Blood Supply to the Brain Flashcards by RR LL

Normal CBF (mL/100g of brain tissue/min)

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CBF in reversible ischemic penumbra (mL/100g of brain tissue/min)

8-23

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CBF in irreversible neuronal death (mL/100g of brain tissue/min)

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What are the 3 great vessels?

Brachiocephalic into R common carotid and R subclavian
L common carotid
L subclavian

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Which great vessels give off the vertebral, thyrocervical and costocervical trunks?

Brachiocephalic (R subclavian)

L subclavian

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What % of population has a dominant vertebral artery?

50% Left side
25% Right side
25% Nondominance

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What % of cases the left vertebral artery arises from the aorta?

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What % of population has a hypoplastic vertebral artery?

40%

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Draw the arteries of the head

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What are the 8 major branches of the ECA? (SALFOPSI)

Superior thyroid artery
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Superficial temporal artery
Internal maxillary artery

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Vascular supply and anastomoses: Superior thyroid artery

Larynx and upper thyroid

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What artery supplies the superior and inferior thyroid?

Superior: superior thyroid artery
Inferior: thyrocervical trunk (from subclavian) + isthmus

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Vascular supply and anastomoses: Ascending pharyngeal

Nasopharynx, oropharynx and middle ear
CN IX, X, XI
Meninges
Anastomoses with vertebral artery branches

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Vascular supply and anastomoses: Lingual artery

Tongue and floor of mouth

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Vascular supply and anastomoses: Facial artery

Face, palate, lips
Angular branch of the facial artery anastomoses with ophthalmic artery

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Vascular supply and anastomoses: Occipital artery

Posterior scalp, upper cervical musculature
Posterior fossa and meninges
Anastomoses with the vertebral

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Vascular supply and anastomoses: Posterior auricular

Pinna, external auditory canal, scalp

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Vascular supply and anastomoses: Superficial temporal artery

Scalp and ear

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Vascular supply and anastomoses: Internal maxillary artery

Deep face
Gives off middle meningeal and accessory meningeal
Anastomoses with inferior lateral cavernous sinus trunk and ophthalmic artery through ethmoidal branches

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Where is the IJV and eustachian tube in relation to petrosal ICA?

Anterior to IJV
Behind eustachian tube

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Where is the intraosseous segment of ICA in relation to cochlea?

Anterior to cochlea and tympanic cavity

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Where is the intraosseous branch of ICA in relation to cartilage-filled foramen lacerum?

Superior

What are the 2 main branches of intraosseous/petrous ICA?

Caroticotympanic artery

Anastomoses with inferior tympanic artery (ascending pharyngeal)

Vidian artery (artery of the pterygoid canal) through vidian canal and foramen lacerum, anastomoses with ECA

What is the persistent stapedial artery?

Embryonic stapedial fails to involute
Vertical segment of petrous ICA through bony canal on cochlear promontory and traverses footplate of stapes to termiinate as MMA

What is the persistent otic artery?

Primitive otic artery fails to involute Connects petrous ICA to embryonic dorsal longitudinal neural arteries

Relation of the cranial nerves to the carotid artery in the cavernous sinus

CN VI lies inferolaterally CN III, IV, V1 and V2 are lateral within the lateral dural wall

What are the 5 parts of the intracavernous ICA (proximal to distal)?

C5 ascending C4 posterior genu C3 horizontal portion C2 anterior genu C1 remainder

What are the 3 main branches of the meningohypophyseal trunk?

Tentorial artery of Bernasconi and Cassinari (tentorium) Inferior hypophyseal artery (Neurohypophyseal) Dorsal meningeal artery (CN VI and part of clivus)

Where does the inferolateral trunk (artery of the inferior cavernous sinus) travels to?

Inferolateral cavernous sinus wall Foramen ovale and spinosum to supply CN III, IV, VI and gasserian gnaglion Anastomose with maxillary artery (a. of foramen rotundum) and MMA

What is the most common primitive ICA-basilar anastomosis?

Persistent trigeminal artery Associated (25%) with higher incidence of vascular abnormalities.

What is usually the first intracranial ICA branch?

Ophthalmic artery

Where does the ophthalmic artery course in relation to the ICA and anterior clinoid?

Superomedial or anteromedial to ICA and under anterior clinoid process (rarely originates within cavernous sinus)

What is the course of the ophthalmic artery in relation to CN II

Initially inferolateral to CNII and medial to CN III/VI, then croses between CNII and superior rectus muscle to the medial orbital wall between medial rectus and superior oblique muscles.

Aneurysms arising from ophthalmic artery: points which direction

From superior wall of the ICA distal to the origin of opthalmic artery Points upward against the optic nerve

What are the opthalmic branches

1. Ocular (central retinal, ciliary) 2. Orbital (lacrimal, recurrent meningeal) 3. Extraorbital (supraorbital, ethmoidals, dorsal nasal, palpebral, supratrochlear)

Superior hypophyseal arteries: where do they arise and where do they course in relation to the optic nerve?

From posteromedial portion of the intradural ICA and course beneath the optic nerve

What do the superior hypophyseal arteries supply?

Pituitary (anterior lobe, stalk) and tuber cinereum Inferior surface of the optic nerve and chiasm

What is the hypophyseal portal system?

Anastomosis of the superior hypophyseal arteries on contralateral side and inferior hypophyseal arteries

Aneurysms arising from superior hypophyseal arteries point in what direction?

Inferiorly and medially

Where does the PCOMM artery arise and what is its course in relation to the CN III?

Posterior aspect of the intradural ICA and course posterolaterally above CN III to join P1

How many perforators are there for the PCOMM artery? What do they supply?

7 perforators Supply potsterior hypothalamus, anterior thalamus, subthalamic nucleus, posterior limb of the internal capsule

What is the largest perforator of the PCOMM artery?

Anterior thalamoperforating artery terminates between mamillary bodies and optic tracts

PCOMM variants are observed in what % population, including what types?

50% 30% absent or hypoplastic 20% fetal origin duplicated or triplicated

What is a fetal PCA?

Failure of regression of fetal PCA Dominant blood supply of occipital lobes from ICA

How to recognize a PCOMM infundibulum?

PCOMM aneurysm: position in relation to the PCOMM and anterior choroidal artery

Points posteriorly towards CNIII Anterior choroidal is superior/superolateral to the aneurysm

Where does the anterior choroidal artery arise from?

Posteromedial surface of ICA, 2-4mm distal to PCOMM origin

Anterior choroidal artery: aneurysm tend to locate where in relation to the artery?

Superior or superolaterally to the origin of the anterior choroidal

What does the anterior choroidal artery anastomoses to?

Lateral posterior choroidal arteries

What are the 2 segments of the choroidal arteries?

Cisternal segment (within suprasellar cistern) beneath optic tract, then turns posteromedially around uncus Intraventricular segment

What do the intraventricular segment of the choroidal arteries supply?

1. visual system (inferior optic chiasm, post optic tract, radiation, LGN) 2. Temporal lobe (uncus, parahippocampal gyrus, amygdala) 3. Choroid plexus of temporal horn/atrium 4. Basal ganglia 5. Diencephalon (subthalamus, lateral VA and VL)