Craniofacial Vasculature Flashcards
1
Q
subclavian artery branches/parts
A
2
Q
subclavian steal syndrome:
- obstruction where?
- what does it lead to?
A
3
Q
First part of subclavian A
- vertebral A course
- ITA course
- Thyrocervical trunk and courses of its branches
- suprascapular course
- transverse cervical course
A
4
Q
Second part of subclavian:
branches
A
5
Q
Third part of subclavian A
branches, location
A
6
Q
Vertebral A
- blood supply to brain percentage
- terminates as what
- posterior circulation to what parts of brain
A
7
Q
Internal carotids supply how much blood?
- what is circle of willis?
- **autoregulation?- shunting from anterior to posterior
A
8
Q
Vertebro-basilar insufficiency:
- what is it
- causation
A
9
Q
Common carotid artery:
- where does right common begin?
- where does left common begin?
A
10
Q
Internal carotid artery:
- first branch
- within cranial vault the ICA branches into what
A
11
Q
External Carotid A
-8 branches
A
12
Q
terminating arteries of the ECA
A
superficial temporal and maxillary arteries
13
Q
Course of the superior thyroid artery, major branch
A
major branch is the superior laryngeal artery which pierces the thyrohyoid membrane along w/ internal laryngeal n
14
Q
Course of lingual artery, termination
A
initially located behind tip of hyoid, becomes the profunda lingual artery within substance of the tongue
15
Q
Facial artery:
- where originates, enters face
- branches and their courses
A
16
Q
parts of the maxillary artery
A
mandibular, pterygoid, sphenopalatine
17
Q
mandibular portion of the maxillary artery
- branches
- their courses, what they supply
A
18
Q
Study this
A
19
Q
region 2 of maxillary artery
A
20
Q
3rd part of maxillary artery:
- branches lateral to pteygomaxillary fissure
- branches within the sphenopalatine fossa
A
21
Q
Formation of retromandibular vein
-anastomoses between maxillary vein and cavernous venous sinus happens how?
A
22
Q
pterygoid plexus
-location, drains into what?
A
23
Q
tributaries of EJV
A
24
Q
IJV
- primarily drains what
- course
- at base of skull, what nerves are between IJV and internal carotid
A
25
Superior bulb of IJV vs inferior bulb
tributaries of IJV
26
Lymph nodes of head and neck:
-three groups and their locations
in fat\*
27
Thoracic duct:
- location
- where does it empty what junction?
28
right lymphatic duct:
-lymph coming from where?
empties where
29
Ventricular system:
-describe the general location of four ventricles, what theyre covered with, and where they drain into
30
Lateral Ventricles:
- location?
- lateral wall, floor
- what separates these two
- anterior horn location,body, posterior horn
-
31
Infterventricular foramen of monroe:
location
purpose
32
Third ventricle:
- location
- continuous with lateral ventricles how?
- continuous with fourth ventricle how?
33
Fourth ventricle:
- shaped like
- base (anterior wall) is?
- base is formed by what?
- how does it conect to cerebellomedullary cistern
- condition when central canal enlarges
34
CSF volume where made
35
Hydrocephaly:
- what is it
- signs symptoms
- kids vs adults
- what is sundown eyes/papilledema
- result of excess pressure
36
External hydrocephalus:
- where does CSF accumulate
- can be what types?
37
Internal hydrocephalus:
- communicating or not
- expansion of what?
- due to obstruction of what?
- results in dilation of ventricles in what location
38
Communicating hydrocephalus:
- what does that mean
- most common point of obstruction
- what does this result in
39
40
- normal rate of CBF flow
- what happens when it is 10-20
- luxury perfusion?
41
Watershed strokes
-describe
Watershed strokes occur from poor perfusion of regions that are susceptible to low flow states -- the areas of irrigation between typical vascular territories.
Vascular insufficiency within arterial borderzones produces borderzone infarcts (aka watershed strokes).
Patients with a watershed stroke between the anterior cerebral artery ACA and middle cerebral artery MCA develop weakness of their proximal arms and legs with preservation of hand and feet strength – they act like a “man in a barrel.”
From an anatomical perspective, the ACA supplies the medial one third of the superior cerebrum and the MCA supplies the lateral two thirds; the superior frontal sulcus separates the MCA and ACA supply.
The somatotopic sensorimotor area that corresponds to the borderzone between the MCA and ACA encodes the proximal arms and legs.
42
43
global ischemia:
- common causes
- leads to what type of infarct
- what cells are especially damaged, in what sector
44
Cerebral Artery courses:
- course of internal carotid and vertebral arteries, what space do they enter
- their branches penetrate into what
- what are the branches surrounded by?
45
Blood-brain barrier
- what makes it
- purpose
- absent in what parts of brain
- disease states that diminish it
46
Arteries of the Anterior circulation
Branches of the ICA
- first branch, supplies
- PCoA, supplies
- what supplies the choroid plexus
47
Anterior circulation
branches of the ica
-Anterior cerebral artery
location, potential anastomose, incidence of aneurysm, penetrating branches, communicating artery, cortical branches
48
80% of ischemic strokes happen in what area
-basal ganglia, internal capsule basal ganglia
49
Cortical distribution of ACA
-occlusion may lead to
The cortical branches of the ACA supply the anterior 2/3 of the medial side and
supero-lateral portion of the hemisphere. Branches of the ACA frequently supply the paracentral lobule region, and, therefore, occlusions may result in contralateral paresis and/or paraesthesia of the leg and foot.
50
MCA:
- continuation of what
- percent of aneurysms
- penetrating branches
- cortical branches (5)
51
Broca's aphasia
-result of thrombosis of what?
MCA, likely frontal branch
Thrombosis results in expressive or Broca's aphasia, a motor language disorder characterized by cryptic, telegraphic speech with a frustrating problem in initiation of speech motor patterns. Certain automatic, sometimes profane, speech patterns may persist. Evidence also suggests that "pure" Broca aphasic patients may demonstrate a subtle impairment of linguistic comprehension of certain complex speech patterns.
52
Wernicke's aphasia:
- what is it
- obstruction where
obstruction of MCA in dominant hemisphere
Obstruction of this artery in the dominant hemisphere may result in Wernicke's aphasia, a receptive language disorder. Although patients with Wernicke's aphasia are quite fluent (talkative), they lack content or meaning in their spoken and written comprehension of language. Their language pattern tends to circumlocute with numerous inappropriate word choices and neologisms (new word creations).
53
Posterior circulation:
Vertebral Artery
- ASpA location, supplies what
- what is central cord syndrome
54
Posterior spinal arteries:
- can be branches of what?
- course?
- supply?
The two posterior spinal arteries may be branches of either the vertebral or posterior inferior cerebellar arteries. They course in the postero-lateral sulci of each side, and supply the dorsal roots and about 75% of the posterior columns. These arteries along with the radicular arteries supply the peripheral margins of the cord. Anterior and posterior radicular arteries course with the ventral and dorsal rootlets, respectively. Segmental medullary arteries supply the spinal cord via small anterior and posterior radicular branches of the
ascending cervical, intercostal, and lumbar arteries.
55
Great anterior artery of adamkiewicz
- where does it arise, what does it contribute to?
- major supply to what?
- compromised due to what problems?
56
Ischemic necrosis of the spinal cord
57
PICA
- what is it, what does it supply
- thrombosis results in?
3. Posterior inferior cerebellar artery
The PICA supplies the posterior inferior portion of the cerebellum, the posterolateral aspect of the medulla, and the choroid plexus of the fourth ventricle.
The posterior spinal arteries may be branches of the PICA or VA. They course in the posterolateral sulci of each side, and supply the dorsal roots and about 75% of the posterior columns. These arteries along with the radicular arteries supply the peripheral margins of the cord.
Tabes dorsalis or tertiary neurosyphilis may include a meningovascular infection of these
arteries and their branches with a resultant irritation or destruction of the associated
neuroanatomical structures.
Clinically, displacement of the PICA on angiograms of the posterior cranial fossa may indicate the presence of a space-occupying mass such as a tumor. Thrombosis of the PICA results in
wallenberg syndrome
58
Basilar a
- termination of what
- % of aneurysm
- terminal branch of basilar a
- obstruction leads to
- part of circle of willis usually hypoplastic, why is this clinically problematic
59
Branches of Basilar A.
- PCoA located where?
- what is rostral terminal branch and where does it send its penetrating branches
- cortical branches of PCA
- uncal herniation
Superior cerebellar artery (SCA) is located immediately posterior to the III
nerve. It supplies the superior lateral portion of the cerebellum, the deep
cerebellar nuclei, and portions of the
pons and midbrain.
5. Anterior inferior cerebellar artery
(AICA) is located in the pontobulbar
sulcus next to the VI, VII and VIII
nerves, and the flocculus. It supplies
the anterior inferior portion of the
cerebellum, the superior and middle
cerebellar peduncles, and part of the
brainstem.
6. The labyrinthine artery, the chief artery to the internal ear, may be a branch of
the AICA or a separate branch of the basilar artery. Atherosclerosis or
inflammation of the labyrinthine artery may irritate the vestibulo-cochlear
apparatus (labyrinthinitis) and result in disturbances of equilibrium and/or
hearing.
7. Paramedian and lateral pontine branches supply the medial and lateral aspects of
the pons, respectively. In cross-sections of the brainstem, these branches
distribute to regions of the brainstem in a "pie wedge" pattern. This pattern of
distribution is the basis for the characteristic pattern of necrosis seen in certain
brainstem lesions.
60
know everything in red, asterisked, bold in this chart
61
62
Venous drainage of the spinal cord:
- veins of spinal cord empty into?
- where is this plexus located? and where does it emtpty into
63
Superficial venous drainage of the cerebral hemispheres
- which vein is most prominent? where is it located
- drains what parts of the brain and empties into what via what veins?
64
Deep venous drainage of cerebral hemispheres:
- 3 major veins and their tributaries
- obstruction of which vein is usually fatal? what does it form?
65
study this
66
Venous drainage of the brain:
dural venous sinuses:
- 3 of them
- what do they drain, where do they empty into
- thrombosis in which specific part of a sinus results in cortical ischemia/ necrosis
- thrombosis of what sinus/ part results in necrosis in deep cerebrum, usually death?
VI. Venous Drainage of the Brain A. Dural venous sinuses
1. The superior sagittal sinus is a large venous sinus that extends from the crista galli
to the confluens in the area of the attached border of the falx. It drains most of the
cerebral cortex, and in most cases, it empties into the right transverse sinus. Venous
lacunae are adjacent to the sinus and drain into the sinus along with the superior
cerebral veins.
2. The straight sinus is formed at the intersection of the falx and the tentorium. The
great cerebral vein of Galen drains vital deep structures of the cerebrum, and empties
into the straight sinus. Occlusion of either of these vessels is usually fatal. In most
cases the straight sinus drains into the left transverse sinus.
3. The confluens receives the superior sagittal, straight and occipital sinuses. It is
usually asymmetrical in its drainage pattern. In two-thirds of the cases the superior
sagittal sinus empties directly into the right transverse sinus, and the straight
sinus drains directly into the left transverse sinus.
Thrombosis of the posterior portion of the superior venous sinus or right transverse venous sinus results in cortical ischemia and/or necrosis.
Thrombosis of the posterior portion of the straight venous sinus or left transverse venous sinus results in ischemia and/or necrosis of structures in the deep cerebrum. This is usually fatal.
67
study this
68
69
70
meninges:
71
Herniations:
- Falx herniation and common presentation in ct
- Tentorial or Uncal Herniation, bleeding expands what space causing what to happen, why does consciousness begin to cease
- tonsillar herniation: seen with what type of malformation, space occupying masses where, where does the herniation go through? what other direction can they go
72
study this
73
Hematomas:
- epidural hematoma: fracture at what bone might rupture MMA? bleeding goes where? what type of herniation is likely to present
- what is papilledema
- Subdural hematomas: what veins are vulnerable to sheer force created during movement of brain vs dura? onset of symptoms?
74
subarachnoid hemorrhage:
- what is the subarachnoid space?
- what is sign of SA hemorrhage?
75
Trauma to midbrain:
- what can happen to the brainstem?
- result?
76
Circle of willis
mnemonic
components
C - Anterior communicating artery
A - Anterior cerebral arteries
I - Internal carotid arteries
C - Posterior communicating arteries
P - Posterior cerebral arteries
B - Basilar artery
S - Superior cerebellar arteries
P - Pontine arteries
A - Anterior inferior cerebellar arteries
V - Vertebral arteries
P - Posterior inferior cerebellar arteries
