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C&M > blood supply to the brain and the meninges > Flashcards

blood supply to the brain and the meninges Flashcards

1
Q

what are the meningeal layers of the brain and spinal cord?

A

dura, arachnoid and pia mater

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2
Q

what is a characteristic feature of the dural mater?

A

dural infoldings

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3
Q

how can you detect blood supply to the brain?

A

branches, circle of willis and territories of supply can be seen on an angiogram

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4
Q

what are meninges?

A

they are protective airbags around the brain and spinal cord

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5
Q

what is the most superficial meningeal layer and where is it found?

A

the dural mater and is just deep to the skull and covers spinal cord as well

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6
Q

what is the arachnoid mater?

A

the intermediate layer

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7
Q

what is the pia mater?

A

it covers the cortex - it is microscopically thin and follows the sulci and gyri

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8
Q

what are the characteristics of dural mater?

A

tough, fibrous, protective layer

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9
Q

what are the characteristics of arachnoid mater?

A

spider web like, thin and delicate and vascular layer and cannot see all the sulci and gyri if this is still present `

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10
Q

how is the dural attached to the skull?

A

very tightly - no gap between the skull and layer or with the arachnoid. There is an outer periosteal layer and inner meningeal layer

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11
Q

what are dural infoldings?

A

there are specific places where these layers separate and reflect - double layered dura that protrudes into the cranial cavity at specific points

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12
Q

what is created by the dural infoldings?

A

channel/space - venous dural sinus - veins drain into these along with CSF - reabsorbed into the venous system through a projection of arachnoid called arachnoid villi/granulations - protrusions of the arachnoid layer

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13
Q

what is the space between the arachnoid and pia mater?

A

a space - subarachnoid space - CSF contained in here

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14
Q

what does CSF resemble?

A

plasma of blood - bathes all structures of the CNS

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15
Q

what are the functions of the CSF?

A

cushion the brain, shock absorber, and provides with nutrients

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16
Q

where is CSF produced?

A

ventricular system of the brain

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17
Q

what are the dural folds?

A

falx cerebri, falx cerebelli and tentorium cerebelli

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18
Q

what is the falx cerebri?

A

it is found the sagittal plane separating the right and the left hemispheres - crescent shaped and protrudes into cranial cavity

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19
Q

where is the tentorium cerebelli?

A

between the temporal and occipital lobe on top of the cerebellum

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20
Q

what is the falx cerebelli?

A

it is found between the two cerebellum hemispheres and is smaller protrusions of the dural mater

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21
Q

where is the transverse sinus?

A

it is found in the transverse plane on either side and is attached to the tentorium cerebelli

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22
Q

how will dural mater appear on MRI?

A

shiny

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23
Q

the falx cerebri has two points of attachment, where are these?

A

anteriorly (protrusion of the ethmoid bone on cribriform plate) and posteriorly (occipital bone)

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24
Q

where is the epidural space and what is it in SC?

A

it is a fat filled space that is found between the dural and the vertebrae

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25
Q

what is the subarachnoid space ?

A

space deep to arachnoid mater that is filled with CSF

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26
Q

what are denticulate ligaments?

A

they are lateral extensions of the pia mater that anchor the spinal cord to the arachnoid to prevent excessive movement

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27
Q

what are real spaces?

A

the epidural (SC only)and subarachnoid spaces as they are filled with fat or CSF

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28
Q

what are potential spaces?

A

the subdural or space above dura as it is not filled with anything except in pathology - potentially blood

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29
Q

where is the middle meningeal artery found?

A

in the subdural space

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30
Q

why does the brain need a large blood supply?

A

neural tissue has a high metabolic rate and therefore although the weight of the brain is only 2% of the total body weight it uses 20% of the blood supply

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31
Q

what is the epidemiology of stroke?

A

it is a common neurological deficit of vascular origin that occurs in 1 in 100 people over the age of 65

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32
Q

what are the two arteries that supply the brain?

A

internal carotids and vertebral - these are connected at the base of the brain and at the circle of Willis
internal carotids

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33
Q

where do the vertebals pass through?

A

the transverse foramen in the neck (cervical vertebrae) and the foramen magnum to enter skull with the SC

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34
Q

what is the fusion between the two vertebral arteries at the bottom of the brainstem called?

A

the basilar artery

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35
Q

what does the external carotid artery supply?

A

blood supply to the skin and the muscles of the face and then internal to the brain

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36
Q

where does the internal carotid course?

A

carotid canal at base of temporal bone

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37
Q

where does the internal travel?

A

wiggling path to the floor of the skull

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38
Q

what are the vertebral arteries branches of?

A

subclavian arteries

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39
Q

what is the internal carotid a branch of?

A

the common carotid

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40
Q

what is the optic chiasm?

A

it is where the two optic nerves fuse at the ventral surface of the brain

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41
Q

where is the basilar artery formed?

A

at the base of the pons

42
Q

how is the anterior spinal artery formed?

A

it is a single artery made from the branches of the vertebral arteries that come down and fuse to form one - all the way down the surface of anterior spinal cord

43
Q

what are the posterior spinal arteries formed from?

A

the paired arteries are also from the vertebral arteries - one off each down the posterior SC

44
Q

what arteries supply the posterior cerebellum?

A

the posterior inferior cerebellar arteries - paired and branch off vertebrals

45
Q

how are the transverse pontine arteries formed?

A

they come off the basilar artery and are paired and they travel horizontally along the pons

46
Q

what supplies the superior cerebellum and how are they formed?

A

the superior cerebellar arteries - paired and branch off the basilar at the level of the end of the pons

47
Q

what is the last branch of the basilar artery?

A

it is the branch that comes off above the level of the cerebellum and supplies the cerebrum - it is paired and is the posterior cerebral artery

48
Q

what arteries come off at the level of the medulla - pontine junction in the brainstem?

A

the anterior inferior cerebellar arteries come off the basilar - paired

49
Q

what branches come out of the internal carotid?

A

the internal carotids ascend in the neck and enter the skull through the carotid canal on either side of the optic chiasm. They send branches to the lateral brain (paired middle cerebral artery) and anterior branches to the base of the frontal lobes (anterior cerebral arteries) which are paired.

50
Q

where is the circle of willis found?

A

surrounding the optic chiasm and hypothalamus

51
Q

what does the circle of willis connect and why?

A

it connects the internal carotid and the basilar arteries, it ensures compensation of decreased blood flow when a vessel is occluded

52
Q

what are the constituents of the circle of willis?

A

the internal carotid arteries and the basilar, the anterior, middle and posterior cerebral arteries and the anterior and posterior communicating arteries

53
Q

what do the paired posterior communicating arteries connect?

A

the middle cerebral and posterior cerebral arteries

54
Q

what does the anterior communicating arteries connect?

A

the anterior cerebral arteries

55
Q

what is the importance of the circle of willis?

A

if one vessel is occluded then supplies collateral blood supply, and helps to distribute the blood evenly

56
Q

what are some common variations of the circle of willis?

A

where the AICA arise from - basilar or vertebral, both anterior cerebral arteries leading into one

57
Q

where are berry aneurysms likely to occur?

A

at branching points - points of weakness so prone to aneurysm

58
Q

what is a berry aneurysm?

A

it is a thinning of the vessel walls and because of it’s shape it is called a berry. Rupture of these can cause haemorrhage which can be subarachnoid. This is a vascular stroke type.

59
Q

what are common sites of berry aneurysm?

A

abnormal dilations around the circle of willies or at points of arterial branching

60
Q

how can you see the bend in the internal carotid?

A

the bend as it enters the carotid canal is seen by an angiogram

61
Q

what happens in an angiogram?

A

you inject dye into a vessel and follow its course

62
Q

what are two branches of the posterior cerebral?

A

the temporal and the calcarine branch

63
Q

where is the carotid canal?

A

in the cavernous sinus in nasal cavity

64
Q

where are the coiled branches of the MCA found?

A

in the lateral sulcus

65
Q

what does occlusion of a cerebral vessel lead to?

A

loss of function of that territorial area

66
Q

where does the ACA supply?

A

it goes to the medial aspect of the frontal and parietal lobes, and some superior tips, and the corpus callosum

67
Q

what supplies the lateral areas of the parietal frontal and temporal lobes?

A

the MCA

68
Q

where does the PCA supply?

A

the occipital lobe and the inferior and medial surface of the temporal lobe

69
Q

what is anterior to the central sulcus?

A

the pre-central gyrus which is a large amount of grey matter

70
Q

what happens to the PCG if the artery is blocked?

A

mostly supplied by MCA - if this is blocked will result in loss of function

71
Q

what are deep arteries?

A

they are branches of the main cerebral arteries that perforate areas of grey matter and supply deep grey matter nuclei in the brain

72
Q

what are the characteristics of deep arteries and how can this be a problem?

A

they are small and delicate meaning that they are likely to rupture of occlude and therefore can result in loss of function in the area that they supply

73
Q

what are some deep arteries called?

A

striate arteries

74
Q

what is the internal capsule?

A

it is a major fibre bundle to and from the cerebral cortex

75
Q

what structures are supplied bu the deep arteries inside the hemisphere?

A

deep nuclei, grey matter, internal capsule and supplies will include the descending motor pathways

76
Q

what are watershed areas?

A

they are the portion of the brain that is supplied by the distal tips of two or more vessles

77
Q

why are watershed regions susceptible to ischaemia?

A

systemic decrease in blood pressure means that these areas are vulnerable to damage as little blood in either vessel - watershed stroke

78
Q

what are the two main watersheds in the brain?

A

the MCA-PCA and ACA-MCA watersheds

79
Q

where are superficial veins?

A

they are covering the cortex

80
Q

what drains the internal surfaces of the brain?

A

the deep veins

81
Q

where does all blood from veins end up?

A

the internal jugular vein

82
Q

what is a confluence?

A

where all the dural venous sinuses meet

83
Q

what are sinuses?

A

they are channels formed at the point of separation between the periosteal layer and the meningeal layer of dural mater

84
Q

where is the inferior sagittal sinus?

A

at the inferior border of the falx cerebri

85
Q

what occurs in the sinuses?

A

venous blood flow

86
Q

what directly connects with the IJV?

A

the sigmoid sinus which continues from the transverse sinus

87
Q

how does blood from the veins reach the sinuses?

A

superficial - drain directly into the sinus which go to the confluence - transverse (if not straight there) - sigmoid sinus - IJV
deep - all drain into the great cerebral vein / great vein of Galen via internal cerebral veins - straight - confluence - transverse - sigmoid - IJV

88
Q

where do the sinuses go after the sinus system?

A

the IJV

89
Q

how does the IJV leave the skull?

A

the jugular foramen

90
Q

what follows the tentorium cerebelli?

A

the transverse sinus

91
Q

what can / cannot be seen in the arachnoid?

A

see all vasculature but not all sulci and gyri

92
Q

where is the MMA?

A

supplies the dura - is found overlying a portion of bones called pterion and is just anterior to the upper ear

93
Q

how does a epidural haemorrhage result?

A

pathological space filled with blood - middle meningeal artery rupture between dural layer and skull

94
Q

what are bridging veins and what pathology are these associated with?

A

they are cerebral veins that drain into the sinus - will briefly pierce the arachnoid to enter the sinus - they are briefly in the subdural space and if these rupture then is a subdural haemorrhage

95
Q

what can cause a subarachnoid heamorrhage?

A

cerebral arteries and veins below the arachnoid layer that rupture

96
Q

what colour does leaking fluid appear and what does it do?

A

it appears white and can push the brain to the side

97
Q

what is blood in the subdural space usually?

A

typically venous blood

98
Q

what is the suture between frontal and parietal bone?

A

coronal suture

99
Q

what is the suture between occipital parietal lobes?

A

lamboid suture

100
Q

what projects into the sinuses?

A

the arachnoid villi

C&M (36 decks)

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