Lecture 3: Blood Supply, Hemorrhage, and Herniation Flashcards
What does the Long Circumferential Branches of Basilar Artery supply?
Lateral Pons
- Mesencephalic Nucleus and Tract
- Spinal Trigeminal Nucleus and Tract
- Facial Motor Nucleus
- Anterolateral System
Label this diagram.
What structures can be compressed in a tonsillar herniation?
Medulla: respiratory center
Upper cervical Spinal Cord
Where does blood supply to the posterior cerebrum come from?
Vertebral Artery
What structures are compressed in a transtentorial herniation?
Upper brainstem
CN III
Maybe Basilar Posterior Cerebral Arteries
What causes a subdural hematoma?
What does it look like on an x-ray?
- Bleeding of bridging veins most commonly seen in babies and the elderly
- Crescent shaped hematoma on side of brain
What supplies the lateral and medial geniculate bodies?
Thalamogeniculate Artery
From Posterior Cerebral Artery
What is the source of bleeding for an intracerebral/subpial hemorrhage?
Middle Cerebral Artery
What does the Posterior Spinal Artery supply?
Lower Medulla
- Gracile fasciculi and nuclei
- Cuneate fasciculi and nuclei
What brainstem structures does the Anterior Spinal Artery supply?
Medulla
- Hypoglossal Nucleus
- Medial Lemniscus (sensory tract)
- Pyramid (motor tract)
Done by sulcal arteries
What does the Middle Cerebral Artery supply?
Most of the lateral surface of frontal and parietal lobes and superior part of temporal lobe
Deals with lateral structures (e.g. arms)
What is vertebral basilar insufficiency?
What causes it?
Reduced blood flow from Vertebral Artery
- Extreme hyperextension of head
- Extreme head rotation (Bowhunter Syndrome)
What is Kernohan’s Phenomenon?
Uncal herniation that shifts the midbrain
Damage to CN III and cerebral peduncle on the other side so that all deficits are now on same side
Where do anterior choroidal arteries come from?
What do they supply?
Distal part of Internal Cartoid Artery
Supplies forebrain and midbrain:
- Choroid plexus of the lateral ventricle and third ventricle
- Optic chiasm and optic tract
- Internal capsule
- Lateral geniculate body
- Globus pallidus
- Tail of the caudate nucleus
- Hippocampus
- Amygdala
- Substantia Nigra
- Red Nucleus
- Crus Cerebri
Patient presenting with contralateral hemiplesia and ipsilateral CN III palsy most likely has a hernia where?
Uncus (and portions of parahippocampal gyrus)
Label the parts of the Internal Carotid Artery
What arteries is the posterior watershed area located between?
Middle Cerebral Artery
Posterior Cerebral Artery
Label the sections of the Vertebral Artery
What are the segments of the Middle Cerebral Artery?
- M1: Sphenoidal/Horizontal Segment
- ICA to bifurcation at insula
- M2: Insular Segment
- Bifurcation at insula to circular sulcus of insula
- M3: Opercular Segment
- Circular sulcus or insula to external surface of lateral fissure
- M4: Cortical Segment
- On Cortex
What supplies the superior and inferior colliculi?
Superior Colliculus: Quadrigeminal (from PCA) and Posterior Medial Choroidal Arteries (from PCA)
Inferior Colliculus: Quadrigeminal and Superior Cerebellar Arteries
Label the Circle of Willis
What causes an epidural hematoma?
What does it look like on an x-ray?
- Ruptured Middle Meningeal Artery: can be caused if hit at the pterion
- Lens shaped hematoma on side of brain