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Blood supply to the eye and the brain Flashcards

1
Q

which blood vessel carries blood that has come from the body

A

vena cava

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2
Q

which blood vessel carries blood from the right ventricle to the lungs

A

the pulmonary artery

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3
Q

what are the parts of the aorta

A

ascending aorta

descending aorta

brachiphelic artery which has 3 branches right subclavian artery, right vertabral artery and right common carotid artery

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4
Q

what is the difference between the left common carotid and the right common carotid artery

A

the left common carotid artery and vertabral arery branches directly off the aortic arch

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5
Q

where do the vertabral arteries branch off

A

the vertabral arteries branch off the subclavian arteries on each side

i.e. left vertabral artery branches off the left subclavian artery and the right subclavian artery branches off the right vertabral artery

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6
Q

at what level does the common carotid artery split into two levels

A

bifurication of the common carotid arteries into internal and external occurs at the level of c4 of your cervical vertabrae - ( the neck area of your spine) (which lies around the superior margin of the thyroid cartilage)

their is a slight dilation at this point - this corresponds to the carotid sinus (baroreceptors involved in BP regulation are here)

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7
Q

what is the function of the external carotid artery

A

supplies areas of the head and neck external to the cranium

branches - some anatomists like freaking out poor medical students

superior thyroid artery

ascending pharyngeal artery

lingual artery

facial artery

occipital artery

posterior auricular artery

maxiallry artery

superficial temporal artery

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8
Q

what are the terminal branches of the external carotid artery

A
  • the maxillary artery and the superficial temporal artery
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9
Q

what is the maxillary artery

A
  • larger of the branches of the external carotid artery

supplies deep structures of the face

3 main portions

mandibular (1st part)

ptyergoid (2nd part )

ptergopaletine (3rd part)

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10
Q

what is the function of the superficial temporal and facial arteries

A

supply superficial facial arteries

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11
Q

what is the difference between the superficial temporal arteries and the maxilary artery

A

maxillary artery- supplies the deep structures in the face

as opposed to the superficial temporal arteries supply the superficial structures of the face

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12
Q

what is the function of the internal carotid artery

A

does not supply any neck structures- goes through the neck but dosnt have any branches in the neck itself

enters the cranial cavity via the carotid canal (which lies in the petrous temporal bone)

goes on to supply the : brain, eyes and forehead

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13
Q

through what foramen do the vertabral arteries travel through

A

transverse foramen

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14
Q

what is the internal carotid artery divided into

A

internal carotid artery is divided into segments c1- c7

one of the braches of your internal carotid artery is your opthalmic segment (c6)- it is from this segment that your opthalmic artery is going to come off-

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15
Q

where does your opthalmic artery come from

A
  • the opthalmic artery comes off your internal carotid artery
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16
Q

where do your vertabral arteries come from

A

arise from the subclavian arteries

enter the cranial cavity via the foramen magnum

right and left vertabral arteries then join to form the basilar artery which goes on to supply the brain

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17
Q

describe the course of the vertabral arteries

A

you have right and left vertabral arteries which travel up the transverse foramen and enter the cranium via the foramen magnum and then it joins together to form the basilar artery which supplies the brain

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18
Q

what are the three main branches of the aorta

A
  • the aortic arch gives rise to 3 main branches the brachiocephalic trunk , left common carotid and left subclavian
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19
Q

at what level does the common carotid artery bifurcate

A
  • the common carotid artery bifurcates into the external and internal common carotid artery at the level of c4
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20
Q

what does the external common carotid artery supply

A

the external common carotid artery supplies the head and the neck structures

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21
Q

what are the two terminal branches off the eca

A

the maxillary artery and the superficial temporal

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22
Q

how does the ica enter the cranial cavity

A

the ica enters the cranial cavity through the carotid canal and supplies the brain , eyes and forehead

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23
Q

what do the vertabral arteries branch off

A
  • the vertabral arteries branch off the subcalvian artery, enter the cranial cavity via the foramen magnum , and join to form the basilar artery which supplies the brain
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24
Q

what is the circle of wlillis

A
  • anastomosis of arteries supplying the brain

comprimises the anterior cerebral arteries

anterior communicating arteries

internal carotid arteries

posterior cerebral arteries

posterior communicating artery

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25
Q

describe the structure of the circle of willis

A
  • the vertabral arteries come off the subcalvian arteries - they join together to form the basilar artery- - the basilar artery then gives off the posterior cerebral arteries - between the posterior cerebral artery and the ica you have the posterior communicating artery - the ica then gives off the anterior cerebral artery - in between these two cerebral arteries ou have the anterior cerebral artery and then at the top you have the anterior communicating artery
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26
Q

where does your brains blood supply come from

A

right and left internal carotid

vertabral arteries

together feeds into the circle of willis which provides blood supply to the brain

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27
Q

what does the middle cerebral artery supply

A

the middle cerberal artery supplies most of the lateral surface of the hemisphere

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28
Q

what does the anterior cerbral artery supply

A

the anterior cerebral artery supplies the medial aspect of the frontal love

supreomedial parietal lobe and internal capsule

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29
Q

what does the posterior cerebral artery supply

A

midbrain and the thalamus

occipital lobe - ( visual cortex)

inferomedial temporal lobe

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30
Q

what is the circle of willis

A

the circle of willis is an arterial anastomosis supplying brain structures

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31
Q

how can the brains vascular territories be divided

A

the brains vascular terrorities can broadly be thought of in terms of anterior, middle and posterior cerebral arteries

32
Q

what is the bamford classification og stroked

A
  • the bamford classification is used for ischaemic strokes and describes 4 main types of ischameic strokes

TACS , PACS , LACS AND POCS

33
Q

what are dural venous sinuses

A
  • how your brain brings blood back towards the heart
  • instead of having veins it has structures called venous sinuses - which lie between the endosteal and meingeal layers of your dura mater in the brain ( the brain has three layers dura mater, arachnoid mater and pia mater)

recieves blood from the cerebral veins and cerebrospinal fluid from the subarachnoid space

drains into internal jugular veins

34
Q

what blood vessel supplies the eye and the orbit

A
  • the opthalmic artery - which is a branch of the internal carotid artery- it is the first branch after it leaves the roof of the cavernous sinus

enters the orbit via the optic canal - below and lateral to the optic nerve

35
Q

what are the branches of the opthalmic artery

A
  • central retinal artery
  • cillary arteries
  • lacrimal arteries
  • muscular branches
36
Q

what is the function of the central retinal artery

A

supplies the inner 2/3 of the retina

37
Q

what is the function of the cillary arteries

A
  • you have 3 types
  • long posterior cillary arteries - usually 2 pierce sclera and run forward to the cillary body , supply choroid, cillary body and iris
  • short posterior cillary arteries- pierce sclera around entrance of the optic nerve, supply choroid , 15-20% cilioretinal artery

anterior cillary artery - supplies sclera and conjuctiva tendon insertions - they are branches of the muscular branches - which supply the recti muscles

in a substet of the population the cillary vasculature can sometimes have an abberration called the cilioretinal artery - useful if you have a blockage in your central retinal artery - because the cilioretinal artery can replace it

38
Q

how does the retina recieve its blood supply

A

cillary arteries supply the retina

choroid supplies the outer 2/3 of the retina

inner 1/3rd via the central retinal artery

39
Q

how is the blood retinal barrier formed

A
  • zona occludents of the endotheliel cells of the cra capillaries
  • zona occludentes between cell membranes in rpe
40
Q

what does a central artery retinal occlusion look like

A

pale retina with a red cherry spot

  • the fovea has a foveal depression- to allow as much light as possible to come through- the choroid is underneath

when you have a CRAO the outer 1/3 of the retina loses its blood supply and becomes pale

in the rest of the retina you can see that it is very pale but because the fovea is very thin you can see through to the choroid which is supplied by the cillary vessels and is therefore is perfused and you are seeing the chorioid which is why you have the cherry red spot

41
Q

what is cilioretinal sparing

A

in people with a cilioretinal artery in a CRAO you get sparing in the area which is supplied by the central retinal artery - good for these patients - prevents blindness

42
Q

what does the lacrimal artery supply

A

the lacrimal gland - gives off a branch called the lateral palpebral artery which supplies the lateral half of the upper eyelid

43
Q

what do the muscular branches supply

A
  • muscular branches go off to the recti muscles and anteriolly give off the anterior cillary arteries
44
Q

what does the superior orbital artery supply

A

the superior orbital artery supplies the levator palpebrae superioris

45
Q

what do the posterior and anterior ethmodial arteries supply

A

they go to the ethmoidal arteries and supply the sinuses and part of the upper nasal cartilage

46
Q

how is the blood from the eye drained

A

venous drainage of the choroid is via vortex veins

  • usually 4 vortex veins one for each quadrant

superior drain to superior opthalmic vein and inferior drain to the inferior opthalmic vein

( 2 superior and 2 inferior )

47
Q

describe venous drainage of the opthalmic veins

A

superior opthalmic veins drain directly into the cavernous sinus

inferior opthalmic vein drains into the pterygoiud venous plexus

valveless system - oribital cellulitis/ facial infection can travel backwards into the cavernous sinus and percipitate cavernous sinus thrombosis

48
Q

describe venous drainage of the central retinal vein

A

central retinal vein

drains inner retina

travels in the optic nerve

joins supeior opthalmic vein and therefore drain into cavernous sinus

49
Q

how is the blood supplied to the eye

A
  • arterial supply is via the opthalmic artery which branches off ica as the first branch after exiting the cavernous sinus

this gives off 11 different branches

50
Q

what is the central retina artery responisble for

A

crao supplies the inner 2/3 of the retina but is an end artery and therefore vunreable to occlusion - crao

51
Q

what is the function of the cillary artery

A

the cillary arteries (long posterior and short and anterior cillary) supply the outer 1/3 of the retina and anastomose within the choroid

52
Q

what is the blood retinal barrier formed by

A
  • sona occludentes of rpe and cra endothelium
53
Q

what is venous drainage of the eye via

A

venous drainage is via vortex veins and the central retinal vein

54
Q

which artery branches directly off the aortic arch

A
  • left subclavian artery
55
Q

describe the branches of the aorta

A
  • brachiphelic artery which gives off your right subcalvian artery, right vertabral artery and right common carotid artery
  • you have left common carotid artery
  • your left subclavian and vertabral artery branch directly off your aortic arch
56
Q

what are the terminal branches of the external carotid artery

A
  • maxillary artery - supplies deep facial structures - and superfical temporal artery
57
Q

what does the internal carotid artery give off

A
  • the internal carotid artery gives off the opthalmic artery
58
Q

what formaen does the internal carotid artery enter the cranial cavity through

A

enters the cranial cavity through the carotid canal

59
Q

what part of the internal carotid artery gives off the opthalmic artery

A
  • the opthalmic segment
60
Q

where do the vertabral arteries arise from

A

the subclavian arteries

61
Q

what do the vertabrak arteries ascend via in the cervical vertabrae

A
  • vertabral arteries ascend via the transverse foramen
62
Q

how do the vertabral arteries enter the cranial cavity

A
  • formaen magnum
63
Q

what do the vertabral arteries join to form what artery

A

basilar artery which go on to supply the brain

64
Q

describe the circle of willis

A
  • vertabral arteries , then bassilar artery , posterior cerebral artery

in between the posterior cerebral artery and the middle cerebral artery is the posterior communicating artery

at the end of the middle cerebral artery is the internal carotid artery

between the middle cerebral artery and the anterior cerebral artery is the anterior communicating artery

65
Q

what artery is most likely to be involved in a total anterior circulation stroke

A

middle cerebral artery -

it supplies the frontal lobe the temporal lobe
supplies more in the brain than the anterior cerebral artery

66
Q

which of the meningeal layers contains the dural venous sinuses

A
  • the dura mater - the dura mater itself has two different layers , the meingeal and endosteal layers
67
Q

where does the blood that drains through the dural venous sinuses come from

A
  • they receive blood from the cerebral veins and cerebrospinal fluid from the subarachnoid
68
Q

where do the dural venous sinuses drain into

A
  • internal jugular veins
69
Q

which artery supplies blood to the eye

A
  • opthalmic artery - which is a branch of the internal carotid artery- first branch off the ica as it leaves the roof of the cavernous sinus
70
Q

what does the central retinal artery supply

A
  • the central retinal artery supplies the inner 2/3rds of the retina - the inner 2/3 has capillaries perfusing it - there are capillaries from the CRA perfusing the inner 2/3 of the retina- the outer 1/3 has no capillary network- relies on diffusion from the choroidal vessels
  • the choroid (posterior cillary arteries) supply the outer 1/3 of the retina
71
Q

what is the blood retinal barrier formed by

A
  • the inner 2/3 of the retina has its blood supply from capillaries which come from the CRA - in order to control what comes into and out of the retina (this is what the blood retinal barrier does) you have meshworks of proteins which lies between the cells of the capillaries
  • because the outer retina has no capillaries within it - it relies on diffusion - and this is from capillaries from the posterior cillary arteries which supply the choroid- choroidal diffusion supplies the outer 2/3 of the retina - in order to control what comes out of the outer 2/3 of the retina because their is no capillaries within here you have zona occludens between the retinal pigmented epithelium
72
Q

how many vortex veins are there draining the choroid

A
  • vortex veins drain the choroid
  • there are usually 4 vortex veins draining the choroid - usually one for each quadrant

superior drain into the superior opthalmic vein and inferior drain into the inferior opthalmic vein

73
Q

where do your superior opthalmic veins drain into

A
  • cavernous sinus
74
Q

where do your inferior opthalmic veins drain into

A

inferior opthalmic veins drain into ptergoid venous plexus

75
Q

what does a fundus image look like in a CRAO

A

central retinal artery supplies the inner 2/3 of the retina and therefore it gives a reduced blood supply and a pale retina

  • inner tissues have lost their blood supply- because cra has been blocked - becomes ischameic and pale which means you can see through to the choroid underneath

the red spot= the choroid

76
Q

what does a fundus image of a central retinal vein blockage

A

tortuous blood vessels

  • blockage of the central retinal vein - blocks the blood supply from flowing back out

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