W12 brain/neck and extremity vasculature anatomy and pathology

Question 1

Circle of Willis

• _ join to from _
• Splits into _
• Continues as _
• Joins and
• Continues as _
• Joined together by _

Answer 1

• Vertebral join to from basilar
• Splits into posterior cerebral
• Continues as posterior communicating
• Joins middle cerebral and carotid junction
• Continues as anterior cerebral
• Joined together by anterior communicating

Question 2

Neck arteries - carotids

• _ from _, posterior to _
• _ from _
• _ bifurcate into _ and _ at _
• _ joins _ at the _ to supply brain
• _ piece _ to supply face
• _ start at _ and ascend through _
• join to form _ which leads to _

Answer 2

• R CCA from brachiocephalic, posterior to sternoclavicular joint
• L CCA from aortic arch
• CCA bifurcate into ICA and ECA at C3/4
• ICA joins COW at the MCA to supply brain
• ECA piece parotid gland to supply face
• Vertebral start at subclavian and ascend through vertebral foramina
• join to form basilar which leads to COW

Question 3

Dural sinuses

• _ begins at crista galli, ends at _
• _ (inf to _ and sup to ) joins to form _, ends at _
• (Confluence of sinus= _ + _ + _)
• _ run laterally into _
• Drain into _
• Drain into _
• _ (each side of the sella)

Answer 3

• SSS begins at crista galli, ends at occipital protuberance
• ISS (inf to SSS and sup to CC) joins vein of galen to form straight, ends at occipital protuberance
• (Confluence of sinus= SSS + straight + transverse)
• Transverse run laterally into sigmoid
• Drain into internal jugular
• Drain into SVC
• Cavernous (each side of the sella)

Question 4

Great vein of galen

• Formed by junction of _ in posterior _
• Passes between _ and _ and curves to join _ to form _ sinus

Answer 4

• Formed by junction of internal cerebral veins in posterior third ventricle
• Passes between splenium and pineal gland and curves to join ISS to form straight sinus

Question 5

Neck veins - jugulars

• _ is the largest vessel in the neck
• Usually _ larger than _ (continuation of _ sinus)
• Lateral/medial? to carotids
• begin at angle of mandible, cross SCM and empty into

Answer 5

• IJV is the largest vessel in the neck
• Usually R larger than L (R is continuation of sigmoid sinus)
• Lateral to carotids
• External jugular vein begin at angle of mandible, cross SCM and empty into subclavian vein

Question 6

= vessel wall weakness causing bulging

symptoms?
cause?

Answer 6

Aneurysm

• symptoms: sudden onset of headache, double/loss vision, confusion, fatigue, speech impairment
• hereditary or associated with disease (eg. polycystic kidneys - Berry aneurysm)

Question 7

= abnormal connection between artery and vein, usually developed before birth

Symptoms?

Answer 7

Arteriovenous malformation (AVM)

• causes: stroke (first symptom), confusion, tinnitus, headache, double/loss vision

Question 8

= clot in dural sinus

causes?

Answer 8

Thrombosis

• causes: OCP, infant shock/ dehydration, coagulopathies

Question 9

vertebral dissection

cause?
appearance on T1?

Answer 9

• cause: trauma (cervical bone pierce vessels)

- T1: occulted vessel or sickle-shape hyperintensity of vessel wall

Question 10

Upper ext arteries

• _ continues as _ at first rib
• Continues as _ at inferior teres minor, traveling _ to humerus to supply arm, then to _
• Divides into _ and _
• _ travels underneath _ muscle lateral to forearm
• _ supply forearm and wrist, branches into _, _, _ and _
• _ and _ end at wrist, forming _, supplying wrist and hand

Answer 10

• Subclavian continues as axillary at first rib
• Continues as brachial at inferior teres minor, traveling medial to humerus to supply arm, then to anterior cubital fossa
• Divides into radial and ulnar
• Radial travels underneath brachioradialis muscle lateral to forearm
• Ulnar supply forearm and wrist, branches into anterior ulnar recurrent, posterior ulnar recurrent, common interosseous and posterior interosseous
• Radial and ulnar end at wrist, forming palmar arch, supplying wrist and hand

Question 11

Upper ext veins

• Divided into deep and superficial
• Union of _ and _ form two _
• Continues as _ at supraspinatus, which is _ to axillary artery
• Drains into _ at first rib
• _ travels along radial side of arm
• _ begins medial to hand, ascends medial to biceps brachii, becomes _

Answer 11

• Divided into deep and superficial
• Union of ulnar and radial form two deep brachial
• Continues as axillary at supraspinatus, which is medial to axillary artery
• Drains into subclavian at first rib
• Cephalic travels along radial side of arm
• Basilic begins medial to hand, ascends medial o biceps brachii, becomes axillary

Question 12

Lower ext arteries

• _ begins at level of _/ femoral head, ends at _
• Branches into superficial and deep
• Superficial branches include , _ and e
• Largest deep branch is _, which originates 4 cm below _
• _ divides into _ and _ – supply adductor, extensor, flexor & gluteal muscles
• _ continues as _
• Divides into _ and _ - at level of popliteus
• _ travels anteriorly at level of fibular head to ankle, becomes _
• _ (largest) travels posterior to leg, divides into _ of the foot

Answer 12

• Femoral begins at level of inguinal ligament/ femoral head, ends at Hunter’s canal
• Branches into superficial and deep
• Superficial branches include inferior epigastric, superficial circumflex iliac and external pudenal
• Largest deep branch is profunda femoris, which originates 4 cm below inguinal ligament
• Profunda divides into medial and lateral circumflex – supply adductor, extensor, flexor & gluteal muscles
• Femoral continues as popliteal
• Divides into anterior and posterior tibial at level of popliteus
• Anterior tibial travels anteriorly at level of fibular head to ankle, becomes dorsalis pedis
• Posterior tibial (largest) travels posterior to leg, divides into medial & lateral planter arteries of the foot

Question 13

Lower ext veins

• Superficial and deep veins
• Superficial arise from _, merge to form _ and _
• _ drain into _ at level of hip joint
• _ join _ postero-laterally
• Deep veins accompany arteries
• _ and _join to form _ behind knee
• Becomes _, which is lateral/medial? to femoral artery
• Continues as _

Answer 13

• Superficial and deep veins
• Superficial arise from dorsal foot, merge to form great saphenous and small saphenous
• Great saphenous drain into femoral at level of hip joint
• Small saphenous join popliteal postero-laterally
• Deep veins accompany arteries
• Anterior and posterior tibial join to form popliteal behind knee
• Becomes femoral, which is medial to femoral artery
• Continues as external iliac

Question 14

= interrupted lower extremities arterial flow, collateral blood supply

can lead to?
causes?
MRI scans from where to where?

Answer 14

Peripheral artery disease (PAD)

• can lead to gangrene of toes/ foot
• due to atherosclerosis, diabetes, smoking
• MRI scan from iliac bifurcation to pedal arch

Question 15

= primary DVT of upper extremity (most in subclavian and axillary)

Cause?
S&S?

Answer 15

Paget-Schroetter syndrome

• due to atherosclerosis
• causes arm swelling and pain

Question 16

= subclavian artery stenosis causing retrograde flow in vertebral artery

leads to what?
subclavian artery distal to stenosis can?
appearance on MRA-CE?

Answer 16

Subclavian steal syndrome

• cause weak pulse and different BP btw two arms
• subclavian artery distal to stenosis can create collateral to supply arm
• MRA-CE: vertebral has delayed enhancement and stenosis

Question 17

= occluded popliteal artery

causes?

Answer 17

Popliteal artery entrapment

• congenital or associated with thrombosis