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Citow - Anatomy > Blood Supply to the Brain > Flashcards

Blood Supply to the Brain Flashcards

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1
Q

What three major head and neck arteries are branched of the subclavian artery?

A

Vertebral Artery
Thyrocervical Trunk
Costocervical Trunk

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2
Q

Which vertebral artery is usually dominate? What percent of time? What percent is usually the other side dominant?

A

Left 50%
Right 25%
Nondominant 25%

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3
Q

What percentage of the population has a hypoplastic vertebral artery?

A

40%

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4
Q

What are the branches of the external carotid artery from proximal to distal?

A 
Superior thyroid artery
Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery 
Superficial temporal artery
Internal MAXillary artery
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5
Q

Which branch of the external carotid supplies CN IX, X, and XI?

A

Ascending pharyngeal artery

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6
Q

What gives off the middle meningeal artery? Accessory meningeal arteries?

A

Internal maxillary artery for both

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7
Q

At what level is the carotid bifurcation?

A

C3-C4 or C4-C5

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8
Q

Name the segments of the ICA, proximal to distal.

A
  1. Cervical
  2. Petrosal
  3. Lacerum
  4. Cavernous
  5. Clinoidal
  6. Ophthalmic
  7. Communicating.
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9
Q

How many segments are there to the Petrous portion of the ICA?

A
  1. Vertical
  2. Genu
  3. Horizontal
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10
Q

What are the branches at each ICA segment?

A

C1 - none
C2 - Caroticotympanic artery, Vidian artery (sometimes, usually ECA)
C3 - none
C4 - Meningohypophyseal trunk, Inferolateral trunk, Medial Trunk (McConnell’s Capsular arteries)
C5 - none
C6 - Ophthalmic artery, Superior hypophyseal artery,
C7 - Anterior choroidal, ACA, MCA, PCom

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11
Q

What does the caroticotympanic artery supply? What does it anastamose with?

A

Supplies the middle and inner ear.

Anastamoses with the inferior tympanic artery, which is a branch of the ascending pharyngeal

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12
Q

What is the most common origin of the Vidian artery? Second most common?

A

External Carotid Artery followed by Internal Carotid artery

It serves as an anastamosis between the two.

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13
Q

The inferolateral trunk anastamosis with the ECA by ________.

A

maxillary artery (through foramen rotundum) and the MMA

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14
Q

What are the branches of the meningohypophyseal trunk? What do they supply?

A

Tentorial Artery (Bernasconi and Cassinari) - tentorium

Inferior Hypophyseal Artery - Neurohypophysis

Dorsal Meningeal Artery - CN VI and part of the clivus

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15
Q

Pt goes in for MMA embolization. Develops unilateral blindness. Why?

A

in 0.5% of the population, the ophthalmic artery comes off the MMA

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16
Q

What is the origin of the Anterior Choroidal Artery?

A

Communicating segment of the ICA just distal to the PcommA origin

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17
Q

Recurrent Artery of Heubner arises from where?

A

A1 or A2 segment (medial distal striate artery)

Usually off of the A2

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18
Q

What does the Recurrent Artery of Heubner supply?

A 
Head of the caudate
Anterior limb of the internal capsule
Anterior Putamen and Globus Pallidus
Septal Nuclei
Inferior Frontal Lobe
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19
Q

What defines the M2 segment of the MCA?

A

from the bifurcation to the genu; insular segment

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20
Q

Lateral Lenticulostriate arteries emerge from what origin?

A

perforated arteries that emerge from M1 (supply much of the basal ganglia)

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21
Q

Which segment of the PCA lies within the ambient cistern?

A

P2

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22
Q

Which segment of the PCA lies within the quadrigeminal cistern?

A

P3

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23
Q

The medial and lateral posterior choroidal arteries arise from what origin?

A

P1 and P2 segments respectively

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24
Q

The vertebral arteries arise from what origin?

A

Subclavian arteries typically (many variants)

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25
The verts enter the foramina transversarium at what level?
C6
26
Occlusion of what vessel causes lateral medullary syndrome? What are the classic symptoms?
PICA Classic signs: - loss of pain and temperature on ipsilateral face but contralateral body - CN IX and X dysfunction - horner's syndrome
27
What are the branches of the basilar artery?
``` AICA Labyrinthine Artery Paramedian Artery Pontine Arteries SCA PCA ``` (of note PICA comes off the Verts)
28
What's the vascular supply to the striatum?
Mainly: MCA (lenticulostriates) Rostrally: Recurrent Artery of Huebner Cuadally: anterior choroidal artery
29
What's the vascular supply to the internal capsule?
Anterior Limb: mostly ACA, RAH (also lateral MCA lenticulostriates) Genu: ICA perforaters and MCA lenticulostriates) Posterior Limb: Anterior Choroidal, PcommA
30
What's the vascular supply to the Thalamus?
Primarily through the PCA and its branches (including posterior choroidal) Rostrally: PcommA and Basilar Bifurcation perforators (thalamoperforating arteries)
31
What's the vascular supply to the Medulla?
Anterior and Posterior Spinal Arteries | PICA and Verts
32
What's the vascular supply to the Pons?
Basilar Paramedian arteries and branches | Circumferential branches from the basilar
33
What's the vascular supply to the midbrain?
Basilar artery, PCA, SCA, PcommA, Anteior Chroidal
34
What's the vascular supply to Cerebellum?
PICA: Inferior cerebellar peduncle, vermis, tonsils, choroid of the 4th AICA: Middle cerebellar peduncle, choroid of the 4th, anterior cerebellum SCA: superior cerebellar peduncle, choroid of the 4th, and the DEEP nuclei
35
The SSS drains predominantly to which transverse sinus?
Right Transverse Sinus (60%)
36
Where does the SSS end and the transverse sinus begin?
internal occipital proturberance
37
The medial internal cerebral venous drainage pathway is as follows:
cortical medical hemisphere veins -> ISS ISS joins great cerebral vein of Galen to form Straight SInus Straight sinus - > Torcula -> transverse sinus (predominantly left)
38
What joins with the sigmoid sinus to become the superior jugular bulb?
inferior petrosal sinus
39
The vein of Trolard and Labbe drain into the which sinuses respectively?
SSS and Transverse Sinuse respectively (both originate at sylvian fissure)
40
What forms the internal cerebral veins?
union of the thalamostriate, choroidal, septal, and epithalamic, and lateral ventricular veins
41
What's the course of the internal cerebral veins?
located in the tela choroidea of the roof of the third ventricle (velum interpositum) travels through quadrigeminal cistern to contribute to the vein of Galen
42
What is the course of the Basal Vein of Rosenthal?
passes through the ambient cistern and joins the internal cerebral vein to form the vein of Galen
43
What is the course of the vein of Galen?
travels under the splenium and merges with the inferior sagittal sinus to form the straight sinus
44
Left vertebral artery arises from the aorta what percent of times?
5%
45
The ____ branch of the facial artery anastamoses with the ____ branch of the ophthalmic artery.
angular orbital
46
The internal maxillary artery anastomoses with inferior lateral cavernous sinus trunk and ophthalmic artery through ____.
ethmoidal branches
47
What are the segments of the intracavernous ICA?
1. Ascending portion 2. posterior genu 3. horizontal portion 4. anterior genu 5. remainder of ICA
48
The intracranial portion of the ICA begins at the ____.
distal dural ring
49
What are the branches of the medial trunk? What do they supply?
anterior and inferior capsular arteries anterior and inferior pituitary
50
Aneurysms of the ICA arise from which four vessels? What is the orientation?
Ophthalmic - superiorly and anteriorly Superior hypophyseal - inferiorly and medially PComm - posterior Anterior choroidal - superior lateral
51
Medial lenticulostriates branch from _____.
A1
52
The Acomm lies in what cistern?
cistern of the lamina terminalis
53
The recurrent artery of Heubner passes through what anatomical structure?
anterior perforating substance
54
The genu of the MCA courses around what structure?
island of Reil
55
The M3 is also known as the ______ segment.
opercular
56
The largest cortical branch of the MCA is the _____.
angular artery
57
Occlusion of what branch of the MCA causes Wernicke's Aphasia and hemianopsia?
posterotemporal branch (M2 inferior trunk branch)
58
P1 lies within what cistern?
interpeduncular
59
What cistern does the Anterior choroidal artery go through?
ambient
60
The anterior choroidal artery enters the choroidal fissure at the _____.
plexal point (temporal horn of lateral ventricle)
61
What artery was historically sacrificed to treat parkinson's disease? Why?
anterior choroidal probably due to decreased supply to VL thalamus
62
What percent of people have a complete circle of willis?
25%
63
What are the segments of the PICA?
1. Anterior medullary segment 2. Lateral medullary segment: supply CNs IX, X, and XI 3. Tonsillomedullary segment: forms a large loop 4. Telovelotonsillar segment: between tela choroidea and inferior medullaryvelum rostrally superior pole of the tonsils caudally 5. Hemispheric branches
64
What are three midbrain stroke syndromes?
Weber's (CN III palsy w/ contralateral hemiplegia) Benedikt (same plus red nucleus lesion aka tremors) Claude (CN III, contralateral hemiparesis and ataxia)
65
What percent of patients with persistent trigeminal arteries have vascular malformations or aneurysms?
25%
66
What is the second most common persistent fetal artery?
hypoglassal (after trigeminal)

Citow - Anatomy (16 decks)

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