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1 Anatomy > Blood Supply to the Brain > Flashcards

Blood Supply to the Brain Flashcards

1
Q

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

A

50

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2
Q

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

A

8-23

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3
Q

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

A

<8

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4
Q

What are the 3 great vessels?

A
  1. Brachiocephalic into R common carotid and R subclavian
  2. L common carotid
  3. L subclavian
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5
Q

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

A

Brachiocephalic (R subclavian)

L subclavian

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6
Q

What % of population has a dominant vertebral artery?

A

50% Left side
25% Right side
25% Nondominance

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7
Q

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

A

5%

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8
Q

What % of population has a hypoplastic vertebral artery?

A

40%

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9
Q

Draw the arteries of the head

A
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10
Q

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

A

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

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11
Q

Vascular supply and anastomoses: Superior thyroid artery

A

Larynx and upper thyroid

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12
Q

What artery supplies the superior and inferior thyroid?

A

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

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13
Q

Vascular supply and anastomoses: Ascending pharyngeal

A

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

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14
Q

Vascular supply and anastomoses: Lingual artery

A

Tongue and floor of mouth

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15
Q

Vascular supply and anastomoses: Facial artery

A

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

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16
Q

Vascular supply and anastomoses: Occipital artery

A

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

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17
Q

Vascular supply and anastomoses: Posterior auricular

A

Pinna, external auditory canal, scalp

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18
Q

Vascular supply and anastomoses: Superficial temporal artery

A

Scalp and ear

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19
Q

Vascular supply and anastomoses: Internal maxillary artery

A

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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20
Q

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

A

Anterior to IJV
Behind eustachian tube

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21
Q

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

A

Anterior to cochlea and tympanic cavity

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22
Q

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

A

Superior

23
Q

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

A
  1. Caroticotympanic artery

Anastomoses with inferior tympanic artery (ascending pharyngeal)

  1. Vidian artery (artery of the pterygoid canal) through vidian canal and foramen lacerum, anastomoses with ECA
24
Q

What is the persistent stapedial artery?

A

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

25
Q

What is the persistent otic artery?

A

Primitive otic artery fails to involute

Connects petrous ICA to embryonic dorsal longitudinal neural arteries

26
Q

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

A

CN VI lies inferolaterally

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

27
Q

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

A

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

28
Q

What are the 3 main branches of the meningohypophyseal trunk?

A

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

29
Q

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

A

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

30
Q

What is the most common primitive ICA-basilar anastomosis?

A

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

31
Q

What is usually the first intracranial ICA branch?

A

Ophthalmic artery

32
Q

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

A

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

33
Q

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

A

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.

34
Q

Aneurysms arising from ophthalmic artery: points which direction

A

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

35
Q

What are the opthalmic branches

A
  1. Ocular (central retinal, ciliary)
  2. Orbital (lacrimal, recurrent meningeal)
  3. Extraorbital (supraorbital, ethmoidals, dorsal nasal, palpebral, supratrochlear)
36
Q

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

A

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

37
Q

What do the superior hypophyseal arteries supply?

A

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

38
Q

What is the hypophyseal portal system?

A

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

39
Q

Aneurysms arising from superior hypophyseal arteries point in what direction?

A

Inferiorly and medially

40
Q

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

A

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

41
Q

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

A

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

42
Q

What is the largest perforator of the PCOMM artery?

A

Anterior thalamoperforating artery

terminates between mamillary bodies and optic tracts

43
Q

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

A

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

44
Q

What is a fetal PCA?

A

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

45
Q

How to recognize a PCOMM infundibulum?

A
46
Q
A
47
Q

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

A

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

48
Q

Where does the anterior choroidal artery arise from?

A

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

49
Q

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

A

Superior or superolaterally to the origin of the anterior choroidal

50
Q

What does the anterior choroidal artery anastomoses to?

A

Lateral posterior choroidal arteries

51
Q

What are the 2 segments of the choroidal arteries?

A

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

Intraventricular segment

52
Q

What do the intraventricular segment of the choroidal arteries supply?

A
  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)
53
Q
A

1 Anatomy (7 decks)

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