Block 6- Neuro Arterial Supply of CNS
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| Where does the internal carotid artery (ICA) begin? | bifurcation of common carotid (upper border of thyroid cartilage
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| The four parts of the internal carotid artery: | cervical, petrous, cavernous, cerebral
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| The boundaries of the cervical part of ICA | from origin to base of skull - the longest part
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| The boundaries of the petrous part of ICA | within carotid canal in petrous part of temporal bone
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| the boundaries of the cavernous part of ICA | within cavernous sinus
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| The boundaries of the cerebral part of ICA | from the point where it pierces the dura mater to its termination, where it divides into anterior and middle cerebral arteries
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| The cerebral part of ICA lies in which portion of brain? | subarachnoid space
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| What is the carotid siphon? | cavernous and cerebral parts of internal carotid arteries together form an S-shaped configuration
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| Branches of the cervical ICA | no branches
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| branches of petrous part of ICA | small branches to tympanic cavity
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| branches of cavernous part of ICA | inferior hypophysial branch(to pituitary); small b's supplying: trigeminal ganglion,
walls of cavernous sinus and adj. dura mater
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| branches of cerebral part of ICA | ophthalmic artery; superior hypophysial branches: anterior choroidal artery,
posterior communicating artery, anterior cerebral artery, middle cerebral artery,
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| Origin and termination of posterior communicating artery? What does it connect? | O/T:internal carotid artery to proximal part of posterior cerebral artery. Connects anterior (carotid) and posterior (vertebro-basilar) circulations
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| What artery runs posterior and inferior to the optic tract? What 8 things does it supply? | Anterior Choroidal Artery. choroid plexus (inferior horn, things on medial aspect temporal lobe (uncus, hippocampus, amygdala), tail of caudate, globus pallidus, inferior part of internal capsule, optic tract, lateral geniculate nucleus, cerebral peduncle
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| What is joined to homologous artery by anterior communicating artery? | Anterior Cerebral Artery (ACA)
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| What are the two segments of the ACA created by the anterior communicating artery? | A1 = proximal/pre-communicating
A2 = distal/ post-communicating
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| Where does the A1 of the ACA travel? | passes anteriorly/superficially and medially above optic nerve
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| Where does the A2 of the ACA travel? | distributed on medial surface of cerebral hemisphere
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| What do the proximal cortical branches of the ACA supply? | medial surface of cerebral hemisphere from frontal pole to parieto-occipital sulcus, corpus callosum, straight gyrus, olfactory bulb & tract
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| What do the distal cortical branches of the ACA supply? | extend over the superior border of hemisphere and supply a strip of cortex on superolateral surface
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| What is the medial striate artery (other name)? | recurrent artery of Heubner is a branch of the ACA
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| Origin & termination of medial striate artery (Heubner) | ACA distal (occasionally proximal) to anterior communicating artery. runs posteriorly and laterally to enter brain via anterior perforated substance
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| What does recurrent artery of Heubner supply? | inferior part of head of caudate nucleus and adjacent parts of anterior limb of internal capsule and putamen
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| What artery runs laterally in the lateral sulcus toward insula? There it divides into superior and inferior trunks. | Middle Cerebral Artery (MCA)
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| Path of MCA M1 segment: | from origin to bifurcation into superior and inferior trunks
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| Path of MCA M2 segment: | Insular part - trunks and their branches as they lie on insula
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| Path of M3 segment: | Opercular part - branches of trunks that curve around opercula
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| Path of M4 segment: | Cortical part - distal branches of trunks that exit lateral fissure and serve cortical areas above and below it
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| what supplies the lateral part of inferior (orbital) surface of frontal lobe? | cortical branch of MCA
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| What supplies insula | cortical branch of MCA
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| what supplies the lateral surface of cerebral hemisphere with the exception of what part? | cortical branch of MCA supplies all except peripheral rim
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| What supplies peripheral rim of cerebral hemisphere? | branches of anterior and posterior cerebral arteries
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| What supplies the cortical areas located above lateral sulcus (frontal lobe and anterior parietal lobe) | superior trunk of MCA
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| What supplies the cortical areas located below the lateral sulcus (upper part of temporal lobe) and posterior part of parietal lobe | inferior trunk of MCA
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| Where does the vertebral artery originate? | 1st part of subclavian artery
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| What is the course of the 1st part of the vertebral artery: | prevertebral - runs superiorly and posteriorly from subclavian artery to transverse foramen of C6
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| course of the 2nd part of vertebral artery | Cervical - ascends through transverse foramina of C6 to C1
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| course of 3rd part of vertebral artery | Atlantic - passes posterior to lateral mass of atlas and lies in a groove on superior surface of posterior arch of atlas
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| course of 4th part of vertebral artery | Intracranial - passes under posterior Atlanto-occipital membrane, pierces dura mater and arachnoid and ascends into cranial cavity (within subarachnoid space) via foramen magnum
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| What is the path of the 4th part of vertebral artery within posterior cranial fossa? | runs superiorly and medially. At the medullopontine sulcus joins vertebral artery of opposite side to form basilar artery
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| What are the branches of the 4th part of vertebral artery? | posterior spinal artery, posterior inferior cerebellar artery, anterior spinal artery
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| What artery descends along the posterolateral sulcus of spinal cord - it may be branch of vertebral artery (75%) or PICA (25%) | posterior spinal artery
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| What artery curves around the medulla to reach inferior cerebellar surface | Posterior Inferior Cerebellar Artery (PICA)
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| What does the PICA supply? | posterolateral part of medulla, choroid plexus of 4th ventricle, medial part of inferior surface of cerebellum
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| two arteries join to form what single anterior spinal artery, which runs along the anterior median fissure of medulla and spinal cord | anterior spinal artery
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| what does the anterior spinal artery supply | supplies the anteriomedial part of medulla
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| What artery runs in a sulcus from medullopontine sulcus to pons-midbrain junction, where it terminates by dividing into 2 posterior cerebral arteries | Basilar Artery
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| What are the branches of the Basilar Artery | pontine branches: anterior inferior cerebellar artery,labyrinthine (internal auditory) artery, superior cerebellar artery
posterior cerebral artery
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| what are the three branches of the pontine branch of the basilar artery? | paramedian, short circumferential and long circumferential artery
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| Path of anterior Inferior Cerebellar Artery (AICA) | lateral along inferior border of middle cerebellar peduncle
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| AICA supplies: | lateral part of inferior surface of cerebellum, lower pons, upper medulla, choriod plexus of 4th ventricle
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| Where does the labyrinthine (internal auditory) artery usually originate? | AICA - usually, but can be basilar artery
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| where do the vessels of the labyrinthine artery go? | enters internal acoustic meatus with CN's VII and VIII to supply internal ear
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| The artery that passes laterally, just inferior to oculomotor nerve | Superior Cerebellar Artery
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| What does the superior cerebellar artery supply | wraps around brainstem to supply upper pons, lower midbrain, superior surface of cerebellum
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| The artery that passes laterally, just above oculomotor nerve and around midbrain and joins inferomedial aspect of temporal lobe | Posterior Cerebral Artery (PCA)
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| Origin of P1 segment of PCA | origin to posterior communicating artery
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| Origin of P2 segment of PCA | posterior communicating artery to 1st temporal branch
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| Origin of P3 segment of PCA | part of PCA that give rise to temporal branches
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| Origin of P4 segment of PCA | distal part of artery that gives rise to branches that supply occipital lobe (parieto-occipital and calcarine arteries)
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| What supplies inferior and medial surfaces of temporal and occipital lobes | PCA
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| What has distal branches that extend over superior and inferior borders of hemisphere to supply a strip of cortex on superolateral surface | PCA
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| What supplies midbrain, thalamus and choriod plexuses of 3rd and lateral ventricles | PCA
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| What is a border zone | areas where terminal branches of anterior, middle, and posterior cerebral arteries overlap
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| What is a watershed infarct? | sudden systemic hypotension damages tissue in the border zone - specific inadequate perfusion
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| What are the components of the circle of Willis? | anterior communicating artery; internal carotid artery; posterior communicating artery; posterior cerebral artery
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| What is the benefit of the Circle of Willis? | serves as a potential vascular shunt, assisting in development of collateral circulation if one vessel occluded
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| What are the small branches that originate from arteries of cerebral arterial circle and penetrate the ventral surface of brain | perforating (central) branches
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| What are the groups of perforating branches | anteromedial, anterolateral, posteromedial, posterolatera
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| what originates from A1 of ACA and anterior communicating artery, supploies supraoptic part of hypothathalamus | anteromedial perforating branch
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| what originates from M1 of MCA, enter brain via anterior perforated substance, supply caudate putamen, globus pallidus, internal capsule | Anterolateral arteries - lenticulostriate arteries
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| What is the most common site of intra-cerebral hemorrhage in hypertensive individuals | Anterolateral arteries
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| What originate from posterior communicating artery and P1 segment of PCA, enter brain via posterior perfortated substance | Posteromedial arteries
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| What supplies tuberal and mammillary regions of hypothalamus, subthalamus, anterior part of thalamus, medial parts of midbrain tegmentum and cerebral crus | posteromedial arteries
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| Originates from P2 of PCA, supply thalamus, geniculate nuclei, choroid plexus of lateral and 3rd ventricles (posterior choroidal arteries) and midbrain | posterolateral arteries
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| How many spinal arteries exist | 1 anterior, 2 posterior
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| how much tissue can blood received by the spinal arteries from vertebral arteries supply? | sufficient only for upper cervical segments
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| What arteries reinforce the spinal arteries to ensure proper flow? | anterior and posterior spinal medullary arteries from segmental arteries (vertebral, deep cervical, ascending cervical, posterior intercoastal, lumbar, sacral arteries)
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| What is the largest anterior spinal medullary artery? | Artery of Adamkiewicz
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| Where does the artery of Adamkiewicz travel | travels with ventral root of a lower thoracic or upper lumbar spinal nerve, most frequently on left
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| What do the branches of the anterior spinal artery supply? | anterior 2/3= anterior horn, int. zone, basal part of pos. horn, anterior, lateral funiculi
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| what supplies the posterior 1/3 of spinal cord = posterior horn and posterior funiculus | branches of posterior spinal artery
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| What is arterial vasocorona? | fine arterial plexus connecting anterior and posterior spinal arteries
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| What does the arterial vasacorona supply? | narrow zone of white matter beneath pia mater
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