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LQB389 > Intercranial Structures and Blood Vessels of the Head and Neck > Flashcards

Intercranial Structures and Blood Vessels of the Head and Neck Flashcards

1
Q

Cranial Bones

A

• Have a unique structure consisting of an outer and inner cortical table surrounding the diploe

  • Superior Cortical Layer – Outer Cortical Table
  • Deeper Cortical Layer – Inner cortical table
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2
Q

Meninges of the Brain

A

Dura Mater, Arachnoid Mater, Pia Mater

• Form a protective membranous layer

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3
Q

What does the Dura Mater form

A

• Dura mater forms passageways for venous blood to flow

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4
Q

Arachnoid Mater

A

o Consists of two differing parts

o Has protrusions called arachnoid villi that pass through the dura mater to enter the dural venous sinus (known as arachnoid granulation when calcified in older individuals)

o Does not go deep into all the sulci but rather forms a roof over each sulcus

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5
Q

Role of the Arachnoid Vili

A

o Arachnoid villi allows CSF to drain from the subarachnoid d space into the venous blood to be recycled

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6
Q

Pia Mater

A

o One cell layer thick and is invisible to the naked eye

o Attaches to the superficial surface of the brain and travels into all cerebral sulci

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7
Q

What are the Dural Reflections?

A
  • Falx Cerebri
  • Tentorium Cerebelli
  • Diaphragma Sellae
  • Falx Cerebelli
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8
Q

Falx Cerebri

A

o Located in the longitudinal fissure of the brain

o Separates the right and left cerebral hemispheres

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9
Q

Tentorium Cerebelli

A

o Separates cerebellum from occipital lobes of the cerebrum

o Forms a tent like structure over the cerebellum

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10
Q

Diaphragma Sellae

A

o Roof of sella turcicia
o Protects pituitary gland
o Fold of the dura mater

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11
Q

Falx Cerebelli

A

o Short reflection between cerebellar hemispheres

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12
Q

Significance of Dural Reflections

A

o Form passageways for venous blood to travel back to the heart

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13
Q

Superior Sagittal Sinus

A

o Travels within the longitudinal fissure to reach the confluence of the sinuses posterior to the brain

o Dural venous sinus

o Located within the superior border of the falx cerebri

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14
Q

Inferior Sagittal Sinus

A

o Located within the Falx Cerebri

o Joins with the Great Cerebral Vein to become the Straight sinus

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15
Q

Straight Sinus

A

o Travels within the falx cerebri and the tentorium cerebelli until it drains into the confluence of sinuses

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16
Q

Central Sulcus

A

o Indicates the central sulcus which separates the frontal and parietal lobes of the cerebrum

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17
Q

Lateral Fissure

A

o Separates the temporal lobe from the frontal and parietal lobes

o T-shaped appearance

o Deep to the lateral fissure is the 5th lobe of the cerebrum – the insular lobe

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18
Q

Parieto-occipital Sulcus

A

o Separates the parietal and occipital lobes

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19
Q

What does the Substantia Nigra Produce?

A

• Dopamine is produced and is associated with the function of the basal nuclei

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20
Q

Vermis

A

• The median segment of the cerebellum

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21
Q

Cerebellum

A
  • Consists of two cerebellar hemispheres
  • Surface is arranged into folia and fissures
  • Each side of the brainstem is attached to the ipsilateral cerebellar hemisphere and vermis by three paired cerebellar peduncles
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22
Q

Three Paired Cerebellar Peduncles

A

o Superior – connects midbrain and cerebellum

o Middle – connects pons and cerebrum

o Inferior – connects medulla oblongata and cerebellum

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23
Q

Function of the Cerebellar Peduncles

A

• Cerebellar peduncles allow information transfer between brainstem and cerebellum

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24
Q

What are ventricles?

A

• Ventricles are spaces within the brain

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25
Q

Where is CSF produced?

A

• CSF is produced within the choroid plexus of the ventricles of the brain

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26
Q

Ventricles within the Brain

A

Lateral Ventricle, 3rd Ventricle, Cerebral Aqueduct, 4th Ventricle

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27
Q

Location of the differing parts of the Lateral Ventricles

A
  • Anterior horn of the lateral ventricle – frontal lobe of cerebral hemisphere
  • Body of lateral ventricle – parietal lobe of cerebral hemispheres
  • Inferior horn of lateral ventricle – temporal lobe of cerebral hemisphere
  • Posterior horn of lateral ventricle – occipital lobe of cerebral hemisphere
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28
Q

Location of the 3rd Ventricle

A

Diencephalon

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29
Q

Location of the 4th Ventricle

A

Pons, medulla oblongata and cerebellum

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30
Q

Location of the Cerebral Aqueduct

A

Midbrain of Brainstem

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31
Q

Function of CSF

A
  • Protects brain from trauma

* Allows means of transport for nutrients and waste material

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32
Q

Choroid Plexus Location

A

• Choroid plexus located within the floor of the lateral ventricle, roof of the third ventricle and roof of the fourth ventricle

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33
Q

How much CSF is produced in a day?

A

600-700mL

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34
Q

Cilia role in CSF production

A

Cilia allow beating movement to move the CSF into the subarachnoid space

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35
Q

Flow of the CSF

A
  • CSF leaves the subarachnoid space via the arachnoid villi to the dural venous system for cycling
  • Lateral Ventricle -> flows through interventricular foramen (connect right and left lateral ventricles) -> flows the cerebral aqueduct and is located within the midbrain -> apertures allow CSF to flow out the ventricular system and into the subarachnoid space -> fills all the sulci covering the brain -> drains into the arachnoid villi (only lie within the midsagittal plane as they drain into the superior sagittal sinus)
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36
Q

Apertures

A

• Located at the inferior portion of the fourth ventricle

3 individual apertures
o Single median and two lateral apertures

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37
Q

What is a Cistern

A

• Regions in which there is dilation and CSF begins to pool

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38
Q

Cisterna Magna

A

o Largest Cistern

o Between the medulla oblongata and the inferior part of the cerebellum

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39
Q

Cistern of the Great Cerebral Vein

A

o Located superior to the cerebellum and posterior to the diencephalon

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40
Q

Prepontine (or pontine) Cistern

A

o Passageway anterior to the Pons

o Basilar artery lies here

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41
Q

Interpeduncular Cistern

A

o Lies anterior to the midbrain

o Space located between the two cerebral peduncles and the anterior parts of the midbrain

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42
Q

Chiasmatic Cistern

A

o Located around the optic chiasm

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43
Q

Paracallosal Cistern

A

o Located in the longitudinal fissure

o Between the boundary of the falx cerebri and the corpus callosum

o Parallel to the corpus callosum

44
Q

Gray Matter of the Brain

A
  • Nervous tissue contained cell bodies and synapses of the neurons
  • Grey is due to unmyelinated cell bodies
45
Q

Cerebral Cortex

A

o Forms superficial boundary of the cerebral hemisphere

o Follows all the sulci and gyri of the cerebral hemispheres

o Gyri and Sulci create convolutions in the brain to increase surface area of the cerebral cortex  increased number of neuronal cell bodies within the brain

46
Q

Basal Ganglia

A

Basal nuclei consist of a number of differing centres
 Lentiform nucleus - Lateral
 Caudate nucleus – Anterior

 Important role in motor control

47
Q

Caudate Nucleus

A
  • Comma shaped, curls around lentiform nucleus
  • Shape is the same at the lateral ventricle and lies within the floor
  • Head is anterior, Tail is posterior
48
Q

Thalamus

A

o Located medially in the diencephalon of the brain

o Medial to the lentiform nucleus

o Divided into a right and a left

Interthalamic Adhesion (joins the right and left thalami)

o 20% of the population is missing this (more prominent in males)

49
Q

Hypothalamus

A

o Hypothalamic sulcus

o Separates the hypothalamus and the thalamus

50
Q

Epithalamus

A

 Pineal Gland - Produces melatonin

51
Q

Internal Capsule

A

• An area of white matter located between the lentiform nucleus and caudate nucleus (anterior limb) and the lentiform nucleus and thalamus

52
Q

Corpus Callosum: Four Parts

A

o Rostrum – connection between frontal lobes

o Genu – connection between frontal lobes

o Body – connection between parietal lobes

o Splenium – connection between occipital lobes

53
Q

What is the Corticospinal Tract

A

• A bundle of motor neurons that course from the cerebral cortex of the precentral gyrus of the frontal lobe to the spinal cord to extend into the periphery
o Innervates skeletal muscles for voluntary muscle contraction

54
Q

• Pathway of Motor Neuron Cell Bodies and Axons

A

1) Cerebral cortex of right frontal lobe
2) Corona Radiata
3) Internal Capsule
4) Cerebral Peduncles
5) Pons
6) Decussation of Motor Fibres

55
Q

o Cerebral cortex of right frontal lobe

A

 Cell bodies of the motor neurons of the corticospinal tract arise here in the precentral gyrus of the frontal lobe of the brain

56
Q

o Corona Radiata

A

 White matter zone

 Myelinated axons of neurons course to and from the cerebral cortex

57
Q

o Cerebral peduncles

A

 Anterior columns of midbrain containing white matter

58
Q

o Decussation of Motor Fibres

A

 Motor neurons cross from the right side of the cerebrum to the left side of the spinal cord and vice versa here in the medulla oblongata

59
Q

Right Common Carotid Origin

A

arises as a terminal branch of the brachiocephalic trunk at the right sternoclavicular joint

60
Q

Left Common Carotid Origin

A

arises as a collateral branch of the aortic arch

61
Q

Left and Right Common Carotid Arteries Course and Termination

A

Ascend posterolateral to the trachea and larynx and terminally divide into the external and internal carotid arteries at the superior border of the thyroid cartilage.

Have no collateral branches

62
Q

Subclavian Artery Branches

A

o Major collateral branches include the vertebral and internal thoracic arteries

63
Q

Subclavian Artery Termination

A

o Terminate at the external margin of the 1st rib to become continuous with axillary arteries

o Major collateral branches include the vertebral and internal thoracic arteries

64
Q

Vertebral Artery Origin and Terminaton

A

o Arises as a collateral branch of the subclavian artery and terminates at the pontomedullary junction by uniting with the contralateral vertebral artery to form the basilar artery (supplying the brain)

65
Q

Course of the Vertebral Artery

A

o Travels through the transverse foramina of cervical vertebra C6 to C1

66
Q

Differing Parts of the Vertebral Artery

A

Cervical Part
 Before entering the small passageways within the vertebral column

Vertebral Part
 Enters passageways in the vertebrae from C6 to C1
 Small holes are known as transverse foramina (holes within the transverse processes)

Sub-occipital Part
 Lies directly underneath occipital bone before entering the foramen magnum

Intracranial Part
 Passes through the foramen magnum and enters the cranial space

67
Q

Internal Carotid Artery Origin and Termination

A

o Arises as a terminal branch of the common carotid artery at C3/C4 at the superior border of the thyroid cartilage and terminates by terminally branching into the anterior cerebral, middle cerebral and posterior communicating arteries (supplying the brain)

68
Q

Internal Carotid Artery Branch

A

o Has a single collateral branch in the head, the ophthalmic artery

69
Q

Internal Carotid Artery Differing Parts

A 
Neck Region (Cervical Part) 
Petrous Part 
Cavernous Part 
Cerebral Part
U-Bend
70
Q

Petrous Part of the Internal Carotid Artery

A

 Passes through the petrous part of the temporal bone

 Passes through a passageway known as the carotid canal

71
Q

Neck region of the internal carotid artery

A

 Travels with the Internal Jugular Vein in the carotid sheath

72
Q

Cavernous part of the internal carotid artery

A

 Following the carotid canal
 Passes through the cavernous venous sinus
 Continues passing through to the anterior part of the head

73
Q

Cerebral Part of the Internal Carotid Artery

A

 Terminal part which lies on the inferior surface of the brain with the terminal branches contributing to the blood supply of the brain

74
Q

U-Bend of the Internal Carotid Artery

A

 Formed by the distal part of the cavernous part and the proximal part of the cerebral part is called the carotid siphon

75
Q

Opthalmic Artery

A

o Arises from the carotid siphon in the cranial cavity and courses into the orbital cavity to supply blood to the eyeball

o Branches off between the cavernous and cerebral regions at the U bend

76
Q

Internal Jugular Vein Origin

A

o Arises as a continuation with the sigmoid sinus at the jugular foramen and terminates as a confluence with the subclavian vein to form the brachiocephalic vein

77
Q

Internal Jugualr Vein Location

A

o Lies superficial to the internal and common carotid arteries

78
Q

Subclavian Vein Course

A

o Continuous with the axillary vein at the lateral border of the 1st rib

79
Q

External Carotid Artery

A

o Lies anterior and superficial to the internal carotid artery, supplying blood to the face and extracranial structures

o Has many collateral branches in the neck (supplying the thyroid gland and all parts of the head except the brain and eyes

80
Q

Internal Carotid Artery Branches

A

o Has no branches within the neck (only a single collateral branch in the head – the ophthalmic artery

81
Q

Carotid Sinus

A

o Located in the most proximal part of the cervical part of the internal carotid artery

o Is a dilation containing baroreceptors in its walls to measure blood pressure

82
Q

Aortic Arch Variation

A
  • Variation in the aortic arch can occur during the development of the aorta
  • Typically, the arch consists of three collateral branches (brachiocephalic trunk, left common carotid, left subclavian arteries)
83
Q

Bovine Arch

A 
Bovine Arch (8-25%) 
o	One of the most common variations 
o	Brachiocephalic trunk and left common carotid share the same origin
84
Q

Middle Meningeal Arteries Origin

A

• Middle meningeal artery is a collateral branch of the maxillary artery of the external carotid artery

85
Q

Middle Meningeal Artery Course

A

• Enters the cranial cavity through the foramen spinosum

86
Q

Middle Meningeal Artery Branches

A

• At the pterion (cranial landmark), it divides into the anterior and posterior branches and supplies the cranial bones and dura

87
Q

Variation in Cerebral Arterial Circle

A

Only 20-30% of the population have a complete Cerebral arterial circle

Hypoplastic - small diameter or absence of the posterior communicating artery

Absence or small diameter of the anterior cerebral artery

Anterior communicating artery absent or narrowed

Most common - underdeveloped or absent posterior cerebral artery.

88
Q

Middle Cerebral Artery

A
  • Arises as a terminal branch of the internal carotid artery
  • Courses through the lateral fissure to supply blood to the lateral surfaces of the frontal, parietal and temporal lobes
89
Q

Posterior Cerebral Artery

A
  • Arises as a terminal branch of the basilar artery
  • Courses posteriorly around the midbrain to supply blood to the inferior surface of the temporal lobe and the entire occipital lobe
90
Q

Anterior Cerebral Artery

A
  • Arises as a terminal branch of the internal carotid artery
  • Courses into the longitudinal fissure between the corpus callosum and flax cerebri in the Paracallosal cistern to supply blood to the medial surfaces of the frontal and parietal lobes
91
Q

Dural Venous Sinus

A
  • Allow the drainage of blood from the brain

* Passageways running through two layers of the dura mater before exiting the cranial cavity

92
Q

Transverse sinus

A

Becomes continuous with the sigmoid sinus at the petrus part of the temporal bone

93
Q

Sigmoid Sinus

A

o S-shaped

o Travels more inferiorly across the petrus part of the temporal bone and becomes continuous with the internal jugular vein at the jugular foramen

94
Q

Flow in the Dural Venous Sinuses

A
  • SSS drains blood posteriorly to enter a dilation called the confluence of the sinuses
  • ISS drains posteriorly in the inferior border of the Falx Cerebri –> drains into the straight sinus
  • Great Cerebral vein forms confluence with ISS to form straight sinus –> Straight sinus joins the SSS at the confluence of the sinuses
  • Blood is diverted around the posterior cranial cavity by entering the R and L transverse sinuses which wrap around posteriorly on the occipital bone
95
Q

Cerebral Arterial Circle

A
  • Unique system of arteries located inferior to the brain and provides all blood supply to the brain
  • Arises from two major blood vessels – internal carotid arteries and vertebral arteries
96
Q

Cerebral Arterial Circle Flow

A
  • Vertebral arteries unite to form the basilar artery
  • Basilar artery terminally divides into the posterior cerebral artery (provides blood to the occipital lobe and the inferior surface of the brain)
  • Internal Carotid Arteries terminally divide into the anterior cerebral arteries, middle cerebral arteries and the posterior communicating arteries
  • Posterior Communicating Arteries connect to the posterior cerebral arteries to form an anastomoses around the optic chiasm
97
Q

Cerebral Arterial Circle: Anastamoses between PCOMA and Posterior Cerebral Arteries

A

o Allows for alternate routes of blood flow

o Neurons are postmitotic in adults  cannot proliferate  death is permanent

98
Q

Pathology in Cerebral Arterial Circle

A

o Narrowing or occlusion of blood vessel due to clot or plaque

99
Q

Anterior Communication Artery

A

Connects between two paired anterior cerebral arteries and completes the cerebral arterial circle

100
Q

What is Hydrocephalus?

A

An abnormal build up of fluid in the ventricles (cavities) deep within the brain

101
Q

What can cause hydrocephalus and what can it lead to?

A
  • Overproduction of CSF, obstruction of flow, interference with absorption –> excess of CSF in the ventricles
  • Excess CSF –> dilates ventricles, thinning the surrounding brain. In infants, this can separate the bones of the skull.
102
Q

Obstructive Hydrocephalus

A

Obstruction of cerebral aqueduct, interventricular foramen, apertures

103
Q

Communicating Hydrocephalus

A

Obstruction outside the ventricular system (subarachnoid space or arachnoid villi)

104
Q

What are the consequences of increased pressure on the brain?

A

Atrophy of cells - depends on the age of the individual

Adult - Permanent, lack of mitotic capacity
Neonate - Some regenerative capacity

105
Q

What are the consequences of increase pressure on the skull?

A

May occlude blood vessels/sinuses

Expansion of sutures in young children –> enlargement of cranial cavity

106
Q

Treatment Options for Hydrocephalus

A

Shunting of CSF through surgical introduction of shunt - provide an alternative route
(usually from ventricle or subarachnoid space to abdominal cavity or heart)

LQB389 (13 decks)

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