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Vascular Anatomy of CNS Flashcards

1
Q

what is the source of bs of the brain

A

2 internal carotid arteries and 2 vertebral arteries

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1
Q

how is the circle of Willis formed

A

mag aanastomose yung branches ng ICA and VA

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2
Q

where does the ICA originate

A

from the bifurcation of the common carotid artery

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3
Q

where does the ICA enter the skull

A

via carotid canal

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4
Q

from its origin sa common carotid the ICA will ascend in ________

A

ascend in front of transverse process of upper 3 cervical vertebrae

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5
Q

after entering the skull. the ICA runs ________

A

then runs horizontall w/in cavernous sinus

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6
Q

after the cavernous sinus the ICA will _____

A

pierce the dura to begin the its subarachnoid course

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7
Q

after it pierces the dura the ICA then ______

A

turns post medial to lateral sulcus where it divides into the ACA and MCA

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8
Q

what is the carotid siphon

A

intracavernous and cerebral segments bcs of the S-shaped configuration

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8
Q

in the cavernous sinus the ICA lies close to _______

A

middle wall adjacent to CN VI

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9
Q

what are the branches of the cerebral portion of the ICA

A

ophthalmic
anterior choroidal
anterior cerebral
middle cerebral
posterior communicating

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9
Q

discuss the path of the ophthalmic artery

A

branches from ICA sa cavernous sinus

tas enters the orbit through optic canal below and lateral the optic nerve

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10
Q

what does the ophthalmic artery supply

A

optic nerve and gives rise to central artery of the retina

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11
Q

what does the terminal branches of the ophthalmic artery supp

A

frontal area of scalp, ethmoid and frontal sinuses and dorsum of the noise

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12
Q

discuss the origin of the anterior choroidal artery

A

emerges after ICA enters cavernous sinus and will pass ventral to the optic tract

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13
Q

what does the anterior choroidal artery supply

A

optic tract
cerebral peduncles
LGB
posterior limb of the internal capsule
tail of the caudate
uncus
amygdala
anterior hippocampus
choroid plexus of the temporal horn
sometimes the globus pallidus

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13
Q

discuss the origin of the ACA

A

originates from the ICA lateral to the optic chiasm

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14
Q

after passing the optic chiasm the ACA will ______

A

course dorsal sa optic nerve to reach inter hemispheric fissure

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14
Q

after reaching the inter hemispheric fissure the ACA will _______

A

curve around the corpus callosum and will continue as the pericallosal artery

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15
Q

what joints the 2 ACAs

A

as the 2 ACAs approach the interhemispheric fissure they are joined by the Acomm

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16
Q

what does the cortical branches of the ACA supply

A

entire medial surface of cortex until parieto-occipital sulcus and strip of cortex sa anterior lateral part

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16
Q

it is the main branch of the ICA

A

middle cerebral artery

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16
Q

what does the central branches of the ACA supply

A

pierces anterior perforated substance and helps supp parts of lentiform. caudate nuclei and internal capsule

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17
Q

what are the 4 segments of the MCA

A

M1 - sphenoidal
M2 - insular
M3 - opercular
M4 - cortical

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18
Q

where is the M1 - sphenoidal segment

A

posterior and parallel to sphenoid ridge

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19
Q

where is the M2 - insular segment

A

sa insula

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19
Q

where is the M3 - opercular segment

A

courses over frontal, parietal and temporal opercula

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19
Q

where is the M4 - cortical segment

A

spreads over the cortical surface

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19
Q

the MCA courses within the _____

A

sylvian fissure

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20
Q

what does the MCA supply

A

limited to the inferior margin of cerebral hemisphere and the inferior surfaces of frontal and temporal lobes

basta gitna ng lateral part

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21
Q

what does the cortical branch supply

A

entire lateral surface of hemisphere

except anterior strip kasi sa ACA yun, occipital pole and inferolat nun bcs sa PCA yun

entire motor area excepts sa legs

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22
Q

where dose the Pcomm come from

A

runs post above the oculomotor nerve to join the PCA

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22
Q

what does the Pcomm connect

A

ICA w PCA

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22
Q

what does the PComm supply

A

genu and anterior part of the
posterior limb of the internal capsule

anterior part of the thalamus

parts of the hypothalamus and subthalamus.

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23
Q

where does the vertebral artery come from

A

arises from the subclavian artery

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24
Q

the VA ascends with in the _____

A

foramina of the transverse
processes of the upper 6 vertical vertebrae

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25
Q

after ascending the VA (intraosseous seg) will ______ and will form the _____

A

intraosseous segment will curve backward around the lateral mass of atlas

and form atlantoaxial segment

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26
Q

after the atlas the VA will _____

A

enter cranium via foramen magnum

forming intracranial segment

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27
Q

where does the VA lie w/in the cranium

A

lie on inferior surface of medulla

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28
Q

what is formed when 2 VAs join

A

joined at caudal end of pons to form basilar artery

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29
Q

what are the branches of the VA

A

posterior spinal
anterior spinal
posterior inferior cerebella
meningeal branches

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29
Q

what does the meningeal branches supply

A

supply meninges of the posterior fossa including the falx cerebelli

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29
Q

discuss the path of the posterior spinal artery

A

2 posterior spinal arteries pass caudally over the medulla and posterior of SC close sa posterior roots

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29
Q

what reinforces the posterior spinal artery

A

radicular arteries that enter VC through IV foramina

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29
Q

what does the anterior spinal artery supply

A

medullar pyramids and paramedian medullary structures

anterior 2/3 of SC

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29
Q

what does the posterior spinal artery supp

A

posterior aspect of medulla below obex and post column and posterior horns of SC

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30
Q

discuss the path of the anterior spinal artery

A

starts as 2 vessels that joint to form a single artery

descends on ventral of medulla into anterior median fissure of SC

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31
Q

what reinforces the anterior spinal artery

A

radicular arteries that enter VC through IV foramina

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32
Q

discuss the path of the posterior inferior cerebellar artery

A

PICA follows an s-shaped course over olive and inferior cerebellar peduncle

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33
Q

origin of basilar artery

A

formed by union of 2 VA at caudal end of pons

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33
Q

what does the PICA supply

A

inferior cerebellum
dorsolat of medulla
choroid plexus of 4th vent
part of deep cerebellar nuclei

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33
Q

what are the main branches of the basilar

A

paramedian penetrating fibers
short circumferential arteries
long circumferential arteries
PCA

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33
Q

discuss the path of basilar artery

A

runs in pontine groove on ventral of pons and terminates at rostral end to give 2 PCA

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34
Q

what does paramedian penetrating fibers supply

A

paramedian zone of the basilar portion of the pons and adjacent pontine tegmentum

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34
Q

what does short circumferential arteries supply

A

anterolateral and posterolateral parts of the pons

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34
Q

what are the long circumferential arteries from basilar

A

Auditory (labyrinthine) artery

Anterior inferior cerebellar artery (AICA)

Superior cerebellar artery (SCA)

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35
Q

what does Auditory (labyrinthine) artery supply

A

supplies inner ear and root fibers of facial nerve

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35
Q

what does Auditory (labyrinthine) artery join

A

sumasama sa CN VII and CN VIII into internal auditory meatus

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36
Q

what does the AICA supp

A

inferior cerebellum

brachium pontis and restiform body

tegmentum of lower pons and upper medulla

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37
Q

discuss the path of SCA

A

winds around the cerebral peduncle

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37
Q

what does SCA supply

A

sup cerebellum

part of dentate nuc

brachium pontis and conjunctivum

tegmentum of upper pons

inferior colliculus

38
Q

what does the cortical branch of the PCA supply

A

inferolateral and medial surfaces of temporal lobe

lateral and medial surfaces of occipital lobe

visual cortex

38
Q

what does the central branch of the PCA supply

A

pierce the brain substance to supply

parts of thalamus and lentiform nuc and midbrain

pineal and medial geniculate bodies

38
Q

what does the choroidal branch of the PCA supply

A

enters inferior horn and lateral vent and supp

choroid plexus of lat and 3rd vent

38
Q

discuss the path of the posterior cerebral artery

A

curves laterally and backward around the midbrain and is joined by PComm

38
Q

what supplies the corpus striatum and internal capsule

A

medial and lateral striate central branches of MCA

39
Q

what supps the thalamus

A

branches of PComm, basilar and PCA

40
Q

what supps the midbrain

A

PCA, SCA and basilar

40
Q

what supps the medulla

A

VA, ant and post spinal, PICA, basilar

41
Q

what supps cerebellum

A

SCA, AICA, PICA

42
Q

what makes up the circle of willis

A

proximal portions of the ACA, MCA, PCA connected by AComm and PComm

43
Q

whre does the circle of willis lie

A

in the interpeduncular fossa

around infundibulum of pituitary and optic chiasm

43
Q

significance of circle of willis

A

important anastamotic channel betw ICA at vertebrobasilar systems

44
Q

where does the veins of brain lie

A

in subarachnoid space

44
Q

describe the structure of the veins of the brain

A

no muscular tissue and valves and has very thin walls

45
Q

what is the path of brain veins

A

pierces arachnoid matter and meningeal layer of dura and drain into cranial venous sinus

46
Q

discuss the path of the superficial cerebral veins

A

pass upward over the lateral surface of the cerebral hemisphere and

46
Q

what do superficial cerebral veins drain

A

dorsolat and dorsomed surfaces of hemisphere

47
Q

where do superficial cerebral veins enter

A

enters superior sagittal sinus

48
Q

most prominent superficial vein and what does it connect

A

superior anastomotic vein of Trolard

connects sup and middle groups of veins

49
Q

discuss the path of superficial middle cerebral veins

A

runs along the sylvian fissure

50
Q

what do superficial middle cerebral veins drain

A

drains inferolat surface of hemisphere

51
Q

where do superficial middle cerebral veins open into

A

cavernous sinus

52
Q

what do inferior cerebellar veins drain

A

inf surface of hemisphere

53
Q

where do inferior cerebellar veins open into

A

cavernous and transverse sinuses

54
Q

what connects middle and inferior groups of inferior cerebral veins

A

inferior anastomotic vein of Labbe

55
Q

where does the inferior anastomotic vein of Labbe cross

A

crosses the temporal lobe 5cm behind its tip

56
Q

what drains the medial surface of the hemisphere and where does the veins open into

A

number of veins that open into the sup and inf sagittal sinuses, basal vein and great cerebral vein of Galen

57
Q

what consists the external/superficial venous system

A

superficial cerebral, superficial middle cerebral and inferior cerebral veins

58
Q

what forms the deep venous system

A

2 internal cerebral veins are formed by the union of thalomostriate vein and choroid vein at IV foramen

59
Q

discuss the path of internal cerebral veins

A

run post in the tela choroidea of 3rd vent and unite under the splenium of corpus callosum

60
Q

what is formed at the splenium of the corpus callosum

A

internal cerebral veins unite there to form great cerebral vein

61
Q

where does the deep venous system empty

A

straight sinus

62
Q

what drains the midbrain

A

veins that open into the basal or great cerebral veins

63
Q

what drains the pons

A

basal vein, cerebellar veins or neighboring venous sinuses

64
Q

what drains the medulla

A

spinal veins and neighboring venous sinuses

65
Q

what drains the cerebellum

A

great cerebral vein or adjacent venous sinuses

66
Q

what lines cerebral dural venous sinuses

A

by the endothelium and devoid of valves

67
Q

loc of cerebral dural venous sinuses

A

between the periosteal and meningeal layers of the dura

68
Q

what is the function of cerebral dural venous sinuses

A

low-pressure channels for venous blood flow back to the systemic circulation

69
Q

where does the sup sagittal and inf sagittal sinus lie

A

superior and inferior portions of the falx cerebri

70
Q

where do superior cerebral veins drain into

A

superior and inferior sagittal sinuses

71
Q

how is the straight sinus formed

A

inferior sagittal sinus is joined by the Great vein of Galen to form the straight sinus

72
Q

where is the straight sinus loc

A

junction of the falx cerebri and tentorium cerebelli

73
Q

where does the straight sinus drain into

A

confluence of sinuses

74
Q

what is the path of the blood drained from the straight sinus

A

pass laterally and forward in a groove in the occipital bone

75
Q

after the occipital bone the straight sinus will ______

A

sa occipitopetrosal junction they curve downward and backward as the sigmoid sinus

76
Q

where does the sigmoid sinus drain into

A

internal jugular vein

77
Q

______ connects the confluence of sinuses to the marginal sinus at the _______

A

occipital sinus

foramen magnum

78
Q

into connects the petrosal vein and transverse sinus into the cavernous sinus

A

superior petrosal sinus

79
Q

where does the sup petrosal sinus lie

A

in the dura at the anterior border of the tentorium cerebelli

80
Q

it joins the cavernous sinus to the jugular bulb

A

inferior petrosal sinus

81
Q

inferior petrosal sinus extends _______

A

extends between the clivus and petrous bone

82
Q

describe the structure of cerebral arteries

A

thinner wall and absent external elastic laminae

has astrocytic process and perivascular reticular consisting of arachnoid trabeculae

83
Q

what surrounds cerebral cappilaries

A

surrounded by perivascular glial (astrocytic) processes

84
Q

significance of blood-brain barrier

A

isolates the brain tissue from the rest of the body

85
Q

what forms the blood-brain barrier

A

formed by the tight junctions that exist between the endothelial cells in the capillary beds

86
Q

describe cerebral veins

A

thinner walls and devoid of valves and muscle fibers

87
Q

function of cerebral veins

A

allows reversal of blood flow during occlusion

88
Q

extrinsic factors that affect cerebral circulation

A

systemic BP
blood viscosity
vessel lumen

89
Q

intrinsic factors that affect cerebral circulation

A

auto regulation and biochemical factors

90
Q

what regulates systemic BP

A

by baroreceptors located at the aortic arc and carotid sinus

91
Q

exp the effects of systemic BP to CBF

A

little changes will not affect it but i

Decrease in CBF if SPB <200mmHg or DBP >110-120mmHg

92
Q

CO2 – hypercapnia = vasodilation =

A

increase CBF

93
Q

Oxygen – hypoxia = vasodilation =

A

increase CBF

94
Q

explain autoregulation

A

Smooth muscles in small cerebral arteries and arterioles change their tension in response to intramural pressure to maintain a constant flow despite changes in perfusion pressure

95
Q

nerve supp of cerebral arteries

A

sympathetic postganglionic nerve fibers from superior cervical sympathetic ganglion

+ vasoconstriction

96
Q

what is formed from spinal cord arteries

A

2 posterior spinal arteries and 1 anterior spinal artery

97
Q

what reinforces spinal arteries

A

by small segmentally arranged arteries

98
Q

where does the small segmentally arranged arteries come from

A

from arteries outside the vertebral column and enter the vertebral canal through the intervertebral foramina

99
Q

spinal cord arteries anastomose on _____

A

surface of the cord

100
Q

spinal cord arteries send out branches on

A

into the substance of white and gray matter

101
Q

origin of posterior spinal arteries

A

directly from the vertebral arteries (or indirectly from the PICA)

102
Q

path of posterior spinal arteries

A

Descends on the posterior surface of the spinal cord close to the posterior nerve root

103
Q

posterior spinal artery branches to ______

A

gives off branches that enter the substance of the cord

104
Q

posterior spinal artery supplies

A

posterior ⅓ of the spinal cord

105
Q

explain significance of “small in upper thoracic ang posterior spinal artery

A

First 3 thoracic segments are vulnerable to ischemia

106
Q

origin of anterior spinal artery

A

by union of 2 vertebral arteries

107
Q

path of anterior spinal artery

A

Descends on anterior surface of the spinal cord within the anterior median fissure

108
Q

anterior spinal artery supps ?

A

anterior 2/3 of the spinal cord

109
Q

explain the sig of upper and lower thoracic segments have small ASA

A

T4 and L1 are particularly susceptible to ischemia

110
Q

At each intervertebral foramen, the
________ are reinforced by small segmental arteries on both sides.

A

longitudinally running posterior and anterior spinal arteries

110
Q

Each segmental artery gives rise to ______

A

anterior and posterior radicular arteries

111
Q

anterior and posterior radicular arteries accompanies ______

A

anterior and posterior nerve root to the SC

112
Q

origin of the segmental arteries

A

Branches of deep cervical, intercostal and lumbar arteries (outside the vertebral column)

113
Q

_____ anastomose with ASA and PSA

A

Feeder arteries

114
Q

Great anterior medullary artery of Adamkiewicz arise from?

A

aorta in the lower thoracic or upper lumbar vertebral levels

115
Q

Great anterior medullary artery of Adamkiewicz supp?

A

unilateral (most on L); may be a major source of blood supply to the lower ⅔ of the SC.

116
Q

where does spinal veins drain mainly

A

into the intervertebral venous plexus

117
Q

aside from the intervertebral venous plexus where do spinal veins drain into

A

longitudinal channels that communicate superiorly within the skull with the veins of the brain and the venous sinuses

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