Lectures - Day 2 Flashcards
Methods of cerebrovascular imaging
Transfemoral catheter angiogram
Contrast-enhanced CT thorax
MR angiogram with contrast agent
Branches of the Aortic arch
Brachiocephalic trunk
Left common carotid artery
Left Subclavian artery
Left vertebral artery
What does Brachiocephalic trunk divide into
Right common carotid
Right subclavian
At what level do the common carotid arteries bifurcate
C3-C4
Do the common carotid arteries have any branches
No
Different parts of internal carotid arteries
Cervical (neck segment)
Petrous
Cavernous
Supraclinoid (intradural)
Where is the cervical ICA in relation to internal jugular vein and ECA
Anterior and medial to internal jugular vein
Lies posterior and lateral to ECA at origin; ascends behind and medial to ECA
Does the cervical ICA have any narrowings/dilations/branches
No
Describe path of petrous ICA
Penetrates temporal bone and runs anteromedially in the carotid canal
Does the petrous ICA have any branches
Small branch to middle/inner ear
Vidiam artery may connect to ECA
Describe path of cavernous ICA
Turns superiorly at foramen lacerum
Enters cavernous sinus
Pierces dura at level of anterior clinoid process
Does the cavernous ICA have any branches
Small branches supply dura, cranial nerves 3-6 and posterior
Meningo-hypophyseal artery; Inferolateral trunk (ILT); potential small connections with ECA via ILT
Branches of the supraclinoid ICA
Ophthalmic artery
Superior hypophyseal
Posterior communicating artery
Anterior choroidal artery
What does superior hypophyseal artery supply
Pituitary gland, stalk, hypothalamus and optic chiasm
Whta does the anterior choroidal artery supply
Choroid plexus. Optic tract, Cerebral peduncle, Internal capsule, Medial temporal lobe
WHat structures form the Lentiform nucleus
Putamen
Globus pallidus
Describe anatomical path of middle cerebral artery
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
What is the larger of the 2 terminal ICA branches
Middle cerebral artery
What do the lateral lenticulostriate arteries supply (M1 of MCA)
Lentiform nucleus
Caudate nucleus
Internal capsule
What is the smaller of the 2 terminal ICA branches
Anterior cerebral artery
Describe sections of anterior cerebral artery
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
Where do the vertebral arteries arise from
Subclavian arteries
left vertebral artery usually>right
Describe anatomical pathway of the extracranial vertebral arteries
Enter foramina transversarium at C6
Turn laterally at C2
Loop posteriorly at C1
Through foramen magnum anterolateral to medulla
What do branches of the Extracranial Vertebral arteries supply
Neck muscles Spinal meninges (cervical spine) Spinal cord (cervical cord) Anastomoses with other neck vessels (external carotid branches)
Branches of Intracranial vertebral artery
Anterior spinal artery
Small medullary perforators
Posterior inferior cerebellar artery (PICA)
What does the Posterior Inferior Cerebellar artery supply
Medulla
Inferior cerebellum
What do the vertebral arteries fuse to form
Basilar artery
Describe anatomical location of the Basilar artery
Runs anterior to pons
Branches of basilar artery
Multiple perforating arteries to brain stem (pontine?)
Bilateral anterior inferior cerebellar arteries
Bilateral superior inferior cerebellar arteries
What does anterior inferior cerebellar arteries supply
Cerebellum
CNs 7 and 8
What arteries arise from the terminal bifurcation of the basilar artery
Posterior cerebral arteries
What does the posterior cerebral arteries supply
Thalamus Geniculate bodies Cerebral peduncles Tectum Visual cortex and occipital lobe (PCAs partially encircle the midbrain)
What do the medial and lateral posterior choroidal arteries supply
Tectum
Thalamus
Choroid of the 3rd and lateral ventricles
Where does the posterior cerebral artery anastomose with the middle cerebral artery
Inferior temporal lobe
Where does the posterior cerebral artery anastomose with the anterior cerebral artery
Posterior third of interhemispheric surface
**Important acute stroke imaging questions
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?
Important questions in non-acute or intermittent ischaemic stroke
Is there brain injury?
Are the blood vessels normal?
Is the brain starved of blood?
