Lectures - Day 2

Question 1

Methods of cerebrovascular imaging

Answer 1

Transfemoral catheter angiogram
Contrast-enhanced CT thorax
MR angiogram with contrast agent

Question 2

Branches of the Aortic arch

Answer 2

Brachiocephalic trunk
Left common carotid artery
Left Subclavian artery
Left vertebral artery

Question 3

What does Brachiocephalic trunk divide into

Answer 3

Right common carotid

Right subclavian

Question 4

At what level do the common carotid arteries bifurcate

Answer 4

C3-C4

Question 5

Do the common carotid arteries have any branches

Answer 5

No

Question 6

Different parts of internal carotid arteries

Answer 6

Cervical (neck segment)
Petrous
Cavernous
Supraclinoid (intradural)

Question 7

Where is the cervical ICA in relation to internal jugular vein and ECA

Answer 7

Anterior and medial to internal jugular vein

Lies posterior and lateral to ECA at origin; ascends behind and medial to ECA

Question 8

Does the cervical ICA have any narrowings/dilations/branches

Answer 8

No

Question 9

Describe path of petrous ICA

Answer 9

Penetrates temporal bone and runs anteromedially in the carotid canal

Question 10

Does the petrous ICA have any branches

Answer 10

Small branch to middle/inner ear

Vidiam artery may connect to ECA

Question 11

Describe path of cavernous ICA

Answer 11

Turns superiorly at foramen lacerum
Enters cavernous sinus
Pierces dura at level of anterior clinoid process

Question 12

Does the cavernous ICA have any branches

Answer 12

Small branches supply dura, cranial nerves 3-6 and posterior

Meningo-hypophyseal artery; Inferolateral trunk (ILT); potential small connections with ECA via ILT

Question 13

Branches of the supraclinoid ICA

Answer 13

Ophthalmic artery
Superior hypophyseal
Posterior communicating artery
Anterior choroidal artery

Question 14

What does superior hypophyseal artery supply

Answer 14

Pituitary gland, stalk, hypothalamus and optic chiasm

Question 15

Whta does the anterior choroidal artery supply

Answer 15

Choroid plexus. Optic tract, Cerebral peduncle, Internal capsule, Medial temporal lobe

Question 16

WHat structures form the Lentiform nucleus

Answer 16

Putamen

Globus pallidus

Question 17

Describe anatomical path of middle cerebral artery

Answer 17

M1 - runs laterally to limen insulae (lateral lenticulostriate branches)
M2: runs in insular cistern
M3: emerge onto the brain surface
M4: vessels on the brain surface

Question 18

What is the larger of the 2 terminal ICA branches

Answer 18

Middle cerebral artery

Question 19

What do the lateral lenticulostriate arteries supply (M1 of MCA)

Answer 19

Lentiform nucleus
Caudate nucleus
Internal capsule

Question 20

What is the smaller of the 2 terminal ICA branches

Answer 20

Anterior cerebral artery

Question 21

Describe sections of anterior cerebral artery

Answer 21

A1: runs medially to connect with contralateral ACA via anterior communicating artery (medial lenticulostriate arteries supply head of caudate nucleus and internal capsule)
A2: runs in interhemispheric fissure to genu of corpus callosum (Recurrent artery of Heubner) and 2 cortical branches
A3: cortical branches from callosomarginal and pericallosal arteries

Question 22

Where do the vertebral arteries arise from

Answer 22

Subclavian arteries

left vertebral artery usually>right

Question 23

Describe anatomical pathway of the extracranial vertebral arteries

Answer 23

Enter foramina transversarium at C6
Turn laterally at C2
Loop posteriorly at C1
Through foramen magnum anterolateral to medulla

Question 24

What do branches of the Extracranial Vertebral arteries supply

Answer 24

Neck muscles
Spinal meninges (cervical spine)
Spinal cord (cervical cord)
Anastomoses with other neck vessels (external carotid branches)

Question 25

Branches of Intracranial vertebral artery

Answer 25

Anterior spinal artery
Small medullary perforators
Posterior inferior cerebellar artery (PICA)

Question 26

What does the Posterior Inferior Cerebellar artery supply

Answer 26

Medulla

Inferior cerebellum

Question 27

What do the vertebral arteries fuse to form

Answer 27

Basilar artery

Question 28

Describe anatomical location of the Basilar artery

Answer 28

Runs anterior to pons

Question 29

Branches of basilar artery

Answer 29

Multiple perforating arteries to brain stem (pontine?)
Bilateral anterior inferior cerebellar arteries
Bilateral superior inferior cerebellar arteries

Question 30

What does anterior inferior cerebellar arteries supply

Answer 30

Cerebellum

CNs 7 and 8

Question 31

What arteries arise from the terminal bifurcation of the basilar artery

Answer 31

Posterior cerebral arteries

Question 32

What does the posterior cerebral arteries supply

Answer 32

Thalamus
Geniculate bodies
Cerebral peduncles
Tectum
Visual cortex and occipital lobe
(PCAs partially encircle the midbrain)

Question 33

What do the medial and lateral posterior choroidal arteries supply

Answer 33

Tectum
Thalamus
Choroid of the 3rd and lateral ventricles

Question 34

Where does the posterior cerebral artery anastomose with the middle cerebral artery

Answer 34

Inferior temporal lobe

Question 35

Where does the posterior cerebral artery anastomose with the anterior cerebral artery

Answer 35

Posterior third of interhemispheric surface

Question 36

**Important acute stroke imaging questions

Answer 36

Is there bleeding? 
Yes. Has a blood vessel ruptured ? 
No. Is a blood vessel blocked ?
Is the blood supply reduced? 
Is the brain tissue injured?

Question 37

Important questions in non-acute or intermittent ischaemic stroke

Answer 37

Is there brain injury?
Are the blood vessels normal?
Is the brain starved of blood?