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Brain Blood Supply and Venous Drainage Flashcards

1
Q

What bones does the skull consist of?

A
  • cranium
  • facial skeleton
  • mandible
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2
Q

What is the cranium?

A

bony container for the brain

made up on the skull base and vault (calvaria)

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3
Q

What is the calvaria made up of?

A

several bones which give their names to the underlying loves of cerebral hemispheres

  • parietal
  • frontal
  • occipital
  • temporal

these bones unite at relative immobile fibrous joints called sutures

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4
Q

What does the frontal bone help define the structure of?

A
  • forehead prominence
  • bridge of nose
  • roof of orbits
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5
Q

What is the majority of the side wall of the cranial vault made up of?

A

coronal suture: joining of the frontal bone with 2x parietal bones

join in the midline at the saggital suture

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6
Q

What makes up the posterior part of the cranium?

A

occipital bone

also contributes to the skull base

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7
Q

What are the different portions of the temporal bone?

A

[complex 3D shape]

  • squamous
  • petrous
  • zygomatic
  • mastoid
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8
Q

What important structures are contained within the petrous portion of the temporal bone?

A

petrous is pyramid shaped

[base faces laterally, apex directed anteromedially]

  • inner ear
  • facial nerve
  • internal carotid artery
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9
Q

Where is the sphenoid bone located?

A

at interval between the facial skeleton (anteriorly) and cranium (posteriorly)

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10
Q

What are the aspects of the sphenoid bone structure?

A

CENTRAL REGION
“body”
contains pituitary gland

TWO WINGS of sphenoid
on each side of the body

DEEP CLEFT
wings are separated by this the “superior orbital fissure”

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11
Q

What does the skull base contain?

A

3 broad recesses (fossae):

  • cranial fossae (lie at progressively lower levels)
  • anterior fossa (highest)
  • posterior fossa (lowest)

these accept the inferior surface of the brain

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12
Q

What is the anterior cranial fossa?

A

overlies orbital and nasal cavities

consists of the orbital plate of frontal bone (LATERALLY)
and
cribriform plate of themoid bone (MEDIALLY)

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13
Q

What does the cribriform plate contain?

A

multiple openings that transmit the fascicles of the olfactory nerve (CN I) from the mucosa of upper nasal cavity

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14
Q

Where does the middle cranial fossa lie?

A

between the sphenoid ridge (anteriorly) and the petrous ridge (posteriorly)

located either side of the pituitary region

contains important skyll base foraminae

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15
Q

Where does the pituitary gland lie?

A

central within the pituitary fossa in the body of the sphenoid bone

contained within the anterior and posterior clinoid structures

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16
Q

What does the posterior fossa contain?

A
  • brain stem
  • cerebellum

below the tentorium cerebelli

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17
Q

Where is the brain stem said to be continuous with the spinal cord?

A

at the level of the foramen magnum

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18
Q

What is the majority of the cerebral hemisphere supplied by?

A

internal carotid artery

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19
Q

Where does the internal carotid artery arise?

A

in the neck at ~ upper border of the thyroid cartilage

from bifurcation of the common carotid artery

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20
Q

What are the 4 portions of the internal carotid artery?

A
  • cervical
  • petrous
  • cavernous
  • supraclinoid
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21
Q

Where does the cervical portion of the internal carotid artery terminate?

A

as it enters the skull base via the carotid canal

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22
Q

Where is the carotid canal located?

A

in the pyramid-shaped petrous portion of the temporal bone

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23
Q

What is the course of the internal carotid as it enter the skull?

A

runs anteriorly and medially within the petrous bone until it reaches the foramen lacerum

internal carotid occupies the superior portion of the foramen lacerum, inferior portion is occupied by soft tissue

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24
Q

What is the appearance of the foramen lacerum in the skull?

A

jagged or torn appearance

[lacerum = tear (in latin)]

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25
Where does the internal carotid go after it leaves via the foramen lacerum?
passes through a bony groovy to enter the cavernous sinus
26
Where does the cavernous portion of the internal carotid run?
runs forward with the wall of the sinus with the abducens nerve lateral to it then the internal carotid turns upwards, medial to the anterior clinoid process to enter the subarachnoid space
27
What is the course of the supraclinoid internal carotid artery?
supraclinoid is the terminal portion of the internal carotid turns posteriorly forming the "carotid siphon" then it passes lateral to become the 'middle cerebral artery'
28
What is the "carotid siphon"?
hair pin bend of supraclinoid portion of the internal carotid artery can be seen on angiography
29
Where does the middle cerebral artery emerge?
from the lateral sulcus branches to supply much of the hemisphere
30
What are the main cortical branched to the internal carotid artery?
- middle cerebral artery | - anterior cerebral artery
31
What are the various portions of the middle cerebral artery?
bifurcates into the upper and lower divisions within the lateral sulcus [this overlays the insular complexes]
32
What are the main areas that the middle cerebral artery supplies?
gives off branches to the frontal, parietal and temporal lobes and supplies most of the hemisphere convex surface, inc: - primary motor and sensory areas of face and upper extremity - main cortical language areas in frontal + temporal lobes
33
What are the 2 main cortical language areas called?
BROCA AREA located in frontal lobe on usually LHS involved in speech production WERNICKE'S AREA located surrounding the auditory cortex of the lateral sulcus comprehension of written/spoken language
34
What is the structure of the anterior cerebral artery?
much smaller than the middle cerebral artery receives only 20% of the internal carotid blood flow
35
Where is the middle cerebral artery located?
wraps around the genu and body of the corpus callosum passes as far back as the parieto-occipital sulcus
36
Where does the anterior cerebral artery give off its branches? What do they supply?
as it encircle the corpus callosum, it becomes the pericallosal artery cortical branches supply - medial surface of frontal and parietal lobes [- inc: motor and sensory areas of the lower limbs and genitalia]
37
Where does the posterior circulation (to the brain) derive from?
from the paired vertebral arteries (branches of subclavian) these ascend the neck nay passing through the transverse foramina in the upper six cervical vertebrae
38
What is the course of the vertebral artery as it passes the atlas (C1)?
winds around the lateral mass of the atlas then pierces the atlanto-occipital membrane then passes through the foramen magnum to enter the subarachnoid space
39
Where do the 2 vertebral arteries unite?
in front of the brain stem at the junction of the pons and medulla => form the (unpaired) basilar artery
40
What does the basilar artery occupy?
basilar groove of the pons | lies between the brain stem and the sloping clivus of the skull base
41
What is the course of the basilar artery?
runs superiorly to the upper border of the pons then divides into the 2 posterior cerebral arteries (terminal branches) these vessels wind around the midbrain and then pass posteriorly (above the tentorium cerebelli) to supply: - occipital lobe - ventral surface of temporal lobe
42
What is the circle of Willis?
circulus arteriosus formed by combo of three communicating vessels formed at the base of the brain example of a "collateral circulation" - helps to maintain circulation in the event of a vascular obstruction
43
In what proportion of people, is there an incomplete circle of Willis?
<50% therefore the collateral circulation will be ineffective
44
What is the structure of the circle of Willis?
anterior communicating artery (only 2-3mm) connects the left and right anterior cerebral arteries posterior communicating arteries: extend from the internal carotid anteriorly to the posterior cerebral artery posteriorly
45
In what proportion of people is the anterior cerebral artery absence or very narrow?
<10% in these cases, the medial parts of the frontal and parietal lobes are supplied by a single anterior cerebral artery and an abnormally large anterior communicating artery
46
What do the deep cerebral veins drain?
the hemispheric grey and white matter
47
Where do the superficial and deep cerebral veins drain?
into the dural venous sinuses
48
What are the dural sinuses?
large, endothelium-lined vascular channels similar to veins, but lack valves found at the free and attached margins of the dural partitions return venous blood to the superior vena cava and right atrium
49
What do the dural venous sinuses include?
SUPERIOR SAGGITAL SINUS runs along attached margins the falx cerebri INFERIOR SAGGITAL SINUS runs along g the free edge of falx cerebri STRAIGHT SINUS found at junction of the falx cerebri and tentorium cerebelli TRANSVERSE SINUSES located along the attached margin of the tentorium SIGMOID SINUS drains from the transverse sinus into the internal jugular vein CAVERNOUS SINUS lateral to body of the sphenoid bone
50
What is the confluence of the sinuses?
where the superior, straight and transverse sinuses meet
51
Where does the superficial drainage system converge?
on the superior saggital sinus, which usually drains into the right transverse sinus
52
Where does the deep drainage system drain?
into the straight sinus and left transverse sinus
53
Where does the cavernous sinus sit?
on either side of the body of the sphenoid bone
54
Why is the cavernous sinus of clinical importance?
contains the - internal carotid artery - abducens nerve (in its medial wall) - cranial nerves III, IV, V1, V2 (in its lateral wall)
55
What is a "cavernous sinus syndrome"?
involves all or some of the structures contained with the cavernous sinus pathologies: thrombosis aneurysm, tumour infiltration etc
56
Where does the middle meningeal artery enter?
enters skull via the foramen spinousum (adjacent to foramen ovale) branches over inner surface of the cranial vault supplies the skull and dura mater
57
Why is the middle meningeal artery described as extradural?
it lies in a plane between the dura mater and the skull bone
58
What is the clinical significance of part of the middle meningeal artery running beneath the pterion in the temporal region?
one of the thinnest parts of the skull therefore, a modest impact here can fracture the skull bone And damage the underlying artery (= EXTRADURAL HAEMORRHAGE) blood escapes under arterial pressure, which can strip the dura from the bone, expanding the haematoma and eventually causes brain compression
59
What is the typical clinical presentation of an extradural haemorrhage?
follows a lateral impact to the head - brief LoC - period of confusion - nausea and memory disturbance (= concussion) - then 'lucid interval' - rapid deterioration which may rapidly end in death - raise ICP and brain shift/internal herniation "talk and die syndrome"
60
What supplies the deep structures of the brain (eg/ basal ganglia, thalamus and subcortical white matter)?
central perforating arteries arise from the circle of Willis arranged into anterior and posterior groups
61
Were does the anterior group of central perforating arteries enter the brain?
via the anterior perforated area just lateral to the optic chiasm (on each side) can be further divided into the medial and lateral subgroups: - medial - lateral lenticulostriate arteries
62
Why are the lateral lenticulostriate arteries referred as the "arteries of brain haemorrhage"?
60% of spontaneous intracerebral haemorrhages occur in deep structures supplied by these vessels esp. the putamen (basal ganglia)
63
How are the posterior group of the central perforating vessels arranged?
into medial and lateral groups MEDIAL entry brain via the posterior perforated area
64
Where is the posterior perforated area located?
lies between the cerebral peduncles of the midbrain supplies the anteromedial thalamus
65
What is the posterior and lateral thalamus supplied by?
the posterolateral group of the central perforating vessels
66
What is the grouping system for the vessels that supply the brain stem and cerebellum?
- paramedian - short circumferential - long circumferential
67
Where do the paramedian vessels arise?
close to the midline e.g. posterior aspect of the basilar artery then they pass directly backwards through the full thickness of the brain stem to reach the ventricular floor supply a rectangular-shaped block of tissue on either side of the midline
68
What is the course of the short and long circumferential vessels?
pass laterally around the circumference of the brain stem e.g. arising from the lateral aspect of the basilar artery supply a wedge-shaped area of the midbrain, pons or medulla
69
What are the 3 long circumferential vessels that supply the postero-lateral parts of the brain stem and various parts of the cerebellum?
SUPERIOR CEREBELLAR ARTERY arises from basilar artery supplies the superior cerebellum ANTERIOR INFERIOR CEREBELLAR ARTERY usually arises from the lowermost part of the basilar artery supplies the anterior inferior cerebellum POSTERIOR INFERIOR CEREBELLAR ARTERY usually a branch of the vertebral artery supplies the lateral part of medulla and posterior inferior cerebellum
70
What other branches do the vertebral arteries give rise to?
- single anterior spinal artery | - two posterior spinal arteries
71
What is the course of the anterior spinal artery?
runs along the ventral median fissure of the medulla and spinal cord supplies the anterior 2/3 of cord (including the anterior horns and antero-lateral columns)
72
What do the anterior and lateral columns of the spinal cord contain?
- spinothalamic | - corticospinal tracts
73
Where do the posterior spinal arteries sit?
they occupy the postero-lateral portions of the spinal cord

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