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Neuro > Blood supply to CNS > Flashcards

Blood supply to CNS Flashcards

1
Q

Anterior circulation arteries

A
  • Brain receives 20% of blood
  • All anterior circulation comes off the ICA: internal carotid artery (except anterior communicating). This supplies the frontal, parietal, and parts of the temporal lobe
  • First branch of ICA: opthalmic artery
  • Next branch: anterior choroidal artery
  • Anterior cerebral artery (ACA)
  • The anterior communicating artery is the anterior part of the circle of willis and it connects the ACA on each side to each other
  • Posterior communicating artery is posterior part of the circle of willis and it connects the ICA on one side to the PCA (posterior cerebral artery) on the other
  • Middle cerebral artery (MCA) is terminal branch of the ICA
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2
Q

Posterior circulation arteries

A
  • Posterior circulation is derived from branches of the vertebral arteries (VA) and basilar artery (BA)
  • Posterior circulation supplies the occipital, temporal, brainstem, cerebellum, and spinal cord
  • Branches of VA: anterior spinal artery (ASA), posterior spinal artery (PSA), posterior inferior cerebellar artery (PICA)
  • Branches of the BA: anterior inferior cerebellar artery (AICA), pontine arteries, superior cerebellar artery (SCA), posterior cerebral artery (PCA)
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3
Q

Where CNS arteries come from

A
  • The vertebral arteries arise from the subclavian arteries
  • They travel in the transverse foramen of the cervical vertebrae and enter via the foramen magnum
  • Vertebral arteries join together to form the BA at the level of the pons
  • The ICA comes from the common carotid
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4
Q

Circle of willis

A
  • Anastomotic ring that connects the anterior and posterior circulations, providing collateral flow to cerebral hemispheres
  • The arteries involved in the CoW are ACA, ICA and the PCA
  • The anterior communicating artery (AComm) connects the L ACA to the R ACA
  • The posterior communicating artery (PComm) connects the ICA and PCA on one side only
  • Therefore we have 1 AComm, but 2 PComms (1 PComm for each side)
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5
Q

Opthalmic artery

A
  • First intracranial branch of the ICA
  • It supplies the structures of the orbit and gives off the central artery of the retina that travels in the optic nerve to provide blood supply to the retina
  • This has anastomosis w/ branches of the external carotid artery
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6
Q

Anterior choroidal artery

A
  • Branches off the ICA at the base of the brain, enters the temporal lobe
  • Supplies internal structures of the cerebral hemispheres including the lower 2/3 of the posterior limb of the IC
  • Also supplies globes pallidus, uncus, amygdala, anterior hippocampus, and choroid plexus of lateral ventricles
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7
Q

Localization of blood supply to cerebrum

A
  • Territories of the MCA, ACA, and PCA all have superficial (majority) and deep branches
  • Superficial branches of the MCA give blood to the lateral part of the brain
  • Superficial branches of the ACA give blood to the media/anterior/superior part of the brain
  • Superficial branches of PCA give blood to the posterior/medial/inferior part of brain
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8
Q

MCA 1

A
  • Terminal branch of the ICA, it turns laterally to enter the groove btwn the temporal pole and frontal lobe to gain access to lateral sulcus
  • Small branches called lateral lenticulostriate arteries (LLA) arise from the initial portion of the MCA and supply the basal ganglia (caudate, putamen, globus pallidus) and posterior limb of internal capsule
  • In HTN these LLAs can get narrowed than then infarct (lacunar infarct) or hemorrhage (leading to intracerebral hemorrhage)
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9
Q

MCA 2

A
  • MCA continues laterally and divides into cortical branches over the insula, these branches are then distributed to the dorsolateral surface of the hemisphere
  • The MCA supplies blood to most of the dorsolateral surface of the cortex including the lateral poles of the temporal lobes, and the upper limbs and face areas of the primary motor and sensory cortices
  • The MCA also provides blood to Broca’s area and Wernicke’s area
  • Has anastomoses w/ PCA and ACA
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10
Q

PComm

A
  • Connects the ICA and PCA on the same side
  • Have 2 of them
  • Completes CoW posteriorly
  • Enlargement can cause compression of CN III
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11
Q

ACA

A
  • Turns medial off the ICA and enters the longitudinal fissure btwn frontal lobes to reach the medial surface
  • Gives off medial lenticulostriate arteries that supply the anterior parts of basal ganglia and internal capsule
  • The artery divides into cortical branches over the medial surface of the frontal and parietal lobes, giving blood to them
  • This supplies the lower limb areas (most medial) of the primary motor and sensory cortex
  • Also supplies the orbital surface of the frontal lobe
  • Anastomoses w/ MCA and PCA
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12
Q

AComm

A
  • Connects the 2 ACAs as they enter the longitudinal fissure (only have 1 of them)
  • Completes circle of willis anteriorly
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13
Q

AComm

A
  • Connects the 2 ACAs as they enter the longitudinal fissure (only have 1 of them)
  • Completes circle of willis anteriorly
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14
Q

Posterior circulation

A
  • Branches of VAs (from subclavian) and BA (from VAs) provide supply to brainstem, cerebellum, and SC
  • Terminal branches of BA (PCA) supply the cerebral cortex, subcortical white matter, and diencephalon
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15
Q

Vertebral arteries

A
  • 2 VAs (R and L) ascend on the ventrolateral surface of the medulla and send branches to supply it (separate branches for lateral and medial medulla)
  • Paramedian branches of the VA supply the medial medulla (also supplied by ASA)
  • Infarcts of paramedian branches of VA and ASA result in medial medullary syndrome
  • Penetrating branches from VA supply the lateral medulla (also supplied by PICA)
  • Infarcts of the penetrating branches to the lateral medulla + PICA infarct result in lateral medullary syndrome
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16
Q

Posterior inferior cerebellar artery (PICA)

A
  • PICA arises from the VA close to the pontomedullary junction (last major branch of VA before they form the BA)
  • Turns laterally and is distributed to the posterior part of the inferior surface of the cerebellum
  • Supplies the posterior inferior hemisphere of cerebellum and inferior vermis related to it
  • Also provides branches to the lateral medulla and choroid plexus of the 4th ventricles
  • Infarcts to the PICA contribute to lateral medullary syndrom
17
Q

Basilar artery

A
  • Provides paramedian branches to the medial lower pons (gives blood to descending CBT/CST and nucleus/nerve VI)
  • Paramedian branches come off BA throughout its course, and provide the medial parts of most of the pons/midbrain
  • Pontine arteries come off BA and supply the midpons
  • Labyrinthine branch travels w/ VIII thru internal auditory meatus to supply inner ear
  • Main branches of the BA from inferior->superior: AICA, SCA, PCA (terminal branches)
18
Q

Basilar artery

A
  • Provides paramedian branches to the medial lower pons (gives blood to descending CBT/CST and nucleus/nerve VI)
  • Pontine arteries come off BA and supply the midpons
19
Q

Superior cerebellar artery (SCA)

A
  • Branches off BA beneath the tentorium (inferior to CN III) and courses along the superior surface of the cerebellum
  • Supplies superior surface of both cerebellar hemispheres and superior vermis
  • Also supplies upper pons and parts of the lower midbrain
20
Q

Anterior spinal artery (ASA)

A
  • Arises from the vertebral arteries (initially 2 ASA but quickly combine into 1 ASA)
  • The ASA runs down on the ventral surface of the medulla and provides blood to the upper medial medulla (involved in medial medullary syndrome)
  • Also supplies blood to the anterior 2/3rds of the SC
  • Thus damage to ASA will lead to bilateral loss of pain/temp below the level of the lesion (STT), and bilateral loss of motor at and below the level of the lesion (anterior horns/CST)
  • The motor symptoms will be UMN below the lesion, LMN at the levels that are affected (where ant horn cells are destroyed)
21
Q

Collateral circulation of SC

A
  • Segmented (lateral) spinal arteries that arise from the descending aorta and pass thru the intervertebral foramen with the spinal nerves
  • They then divide into the anterior and posterior radicular arteries
  • The largest of the ant radicular arteries is the artery of Adamkiewicz, which arises from T5-L3 (variable, usually T9-L2) on the left side
  • This provides the major blood supply to lumbar and sacral SC (T8-conus)
  • There is a watershed region of the SC that receives little collateral circulation: region btwn Adamkiewicz and the anterior radicular artery that is superior to it (mid thoracic level)
22
Q

Posterior spinal arteries

A
  • Paired vessels that arise from the vertebral arteries on each side, below the level of the anterior spinal arteries
  • PSAs supply the dorsal 1/3rd of the SC, in particular the dorsal columns and dorsal horn of the SC
  • Therefore damage to one PSA can lead to loss of proprioception/fine touch/vibration on the ispilateral side of the body (DCML has not yet crossed), at and below the lesion
  • Posterior 1/3rd of SC also supplied by posterior radicular arteries from the aorta
23
Q

Posterior spinal arteries

A

-Paired vessels that arise from the vertebral arteries on each side, below the level of the anterior spinal arteries
-PSAs supply the dorsal 1/3rd of the SC, in particular the dorsal columns and dorsal horn of the SC
-Therefore damage to one PSA can lead to loss of proprioception/fine touch/vibration on the ispilateral side of the body (DCML has not yet crossed), at and below the lesion
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Neuro (62 decks)

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