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Hannah Neuro > craniofacial vasculature > Flashcards

craniofacial vasculature Flashcards

1
Q

what innervates the anterior and posterior meninges (not including the floor of the posterior cranial fossa)

A

opthalamic N. ( V1 branch off trigeminal)

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2
Q

what innervates the middle anterior meninges

A

maxillary N. (V2 )

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3
Q

the dura matter layer of the meninges forms two important anatomical and functional structures, what are they?

A
  1. dural venous sinuses (between fibrous layers of dura that drain blood from brain and scalp)
  2. cranial dural septa (membranous partitions from meningeal layer that separate specific parts of brain and add extra stabilization and support to the entire brain) * four of them
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4
Q

which meningeal layer is the strongest ? most fragile?

A
  1. dura matter
  2. pia matter
    * arachnoid is made of collagen and elastic fiber web
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5
Q

what foramen does the internal jugular vein leave from inside the skulll

A

jugular foramen

with CN 9, 10, 11 and inferior petrosal sinus

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6
Q

a tumor in the cavernous sinus can cause what

A

reverse blood flow in the sinuses

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7
Q

what are the 3 branches off the internal carotid A.

A
  • *does not branch until after passing cavernous sinus
    1. opthalamic A. (too eye)
    2. anterior cerebral A.
    3. middle cerebral A.
  • ** the two cerebral A.s are important in terms of the circle of Willis
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8
Q

what innervates the meninges on the floor of the posterior cranial fossa

A

C2 and C3 cervical spinal nerves

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9
Q

what is an epidural hematoma? what is a common way to get this?

A

a bleed above the dura matter
-a blow to the pterion part of the skull can fracture the bone and rupture the middle meningeal A. and cause an epidural hematoma

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10
Q

what are the terminal branches of the lingual A.

A

sublingual A. -sublingual gland and oral floor

deep lingual A. -base of tongue
*runs with lingual N.

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11
Q

what is syncope ? presyncope?

A

syncope: temporary loss of consciousness caused by a sudden drop in blood flow to the brain usually from a rapid fall in blood pressure
(“fainting” or “passing out” )

presyncope: feeling light headed, blurry vision, muscle weakness, “feeling faint” but not actually fainting

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12
Q

what veins drain from scalp to dural venous sinuses and what risk do they have

A

emissary veins

-can carry infection to the meninges and causes meningitis

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13
Q

how does CSF compare to blood plasma

A

CSF has:

  • more Na+, Ca2+, H+
  • less K+
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14
Q

what cranial dural septa overlies the pituitary and forms the cavernous sinus

A

diaphragm sellae

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15
Q

what Artery gives off zygomatic orbital A. and trasverse facial A. above and below the zygomatic arch

A

superficial temporal A.

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16
Q

what veins carry blood from the bone of the skull to the dural sinuses

A

diploic veins

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17
Q

where are the two main sites in the neck where the lymphatic pathways intersect?

A
  1. jugulofacial venous junction
    - where submental and submandibular LN drain into middle deep cervical
  2. jugulo-subclavian venous junction
    - where laryngeal and tracheal and thyroidal LN drain into inferior deep cervical before going into the thoracic duct
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18
Q

the superior cerebral vein drains into the ____sinus

A

superior sagittal sinus via bridging vein

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19
Q

what innervates the baroreceptors of the carotid sinus

A

CN 9 *glossopharyngeal

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20
Q

what are the 4 cervical branches off the facial A.? what are the facial branches off it?

A

cervical:
1. ascending palatine A. (soft palate)
2. tonsillar branch (palatine tonsil)
3. submandibular glandular branch (to submandibular gland) and 4. submental A. (gand and oral floor)

facial

  1. inferior labial A.
  2. superior labial A.
  3. lateral nasal A.
  4. angular A. (terminal branch)
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21
Q

T/F

dural venous sinuses are located inside the cranial dural septa

A

true

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22
Q

what supplies a lot of the rich blood supply to the nose

A
  1. the sphenopalatine A.
    (from the pterygoidpalatine part of the maxillary )
    *gives lateral posterior nasal arteries
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23
Q

what 4 small branches drain directly into the internal jugular vein

A
  1. pharyngeal veins
  2. superior thyroid vein
  3. middle thyroid vein
  4. occipital v.
    (POT)
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24
Q

what are the 2 fibrous layers of the tough membrane of the dura mater ? why are they important

A
  1. periosteal layer (external on bone adhered tightly)
  2. meningeal layer (internal on arachnoid mater)
    * usually adhered but separate to form dual venous sinuses
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25
Q

superficial temporal A. runs close to what nerve? what is that nerve carrying?

A

auriculotemporal N.

-carrying PNS from V3 (mandibular branch of trigeminal)

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26
Q

what innervates the lateral meninges

A

Mandibular N. (V3)

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27
Q

what artery stretches forward with rotation and stretching of the neck due to its relation with the transverse foramen of the c-spine ? why is this important?

A

the vertebral A.

-the artery can become intermittently occluded due to head rotation or extension and cause vertebrobasilar insufficiency

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28
Q

where does ascending palatine and descending palatine arteries originate from?

A
  • *they anastomose
    1. ascending comes from a branch off the facial A.
    2. descending comes from a branch of the pterygoidpalatine part of the maxillary A.
29
Q

what structures make up the cavernous sinus

A
  • in the medial cranial fossa between the sella turcica of the sphenoid bone
    1. sphenoid bone
    2. diapgrham sellae
30
Q

what two spaces surrounding the meninges are considered synonyms

A

subarachnoid space and subdural space

31
Q

what makes CSF

A

-secretions from the ependymal cells in the choroid plexus in each ventricle

32
Q

what are the important parts of the maxillary A.

A
  • *3 parts
    1. mandibular part
  • gives off middle meningeal A.
  • inferior alveolar A. to supply lower teeth, chin, mylohyoid M, mental area
    2. pterygoid part
  • buccal A. to the cheek
  • supplies muscles of mastication , pterygoid M, temporals M.
    3. pterygopalatine part
  • posterior superior alveolar A. , infraorbital A, descending palatine A., shenopalatine A.
  • out of the same named fossa
  • supplies upper teeth, nasal, and palate
33
Q

T/F the arachnoid granulations have valves to prevent back flow of CSF when moving it into the sinus

A

true

34
Q

what acts as a peripheral pump that aids venous return by pumping blood every time the mouth is open ?

A

the pterygoid plexus

-yawning (by the lateral pterygoid muscle) moves blood out and is triggered by venous stagnation

35
Q

what structures are located in the cavernous sinus that are bathed in venous blood

A
  1. CN 3,4,5,6
    (V1 and V2 of trigeminal N. )
  2. pituitary gland
  3. Internal carotid artery

oculomotor
trochlear
trigeminal
abducens

36
Q

what are the 3 additional sources of drainage into the sinus besides the venous blood from the brain

A
  1. scalp (emissary veins)
  2. skull bone (diploic veins)
  3. CSF (arachnoid granulations)
37
Q

what are the cranial meninges? and the 3 layers from superficial to deep ?

A
  • ***dense CT
  • separates soft tissue of brain from cranial bone
  • protects brain vasculature
  • holds/circulates CSF
  • forms venous drainage sinuses
  1. dura mater (on bone adhered tightly)
  2. arachnoid mater ( in middle)
  3. pia mater (on brain adhered tightly)
38
Q

If peripheral LN are only affected what does this tell you about the disease? what about LN located at the venous junctions?

A
  1. localized disease process

2. extensive disease process

39
Q

what are the 4 cranial dural septa

A
  1. falx cerebri (attaches to frontal crest of frontal bone and the crista galli of ethmoid bone)
  2. falx cerebelli
  3. diaphragm sellae (overlies the pituitary and forms the cavernous sinus)
  4. tentorium cerebelli (seperates cerebrum from cerebellum)

**DTF

40
Q

what is the arterial supply to the meninges

A
  1. middle meningeal artery (from maxillary A. off ECA)
    - gives off a anterior and posterior branch
  2. occipital A. (mastoid branch) (off ECA)
  3. vertebral A. (branches)

**VOM

41
Q

where does facial vein (and branches) drain?

A
  1. inferiorly into internal jugular vein

2. posteriorly into the cavernous sinus

42
Q

explain the tract of the inferior petrosal sinus

A

leaves the cavernous sinus, passes through jugular foramen, and enters the internal jugular vein below the superior bulb
(independent of sigmoid sinus)

43
Q

which nerve is most medial in the cavernous sinus closest to the internal carotid A. ? why is this important?

A

abducens (CN 6)

*makes it most susceptible to infections

44
Q

what are the 2 bulbs of the internal jugular vein? which one has a valve?

A
  1. superior bulb ( dilation near origin of vein )
  2. inferior bulb (dilation near termination of vein)
    * inferior bulb has a bicuspid valve
45
Q

where does CSF circulate ? and what is its function ?

A
  • in the subarachnoid (subdural) space
  • bathes exposed CNS
  • buoyancy
  • protection
  • environmental stability
46
Q

which vein passes posteriorly between the sphenomandibular L. and the neck of the mandible before joining another vein

A

maxillary V.

joins superficial temporal V.

47
Q

what is vertebrobasilar insufficiency ?

A
  • decreased posterior circulation because of intermittent vertebral A. occlusion
  • Causes: atherosclerosis, head rotation or extension
  • Symptoms: syncope, dizziness, vertigo, double vision, loss of vision, extremity numbness, slurred speech, nausea, vommitting, coordination loss
  • Risk factors: smoking, HTN, hyperlipidemia, T2DM, obesity, >50 y.o., familial history
48
Q

facial vein is formed by what to end terminal veins

A

the supraorbital and supratrochlear V. come together to make the angular vein–> deep facial V.–> facial vein which will drain into the internal jugular vein

  • communicates with the cavernous sinus via the superior/inferior opthalamic vein and its drainage into the pterygoid plexus which communicates with the deep facial V.
  • note the plexus usually drains into maxillary vein but it can drain into deep facial V.
49
Q

where and how does CSF drain

A

bc lower pressure in venous system, it will drain into the dural sinuses via the arachnoid granulations

50
Q

the 2 vertebral A.s come together to form what artery

A

basilar A.

to cerebellum

51
Q

which vein starts below the chin passes beneath the platysma to the suprasternal notch

A

anterior jugular Vein

drains into external jugular vein

52
Q

what artery runs under the digastric M. and is crossed by CN 12

A

lingual A..

53
Q

where do the anterior and posterior division of the retromandibular vein drain

A

anterior will join the facial vein and drain into the internal jugular vein
posterior will pierce the deep fascia and join the posterior auricular vein which come together to form the external jugular vein

54
Q

what is subclavian steal syndrome

A

**proximal stenosis or occlusion of the subclavian artery in which the blockage causes reverse blood flow of the vertebral A. on the affected side to deliver blood to the upper extremities (stealing it from the brain) and causing reduced blood flow to the brain

  • causes: atherosclerosis, cervical rib, anterior scalene hypertrophy (seen in athletes)
  • symptoms: presyncope, syncope, different blood pressures in upper extremities, neurologic deficits or memory problems
  • dx: doppler ultrasound
  • tx: stent and balloon angioplasty, endarterectomy (removing plaque from artery)
55
Q

what are the names of the dural venous sinuses located in the dural septa

A
  1. superior sagittal sinus (in falx cerebri)
  2. inferior sagittal sinus (in falx cerebri)
  3. straight sinus (found at folds of falx cerebri and tentorium cerebelli)
  4. transverse (in tentorium cerebelli)

SITS

56
Q

which LN. are important in terms of metasis of head and neck tumors

A

deep cervical lymph nodes in neck

*they are located along the internal jugular vein and facial V.

57
Q

which venous plexus sits in the infratemporal region ? where does it drain

A

pterygoid plexus

  • drains into the maxillary
  • can drain into deep facial V. if the maxillary is occluded
58
Q

internal jugular vein receives blood from the ___ , ___, and ___

A

brain
face
neck

59
Q

where does trasnverse cervical V. , supra scapular v drain ?

A

external jugular V. (to subclavian)

-PARTS
posterior auricular, retromandubular, anterior jugular, trasnverse cervical, supra scapular

60
Q

what artery runs under the digastric M. and then runs over CN 12

A

facial A.

61
Q

what nerves innervates all of the meninges (big picture)

A

trigeminal (V1 V2 and V3 branches )

Cervical spinal nerves C2 C3

62
Q

what two terminal veins form the retromandibular V.

A

the superficial temporal vein and the maxillary vein
-maxillary vein drains the pterygoid plexus and then into retromandibular which will split into an anterior and posterior division.

63
Q

what the pharyngeal veins drain and where do they drain

A

they drain the pharyngeal plexus on the outer surface of the pharynx
-end in the internal jugular vein

64
Q

T/F

cavernous sinus is paired

A

true

65
Q

what three branches come off the superior thyroid A>

A
  1. infra hyoid A.
  2. superior layrngeal A.
  3. SCM branch
66
Q

what is the arterial supply to the brain (big picture)

A

internal carotid A. and vertebral A.

67
Q

the confluence sinus directly drains what

A

the superior sagittal sinus and straight sinus

68
Q

what is the danger triangle

A

over the nose and upper lip

  • infection here can lead to an infection draining back into the cavernous sinus
  • don’t pop pimples here
69
Q

a thrombus of the cavernous sinus causes what

A
  • can block venous drainage, or cause reverse flow
  • can block internal carotid A. blood flow
    symptoms: fever, periorbital edema, chemosis (conjunctiva edema), cranial nerve palsy, decreased visual acuity, PNS deinnervation to constrict eye (can’t constrict eye) , cant turn eye laterally during H test because affected CN 6

Hannah Neuro (20 decks)

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