebral A. (branch of P2)

Blood Supply to the Forebrain: - Hits the optic tract and Hippocampal formation - Supplies part of the internal capsule

Anterior Choroidal A.

Blood Supply to the Forebrain: - Supplies the internal capsule

Lateral striate branches (lenticulostriate arteries) of the middle cerebral artery

Blood Supply to the Spinal Cord: - Supplies dorsal fasciuclates (gracile and cuneatus)

Posterior Spinal A

Blood Supply to the Spinal Cord: - Part of the legs of the CST is supplied by?

Dorsal Spinal A.

Blood Supply to the Spinal Cord: - Supplies most of the ventral and dorsal horns

Anterior Spinal A. | Gives off Sulcal arteries- if occluded they affect one side of the spinal cord or medulla

Blood Supply to the Spinal Cord: - What do Posterior and Anterior Spinal A. anastomose with?

Arterial Vasocorona (AVC)

Bleeding into potential space between skull and dura?

Epidural Hematoma | lens shaped

Epidural Hematoma - Common Site: - Source of the bleeding: - Clinical: - Treatment:

- fracture of squamous temporal bone or pterion - Source: middle meningeal artery (2% of all head injuries but more blood to calvaria than dura) - Clinical: Momentary unconsciousness followed by lucid period of hours to 1-2 days then unconsciousness - Treatment - surgical

Bleeding between dura and arachnoid?

Subdural Hematoma | (cresennt shaped and more jagged than lens_

Subdural Hematoma: - Occurence: - Source of bleeding: - Clinical: - Treatment:

- Occurence:Head strikes fixed object - Source of bleeding: venous, usually cortical veins openings into superior sagittal sinus - Clinical: Slower accumulation of blood due to pressure and often self-limiting - Treatment: Surgical

Subarachnoid Hemorrhage: • Common finding in severe head injury * More common is rupture of aneurysm * Source of the bleeding: ? * Clinical: ?

• Source of the bleeding: Arterial bleeding from cerebral a • Clinical: massive bleeding into CSF compartment due to arterial source with headaches and deteriorating level of consciousness "Worse headache of their lives"

* Bleeding within brain substance (stroke) | * Complication in 2-3% of all head injuries

Intracerebral (Subpial) Hemorrhage

Intracerebral (Subpial) Hemorrhage: - Source: - Clinical:

• Source – usually middle cerebral a. | • Clinical – hypertension or degenerative arterial disease commonly seen at autopsy

Uncal Herniation: - Can hit CN ? Which would present with?

- 3 | - Present with contralateral hemiplegia and ipsilateral CN 3 problems (Kernohan Syndrome)