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Citow - Anatomy > Blood Supply to the Brain > Flashcards

Blood Supply to the Brain Flashcards

1
Q

What three major head and neck arteries are branched of the subclavian artery?

A

Vertebral Artery
Thyrocervical Trunk
Costocervical Trunk

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2
Q

Which vertebral artery is usually dominate? What percent of time? What percent is usually the other side dominant?

A

Left 50%
Right 25%
Nondominant 25%

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3
Q

What percentage of the population has a hypoplastic vertebral artery?

A

40%

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4
Q

What are the branches of the external carotid artery from proximal to distal?

A 
Superior thyroid artery
Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery 
Superficial temporal artery
Internal MAXillary artery
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5
Q

Which branch of the external carotid supplies CN IX, X, and XI?

A

Ascending pharyngeal artery

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6
Q

What gives off the middle meningeal artery? Accessory meningeal arteries?

A

Internal maxillary artery for both

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7
Q

At what level is the carotid bifurcation?

A

C3-C4 or C4-C5

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8
Q

Name the segments of the ICA, proximal to distal.

A
  1. Cervical
  2. Petrosal
  3. Lacerum
  4. Cavernous
  5. Clinoidal
  6. Ophthalmic
  7. Communicating.
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9
Q

How many segments are there to the Petrous portion of the ICA?

A
  1. Vertical
  2. Genu
  3. Horizontal
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10
Q

What are the branches at each ICA segment?

A

C1 - none
C2 - Caroticotympanic artery, Vidian artery (sometimes, usually ECA)
C3 - none
C4 - Meningohypophyseal trunk, Inferolateral trunk, Medial Trunk (McConnell’s Capsular arteries)
C5 - none
C6 - Ophthalmic artery, Superior hypophyseal artery,
C7 - Anterior choroidal, ACA, MCA, PCom

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11
Q

What does the caroticotympanic artery supply? What does it anastamose with?

A

Supplies the middle and inner ear.

Anastamoses with the inferior tympanic artery, which is a branch of the ascending pharyngeal

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12
Q

What is the most common origin of the Vidian artery? Second most common?

A

External Carotid Artery followed by Internal Carotid artery

It serves as an anastamosis between the two.

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13
Q

The inferolateral trunk anastamosis with the ECA by ________.

A

maxillary artery (through foramen rotundum) and the MMA

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14
Q

What are the branches of the meningohypophyseal trunk? What do they supply?

A

Tentorial Artery (Bernasconi and Cassinari) - tentorium

Inferior Hypophyseal Artery - Neurohypophysis

Dorsal Meningeal Artery - CN VI and part of the clivus

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15
Q

Pt goes in for MMA embolization. Develops unilateral blindness. Why?

A

in 0.5% of the population, the ophthalmic artery comes off the MMA

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16
Q

What is the origin of the Anterior Choroidal Artery?

A

Communicating segment of the ICA just distal to the PcommA origin

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17
Q

Recurrent Artery of Heubner arises from where?

A

A1 or A2 segment (medial distal striate artery)

Usually off of the A2

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18
Q

What does the Recurrent Artery of Heubner supply?

A 
Head of the caudate
Anterior limb of the internal capsule
Anterior Putamen and Globus Pallidus
Septal Nuclei
Inferior Frontal Lobe
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19
Q

What defines the M2 segment of the MCA?

A

from the bifurcation to the genu; insular segment

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20
Q

Lateral Lenticulostriate arteries emerge from what origin?

A

perforated arteries that emerge from M1 (supply much of the basal ganglia)

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21
Q

Which segment of the PCA lies within the ambient cistern?

A

P2

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22
Q

Which segment of the PCA lies within the quadrigeminal cistern?

A

P3

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23
Q

The medial and lateral posterior choroidal arteries arise from what origin?

A

P1 and P2 segments respectively

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24
Q

The vertebral arteries arise from what origin?

A

Subclavian arteries typically (many variants)

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25
Q

The verts enter the foramina transversarium at what level?

A

C6

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26
Q

Occlusion of what vessel causes lateral medullary syndrome? What are the classic symptoms?

A

PICA

Classic signs:

  • loss of pain and temperature on ipsilateral face but contralateral body
  • CN IX and X dysfunction
  • horner’s syndrome
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27
Q

What are the branches of the basilar artery?

A 
AICA
Labyrinthine Artery 
Paramedian Artery
Pontine Arteries
SCA
PCA

(of note PICA comes off the Verts)

28
Q

What’s the vascular supply to the striatum?

A

Mainly: MCA (lenticulostriates)
Rostrally: Recurrent Artery of Huebner
Cuadally: anterior choroidal artery

29
Q

What’s the vascular supply to the internal capsule?

A

Anterior Limb: mostly ACA, RAH (also lateral MCA lenticulostriates)
Genu: ICA perforaters and MCA lenticulostriates)
Posterior Limb: Anterior Choroidal, PcommA

30
Q

What’s the vascular supply to the Thalamus?

A

Primarily through the PCA and its branches (including posterior choroidal)
Rostrally: PcommA and Basilar Bifurcation perforators (thalamoperforating arteries)

31
Q

What’s the vascular supply to the Medulla?

A

Anterior and Posterior Spinal Arteries

PICA and Verts

32
Q

What’s the vascular supply to the Pons?

A

Basilar Paramedian arteries and branches

Circumferential branches from the basilar

33
Q

What’s the vascular supply to the midbrain?

A

Basilar artery, PCA, SCA, PcommA, Anteior Chroidal

34
Q

What’s the vascular supply to Cerebellum?

A

PICA: Inferior cerebellar peduncle, vermis, tonsils, choroid of the 4th

AICA: Middle cerebellar peduncle, choroid of the 4th, anterior cerebellum

SCA: superior cerebellar peduncle, choroid of the 4th, and the DEEP nuclei

35
Q

The SSS drains predominantly to which transverse sinus?

A

Right Transverse Sinus (60%)

36
Q

Where does the SSS end and the transverse sinus begin?

A

internal occipital proturberance

37
Q

The medial internal cerebral venous drainage pathway is as follows:

A

cortical medical hemisphere veins -> ISS
ISS joins great cerebral vein of Galen to form Straight SInus
Straight sinus - > Torcula -> transverse sinus (predominantly left)

38
Q

What joins with the sigmoid sinus to become the superior jugular bulb?

A

inferior petrosal sinus

39
Q

The vein of Trolard and Labbe drain into the which sinuses respectively?

A

SSS and Transverse Sinuse respectively (both originate at sylvian fissure)

40
Q

What forms the internal cerebral veins?

A

union of the thalamostriate, choroidal, septal, and epithalamic, and lateral ventricular veins

41
Q

What’s the course of the internal cerebral veins?

A

located in the tela choroidea of the roof of the third ventricle (velum interpositum)

travels through quadrigeminal cistern to contribute to the vein of Galen

42
Q

What is the course of the Basal Vein of Rosenthal?

A

passes through the ambient cistern and joins the internal cerebral vein to form the vein of Galen

43
Q

What is the course of the vein of Galen?

A

travels under the splenium and merges with the inferior sagittal sinus to form the straight sinus

44
Q

Left vertebral artery arises from the aorta what percent of times?

A

5%

45
Q

The ____ branch of the facial artery anastamoses with the ____ branch of the ophthalmic artery.

A

angular

orbital

46
Q

The internal maxillary artery anastomoses with inferior lateral cavernous sinus trunk and ophthalmic artery through ____.

A

ethmoidal branches

47
Q

What are the segments of the intracavernous ICA?

A
  1. Ascending portion
  2. posterior genu
  3. horizontal portion
  4. anterior genu
  5. remainder of ICA
48
Q

The intracranial portion of the ICA begins at the ____.

A

distal dural ring

49
Q

What are the branches of the medial trunk? What do they supply?

A

anterior and inferior capsular arteries

anterior and inferior pituitary

50
Q

Aneurysms of the ICA arise from which four vessels? What is the orientation?

A

Ophthalmic - superiorly and anteriorly

Superior hypophyseal - inferiorly and medially

PComm - posterior

Anterior choroidal - superior lateral

51
Q

Medial lenticulostriates branch from _____.

A

A1

52
Q

The Acomm lies in what cistern?

A

cistern of the lamina terminalis

53
Q

The recurrent artery of Heubner passes through what anatomical structure?

A

anterior perforating substance

54
Q

The genu of the MCA courses around what structure?

A

island of Reil

55
Q

The M3 is also known as the ______ segment.

A

opercular

56
Q

The largest cortical branch of the MCA is the _____.

A

angular artery

57
Q

Occlusion of what branch of the MCA causes Wernicke’s Aphasia and hemianopsia?

A

posterotemporal branch (M2 inferior trunk branch)

58
Q

P1 lies within what cistern?

A

interpeduncular

59
Q

What cistern does the Anterior choroidal artery go through?

A

ambient

60
Q

The anterior choroidal artery enters the choroidal fissure at the _____.

A

plexal point (temporal horn of lateral ventricle)

61
Q

What artery was historically sacrificed to treat parkinson’s disease? Why?

A

anterior choroidal

probably due to decreased supply to VL thalamus

62
Q

What percent of people have a complete circle of willis?

A

25%

63
Q

What are the segments of the PICA?

A
  1. Anterior medullary segment
  2. Lateral medullary segment: supply CNs IX, X, and XI
  3. Tonsillomedullary segment: forms a large loop
  4. Telovelotonsillar segment: between tela choroidea and inferior medullaryvelum rostrally superior pole of the tonsils caudally
  5. Hemispheric branches
64
Q

What are three midbrain stroke syndromes?

A

Weber’s (CN III palsy w/ contralateral hemiplegia)

Benedikt (same plus red nucleus lesion aka tremors)

Claude (CN III, contralateral hemiparesis and ataxia)

65
Q

What percent of patients with persistent trigeminal arteries have vascular malformations or aneurysms?

A

25%

66
Q

What is the second most common persistent fetal artery?

A

hypoglassal (after trigeminal)

Citow - Anatomy (16 decks)

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