L3 CNS Blood Supply
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Questions and Answers

Which artery primarily supplies the medial inferior cerebellum and the choroid plexus of the 4th ventricle?

  • Anterior inferior cerebellar artery (AICA)
  • Posterior inferior cerebellar artery (PICA) (correct)
  • Superior cerebellar artery (SCA)
  • Basilar artery
  • What structure is primarily supplied by the anterior spinal arteries?

  • Dorsal spinal cord
  • Ventral spinal cord (correct)
  • Lateral medulla
  • Medial cerebellum
  • Which of the following arteries supplies the pons and midbrain with its numerous branches?

  • Anterior spinal arteries
  • Basilar artery branches
  • Pontine arteries (correct)
  • Posterior spinal arteries
  • Which artery is noted for supplying the anterior inferior cerebellum and the flocculus?

    <p>Anterior inferior cerebellar artery (AICA) (A)</p> Signup and view all the answers

    How is the Basilar artery formed?

    <p>By the fusion of right and left vertebral arteries (B)</p> Signup and view all the answers

    What is the main function of the system described that allows for blood flow management?

    <p>To shunt blood flow from one side to another in case of blockage (A)</p> Signup and view all the answers

    Which artery is not part of the anterior circulation derived from the internal carotid artery (ICA)?

    <p>Posterior cerebral artery (PCA) (B)</p> Signup and view all the answers

    Which of the following arteries directly contributes to the formation of the basilar artery?

    <p>Right vertebral artery (B)</p> Signup and view all the answers

    Which artery is often referred to as the first perforating branch?

    <p>Anterior choroidal artery (C)</p> Signup and view all the answers

    In the Circle of Willis, which artery is located at position 10?

    <p>Superior cerebellar artery (C)</p> Signup and view all the answers

    Which artery is primarily responsible for supplying the anterior inferior cerebellum?

    <p>Anterior inferior cerebellar artery (AICA) (A)</p> Signup and view all the answers

    What characterizes the blood supply to the dorsal medulla?

    <p>Supplied by the posterior spinal arteries (B)</p> Signup and view all the answers

    Which condition is associated with a PICA infarct?

    <p>Unilateral Horner’s syndrome (A)</p> Signup and view all the answers

    Which artery primarily completes the connection from vertebral blood supply to carotid blood supply?

    <p>Posterior communicating arteries (C)</p> Signup and view all the answers

    Which artery supplies the medial inferior cerebellum, 4th ventricle choroid plexus, and lateral medulla?

    <p>Posterior inferior cerebellar artery (PICA) (D)</p> Signup and view all the answers

    Which arteries supply the pons and midbrain?

    <p>Pontine arteries (B)</p> Signup and view all the answers

    Which clinical feature is NOT associated with Lateral Medullary Syndrome?

    <p>Bilateral loss of muscle coordination (D)</p> Signup and view all the answers

    Which artery supplies the rostral pons and caudal midbrain?

    <p>Superior cerebellar arteries (SCA) (D)</p> Signup and view all the answers

    What is the consequence of damage to the anterior spinal artery (ASA)?

    <p>Loss of motor function and sensations of pain and temperature (C)</p> Signup and view all the answers

    Which cranial nerve palsy is caused by a posterior communicating artery aneurysm?

    <p>Cranial nerve 3 (D)</p> Signup and view all the answers

    What do the posterior spinal arteries supply?

    <p>Posterior 1/3 of the spinal cord (B)</p> Signup and view all the answers

    Which structure is responsible for draining into the internal jugular veins?

    <p>Straight sinus (B), Superior sagittal sinus (C)</p> Signup and view all the answers

    Which of the following is a clinical consequence of aneurysms at key locations?

    <p>Compression of cranial nerves causing dysfunction (B)</p> Signup and view all the answers

    What is the role of the inferior sagittal sinus?

    <p>It participates in draining the brain's venous system (B)</p> Signup and view all the answers

    What sensory functions are lost when there is damage to the posterior spinal artery?

    <p>Fine touch and proprioception (B)</p> Signup and view all the answers

    What is the anatomical significance of cranial nerves in relation to blood vessels?

    <p>They can be compressed by aneurysms at key locations. (D)</p> Signup and view all the answers

    What clinical feature is most associated with Medial Medullary Syndrome?

    <p>Contralateral loss of vibration and position sense (C)</p> Signup and view all the answers

    Which ascending tract is primarily responsible for conveying pain and temperature sensation to the face?

    <p>Descending spinal tract of CN V (C)</p> Signup and view all the answers

    What is a common cause of Medial Medullary Syndrome?

    <p>Infarct of paramedian branches of the anterior spinal or vertebral artery (C)</p> Signup and view all the answers

    In which part of the central nervous system are the lesions that lead to both motor and sensory loss from the body and face typically found?

    <p>Brainstem (D)</p> Signup and view all the answers

    What type of sensory loss will result from damage to both the DC-ML and STT pathways in the brainstem?

    <p>Contralateral sensory loss (D)</p> Signup and view all the answers

    What is the typical pattern of tongue deviation observed in a lesion affecting CN XII?

    <p>Deviation towards the unaffected side (D)</p> Signup and view all the answers

    What is the effect of lesions in both the pons and midbrain on sensory function?

    <p>Sensory loss from the face (B)</p> Signup and view all the answers

    Which sensory modalities are affected in the case of alternating syndrome involving STT?

    <p>Pain and temperature (D)</p> Signup and view all the answers

    What is the primary function of bridging veins within the cerebral anatomy?

    <p>To connect cerebral veins to the superior sagittal sinus (D)</p> Signup and view all the answers

    How do bridging veins primarily become susceptible to injury?

    <p>Due to possible tearing from sudden changes in head velocity (A)</p> Signup and view all the answers

    What is a defining characteristic of subdural hematomas compared to other types of hemorrhages?

    <p>Their symptoms typically manifest after a delay (B)</p> Signup and view all the answers

    What anatomical structures do the bridging veins course between?

    <p>The dura mater and arachnoid (A)</p> Signup and view all the answers

    Which of the following is true regarding the bridging veins?

    <p>They can be damaged during sudden head movements (B)</p> Signup and view all the answers

    What is the connection between the cerebral veins and the superior sagittal sinus?

    <p>Cerebral veins drain into the superior sagittal sinus after penetrating the arachnoid (A)</p> Signup and view all the answers

    What physiological consequence can arise from a rupture of bridging veins?

    <p>Increased intracranial pressure leading to brain herniation (C)</p> Signup and view all the answers

    Which of the following best describes the term 'subdural bleed'?

    <p>Bleeding that develops between the dura mater and arachnoid layer (D)</p> Signup and view all the answers

    What role does the inferior sagittal sinus play in cerebral venous drainage?

    <p>It drains deep cerebral veins into the transverse sinus. (B)</p> Signup and view all the answers

    The great cerebral vein is primarily fed by which vein?

    <p>Deep middle cerebral vein (B)</p> Signup and view all the answers

    Which vein runs alongside the septum pellucidum?

    <p>Thalamostriate vein (C)</p> Signup and view all the answers

    Dawson's Fingers are an indicator of which medical condition?

    <p>Multiple Sclerosis (B)</p> Signup and view all the answers

    What is a primary function of the basal vein of Rosenthal?

    <p>Draining orbital frontal cortex and insula (C)</p> Signup and view all the answers

    What is the typical effect of brain stem lesions on sensory information from the face?

    <p>Loss of some sensory information, particularly for pain and temperature (D)</p> Signup and view all the answers

    Which pathways may be involved when lesions occur close to each other in the medulla?

    <p>Both the DC-ML and STT pathways (C)</p> Signup and view all the answers

    When brain stem lesions affect the DC-ML and STT pathways, what type of sensory loss occurs?

    <p>Contralateral loss of sensation (C)</p> Signup and view all the answers

    Which clinical features are associated with brain stem lesions involving cranial nerves?

    <p>Hoarseness, difficulty swallowing, and loss of gag reflex (D)</p> Signup and view all the answers

    What commonly occurs in the presence of lesions to both the DC-ML and STT pathways at the brain stem?

    <p>Contralateral sensory loss affecting both body and face (D)</p> Signup and view all the answers

    The presence of which cranial nerves in the brain stem is critical for the associated sensory and motor functions affected by lesions?

    <p>Cranial nerves III-XII (B)</p> Signup and view all the answers

    What aspect of sensory loss is most pronounced with brain stem lesions affecting sensory tracts?

    <p>Loss of pain and temperature sensation from the face (C)</p> Signup and view all the answers

    What condition involving sensory modalities may result from brain stem issues affecting the STT?

    <p>Alternating syndrome with altered sensory perception (A)</p> Signup and view all the answers

    Which statement accurately describes the function of the anterior communicating artery?

    <p>Connects the left and right anterior cerebral arteries. (D)</p> Signup and view all the answers

    Which region does the middle cerebral artery primarily supply?

    <p>Lateral surface of the frontal lobe. (B)</p> Signup and view all the answers

    What is the primary role of the posterior communicating arteries in the Circle of Willis?

    <p>To connect the anterior and posterior cerebral circulations. (D)</p> Signup and view all the answers

    Which artery primarily supplies the medial surface of the frontal and parietal lobes?

    <p>Anterior Cerebral Artery (ACA) (D)</p> Signup and view all the answers

    Which artery does NOT form part of the Circle of Willis?

    <p>Anterior choroidal artery (D)</p> Signup and view all the answers

    What is the relationship between the anterior choroidal artery and the Circle of Willis?

    <p>It provides blood flow to areas outside the Circle of Willis. (A)</p> Signup and view all the answers

    Where does the middle cerebral artery primarily travel within the brain?

    <p>Laterally into the lateral sulcus. (C)</p> Signup and view all the answers

    Which artery is primarily responsible for supplying the inferior surface of the temporal lobe?

    <p>Posterior cerebral artery (A)</p> Signup and view all the answers

    What is the clinical consequence of damage to the anterior spinal artery?

    <p>Loss of motor function and pain sensation (D)</p> Signup and view all the answers

    Which cranial nerve palsy is associated with a posterior communicating artery aneurysm?

    <p>Cranial nerve 3 palsy (C)</p> Signup and view all the answers

    What does damage to the posterior spinal artery lead to?

    <p>Loss of proprioception and fine touch (D)</p> Signup and view all the answers

    Which sinuses drain into the internal jugular veins?

    <p>Dural venous sinuses (C)</p> Signup and view all the answers

    Which of the following arteries primarily supplies the posterior part of the spinal cord?

    <p>Posterior spinal artery (C)</p> Signup and view all the answers

    What anatomical structures do the bridging veins connect?

    <p>The brain's surface to the venous sinuses (B)</p> Signup and view all the answers

    What is the role of the anterior spinal artery in the spinal cord?

    <p>Supplies blood to the anterior two-thirds of the spinal cord (A)</p> Signup and view all the answers

    What condition may result from aneurysms at key locations relative to cranial nerves?

    <p>Compression of cranial nerves causing dysfunction (B)</p> Signup and view all the answers

    Which artery is primarily responsible for supplying medial structures of the inferior cerebellum and the lateral medulla?

    <p>Posterior inferior cerebellar artery (PICA) (D)</p> Signup and view all the answers

    Which area does the anterior spinal artery primarily supply?

    <p>Ventral spinal cord (A)</p> Signup and view all the answers

    What clinical syndrome is characterized by ipsilateral loss of pain and temperature sensation to the face due to an infarct involving PICA?

    <p>Wallenberg's Syndrome (A)</p> Signup and view all the answers

    Which cranial nerve or associated tract is involved with unilateral Horner's syndrome in the context of Lateral Medullary Syndrome?

    <p>Hypothalamo-spinal tract (B)</p> Signup and view all the answers

    Which arteries branch from the basilar artery to supply the pons and midbrain?

    <p>Pontine arteries (A)</p> Signup and view all the answers

    Which posterior cerebral artery branches are important for providing a connection between the vertebral and carotid blood supply?

    <p>Posterior communicating arteries (A)</p> Signup and view all the answers

    Which artery supplies the dorsal medulla and can also branch from PICA?

    <p>Posterior spinal artery (D)</p> Signup and view all the answers

    What is the primary supply area of the superior cerebellar arteries (SCA)?

    <p>Superior cerebellum and rostral pons (B)</p> Signup and view all the answers

    What percentage of individuals have a complete Circle of Willis?

    <p>34 percent (A)</p> Signup and view all the answers

    Which artery primarily supplies the lateral frontal lobes?

    <p>Middle Cerebral Artery (MCA) (B)</p> Signup and view all the answers

    Which area is typically supplied by the Anterior Cerebral Artery (ACA)?

    <p>Primary motor and sensory for lower limb (B)</p> Signup and view all the answers

    What is the primary function of the Ophthalmic artery?

    <p>Supply the eyeball and retina (C)</p> Signup and view all the answers

    Which arterial territory is associated with visual deficits when damaged?

    <p>Posterior Cerebral Artery (D)</p> Signup and view all the answers

    What does the Lenticulostriate supply primarily provide blood to?

    <p>Basal ganglia (A)</p> Signup and view all the answers

    Which dimension of the cerebral blood supply includes both superficial and deep branches?

    <p>Middle Cerebral Artery (B)</p> Signup and view all the answers

    Which artery supplies the posterior limb of the internal capsule?

    <p>Anterior Choroidal Artery (B)</p> Signup and view all the answers

    The area supplied by the ACA is primarily responsible for which sensory function?

    <p>Primary motor for lower limb (C)</p> Signup and view all the answers

    Which of the following structures is NOT supplied by the Anterior Choroidal Artery?

    <p>Cerebellum (D)</p> Signup and view all the answers

    Which artery's territory includes Broca’s and Wernicke’s areas?

    <p>Middle Cerebral Artery (C)</p> Signup and view all the answers

    Which artery is primarily responsible for supplying the basal ganglia?

    <p>Lenticulostriate arteries (D)</p> Signup and view all the answers

    What is the primary sensory area supplied by the Middle Cerebral Artery (MCA)?

    <p>Upper limb and face (D)</p> Signup and view all the answers

    What common variant is observed in the Circle of Willis?

    <p>Presence of a single anterior communicating artery (A)</p> Signup and view all the answers

    Flashcards

    Circle of Willis

    A network of interconnected arteries at the base of the brain that ensures continuous blood flow even if one artery is blocked.

    ICA's Terminal Branches

    The internal carotid artery (ICA) branches into two main arteries: the anterior cerebral artery (ACA) and the middle cerebral artery (MCA).

    Posterior Circulation

    The posterior circulation of the brain is supplied by the vertebral arteries (VA) which join to form the basilar artery (BA).

    Perforating Branches

    Small arteries that branch off larger arteries and supply deep brain structures.

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    Anterior Choroidal Artery

    The anterior choroidal artery is the first perforating branch that emerges from the internal carotid artery.

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    Basilar artery formation

    Two vertebral arteries merge to form the basilar artery, situated in the groove of the pons.

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    Basilar artery function

    The basilar artery supplies blood to the pons, midbrain, and cerebellum.

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    AICA function

    The anterior inferior cerebellar artery (AICA) supplies blood to the anterior inferior cerebellum, flocculus, and caudal pons.

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    PICA function

    The posterior inferior cerebellar artery (PICA) supplies blood to the medial inferior cerebellum, 4th ventricle choroid plexus, and lateral medulla.

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    SCA function

    The superior cerebellar artery (SCA) supplies blood to the superior cerebellum, rostral pons, and caudal midbrain.

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    Anterior Spinal Arteries

    The anterior spinal arteries are responsible for supplying blood to the ventral (front) portion of the spinal cord.

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    Posterior Inferior Cerebellar Arteries (PICA)

    The posterior inferior cerebellar arteries (PICAs) provide blood to the inferior (bottom) and medial (middle) parts of the cerebellum, the choroid plexus of the fourth ventricle, and the lateral part of the medulla.

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    Posterior Spinal Arteries

    The posterior spinal arteries supply blood to the dorsal (back) portion of the medulla and spinal cord, and can also branch from the PICA.

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    Anterior Inferior Cerebellar Arteries (AICA)

    The anterior inferior cerebellar arteries (AICAs) deliver blood to the anterior and inferior regions of the cerebellum, the flocculus (a small part of the cerebellum), and the caudal (lower) part of the pons.

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    Pontine Arteries

    The pontine arteries are responsible for supplying blood to the pons (part of the brainstem) and midbrain, with many branches.

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    Superior Cerebellar Arteries (SCA)

    The superior cerebellar arteries (SCAs) supply the superior (top) cerebellum, the rostral (front) part of the pons, and the caudal (lower) part of the midbrain.

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    Lateral Medullary Syndrome (Wallenberg's Syndrome)

    Lateral medullary syndrome (Wallenberg's syndrome) is caused by a stroke affecting the PICA, leading to a specific set of symptoms on one side of the body.

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    Symptoms of Wallenberg's Syndrome

    Wallenberg's syndrome features include ipsilateral (same side) loss of pain and temperature sensation in the face, contralateral (opposite side) loss of pain and temperature sensation in the body, and unilateral Horner's syndrome affecting the same side's eye.

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    Supply of the Spinal Cord

    The anterior spinal artery (ASA) supplies the front two-thirds of the spinal cord, while the posterior spinal arteries (PSAs) supply the back third.

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    ASA Damage Effects

    Damage to the anterior spinal artery (ASA) can lead to problems with motor function, as well as the ability to sense pain and temperature.

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    PSA Damage Effects

    Damage to the posterior spinal arteries (PSAs) can lead to loss of fine touch and proprioception. This means the body's awareness of position and movement can be impaired.

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    Dural Sinuses

    The major venous channels within the brain called dural sinuses are responsible for draining blood from the brain.

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    Major Dural Sinuses

    The superior sagittal sinus, inferior sagittal sinus, straight sinus, and cavernous sinuses are major dural sinuses. They drain blood from the brain into the internal jugular veins.

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    Venous Drainage Pathway

    Dural venous sinuses drain blood from the brain and ultimately into the internal jugular veins.

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    Aneurysms and Cranial Nerves

    Aneurysms, which are bulges in arteries, can occur near cranial nerves, potentially compressing them and causing dysfunction.

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    Cranial Nerve 3 Palsy

    Cranial nerve 3 palsy, characterized by the eye being 'down and out' at rest, can result from a posterior communicating artery aneurysm affecting the oculomotor nerve.

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    Vein of Galen

    A short unpaired vein connecting internal cerebral veins, also known as basal veins, with the straight sinus.

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    Superior Sagittal Sinus

    A large venous sinus that runs along the midline of the superior surface of the brain.

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    Cerebral Veins

    Veins that travel through the subarachnoid space and drain into the superior sagittal sinus.

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    Bridging Veins

    The point where cerebral veins pass through the arachnoid membrane to enter the superior sagittal sinus.

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    Subdural hematoma

    A type of bleeding that occurs between the dura mater and arachnoid membranes, typically caused by a torn bridging vein.

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    Vulnerability of Bridging Veins

    Shearing forces, caused by sudden changes in head velocity, can tear bridging veins.

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    Slow Onset of Subdural Hematoma Symptoms

    A subdural hematoma typically develops gradually due to the slow venous bleeding.

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    Causes of Subdural Hematoma

    Subdural hematomas are commonly caused by car accidents.

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    Medial Medullary Syndrome

    A neurological condition characterized by loss or decrease in vibration and position sense on one side of the body and weakness or paralysis on the same side of the body, often due to a stroke affecting the medial medulla.

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    Infarct of paramedian branches

    A specific type of stroke that affects the paramedian branches of the anterior spinal or vertebral artery, leading to medial medullary syndrome.

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    Spinothalamic Tract (STT)

    The pathway responsible for carrying information about pain and temperature from the body to the brain. It crosses over in the spinal cord, meaning the left STT carries information from the right side of the body and vice versa.

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    Dorsal Column-Medial Lemniscus (DC-ML)

    The pathway carrying information about touch, pressure, vibration, and proprioception (position sense). It crosses over in the medulla, meaning the left DC-ML carries information from the right side of the body and vice versa.

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    Alternating Syndrome

    A neurological symptom where a lesion affects both the STT and the descending spinal tract of the Trigeminal nerve (CN V), resulting in loss of pain and temperature sensation on one side of the body and the face.

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    Descending Spinal Tract of CN V

    The descending pathway for the motor control of the face, specifically the muscles of mastication (chewing). Lesions can result in ipsilateral (same side) weakness or paralysis of the facial muscles.

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    Brainstem Lesions

    The brainstem, located between the cerebrum and the spinal cord, contains crucial pathways for sensory and motor information, including the STT, DC-ML, and cranial nerve nuclei. Lesions in this area can cause a variety of neurological deficits, including loss of sensation and motor function.

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    Ipsilateral Tongue Weakness

    A neurological syndrome characterized by ipsilateral (same side) tongue weakness with deviation of the tongue towards the side of the lesion, often caused by a brainstem lesion affecting the hypoglossal nerve (CN XII).

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    Anterior Cerebral Arteries (ACA)

    The anterior cerebral arteries (ACA) travel medially along the corpus callosum, supplying most of the medial and some of the superior surfaces of the frontal and parietal lobes.

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    Middle Cerebral Arteries (MCA)

    The middle cerebral arteries (MCA) travel laterally into the lateral sulcus, supplying the lateral surfaces of the frontal and temporal lobes. They also supply some of the parietal lobe.

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    Posterior Cerebral Arteries (PCA)

    The posterior cerebral arteries (PCA) are the terminal branches of the basilar artery, supplying the medial and inferior surfaces of the occipital and temporal lobes.

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    Anterior Communicating Artery

    The anterior communicating artery connects the left and right anterior cerebral arteries, forming a critical connection in the Circle of Willis.

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    Posterior Communicating Arteries

    The posterior communicating arteries connect the middle cerebral arteries (MCA) to the posterior cerebral arteries (PCA), but under normal circumstances, their flow is minimal.

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    Lenticulostriate Arteries

    The lenticulostriate arteries are branches off the middle cerebral arteries that supply structures deep in the brain, like the basal ganglia.

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    Anterior Choroidal Arteries

    The anterior choroidal arteries supply structures like the thalamus and internal capsule, crucial for relaying information.

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    Brainstem Blood Supply

    The anterior spinal artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery, and superior cerebellar artery provide blood supply to various parts of the brainstem and cerebellum.

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    Anterior Spinal Artery

    The anterior spinal artery supplies blood to the ventral (front) portion of the spinal cord.

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    Posterior Inferior Cerebellar Artery (PICA)

    The posterior inferior cerebellar artery (PICA) supplies blood to the medial inferior cerebellum, the 4th ventricle choroid plexus, and the lateral medulla.

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    Superior Cerebellar Artery (SCA)

    The superior cerebellar artery (SCA) supplies blood to the superior cerebellum, the rostral pons, and the caudal midbrain.

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    Anterior Inferior Cerebellar Artery (AICA)

    The anterior inferior cerebellar artery (AICA) supplies blood to the anterior inferior cerebellum, the flocculus, and the caudal pons.

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    What is the Circle of Willis?

    The Circle of Willis is a network of arteries at the base of the brain that connects the anterior and posterior circulation. It ensures continuous blood flow to the brain even if one artery is blocked.

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    What are the terminal branches of the internal carotid artery?

    The internal carotid artery (ICA) is the major blood vessel supplying the anterior circulation of the brain. It branches into the anterior cerebral artery (ACA) and the middle cerebral artery (MCA).

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    What does the Anterior Cerebral Artery (ACA) supply?

    The anterior cerebral artery (ACA) supplies blood to the medial (middle) and superior (top) parts of the frontal and parietal lobes, as well as the hippocampus and some midline thalamus.

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    What does the Middle Cerebral Artery (MCA) supply?

    The middle cerebral artery (MCA) supplies blood to the lateral (side) parts of the frontal and parietal lobes, the temporal lobe, as well as key areas for motor and sensory function.

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    What does the Posterior Cerebral Artery (PCA) supply?

    The posterior cerebral artery (PCA) is a major artery supplying the posterior circulation of the brain. It provides blood to the occipital lobes (vision), parts of the temporal lobes, and thalamus.

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    What does the Anterior Choroidal Artery (AChA) supply?

    The anterior choroidal artery (AChA) is a small but important artery that supplies blood to deep structures in the brain, including the basal ganglia, thalamus, and hippocampus.

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    What are perforating arteries?

    Perforating arteries are small branches that emerge from larger arteries and supply blood to deep structures within the brain.

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    What are lenticulostriate arteries?

    Lenticulostriate arteries are a group of perforating arteries that emerge from the middle cerebral artery (MCA) and supply blood to the basal ganglia and internal capsule.

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    What is the recurrent artery of Heubner?

    The recurrent artery of Heubner is a perforating artery that arises from the anterior cerebral artery (ACA) and supplies blood to the anterior part of the basal ganglia and internal capsule.

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    What does the Anterior Spinal Artery (ASA) supply?

    The anterior spinal artery (ASA) supplies blood to the anterior (front) part of the spinal cord.

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    What do the Posterior Spinal Arteries (PSAs) supply?

    The posterior spinal arteries (PSAs) supply blood to the posterior (back) region of the spinal cord.

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    What does the Posterior Inferior Cerebellar Artery (PICA) supply?

    The posterior inferior cerebellar artery (PICA) supplies blood to the inferior (bottom) and medial (middle) parts of the cerebellum, the choroid plexus of the fourth ventricle, and the lateral part of the medulla.

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    What does the Anterior Inferior Cerebellar Artery (AICA) supply?

    The anterior inferior cerebellar artery (AICA) supplies blood to the anterior (front) and inferior (bottom) parts of the cerebellum, the flocculus (a small part of the cerebellum), and the caudal (lower) part of the pons.

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    What does the Superior Cerebellar Artery (SCA) supply?

    The superior cerebellar artery (SCA) supplies blood to the superior (top) part of the cerebellum, the rostral (front) part of the pons, and the caudal (lower) part of the midbrain.

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    What is the basilar artery and what does it supply?

    The basilar artery is formed by the fusion of the two vertebral arteries and supplies blood to the brainstem structures, including the pons, midbrain, and cerebellum.

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    Spinal Cord Blood Supply

    The anterior spinal artery (ASA) supplies blood to the anterior 2/3 of the spinal cord, while the posterior spinal arteries (PSA) supply the posterior 1/3.

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    ASA Damage

    Damage to the ASA can lead to loss of motor function, pain, and temperature sensation to the body wall.

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    PSA Damage

    Damage to the PSA leads to loss of fine touch and proprioception, the body's awareness of position and movement.

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    Deep Cerebral Veins

    These veins are responsible for draining blood from the deep structures of the brain, including the thalamus, caudate nucleus, and basal ganglia.

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    Internal cerebral veins

    These are small, short veins that drain into the deep cerebral veins. They play a vital role in the drainage of the brain and help to maintain proper blood flow.

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    Study Notes

    CNS Blood Supply

    • Blood flow to the brain accounts for approximately 20% of total circulation.
    • 10-15 seconds without blood flow causes loss of consciousness.
    • 5 minutes of interrupted blood flow causes irreversible brain damage.
    • Although overall blood flow to the brain is consistent, active brain regions have higher energy needs, leading to localized increases in blood flow. This is the basis for fMRI.

    Learning Objectives

    • Students will be able to trace the major arterial supply paths to the cerebral hemispheres and brain regions.
    • Students will understand the pathway of major arterial supply to the cerebellum and brainstem.
    • Students will be able to identify arterial branches at the base of the brain, including the Circle of Willis.
    • Students will identify the major sinuses and veins, and the areas they drain.
    • Students will be able to assess clinical findings and presentations of symptoms for cranial hematomas.

    Arteries Supplying the CNS

    • Internal Carotid Arteries: Branch from the common carotid, supplying most of the cerebrum. Sections include cervical, petrous, and cavernous segments. Branches supply pituitary, dura of the anterior cranial fossa, and trigeminal ganglia.
    • Vertebral Arteries: Branches of the subclavian artery, supplying the brainstem, cerebellum, and posterior cortex.

    Circle of Willis

    • Connects the carotid and vertebral blood supplies.
    • Consists of anterior cerebral arteries, anterior communicating branches, internal carotid arteries, middle cerebral arteries, posterior communicating arteries, posterior cerebral arteries, and the basilar arteries.
    • Allows for blood shunting between sides in case of blockage or decreased pressure.
    • Under normal conditions, minimal blood flow to the posterior communicating arteries; carotid and vertebral flows do not directly mix.

    Anterior and Posterior Circulation

    • Anterior Circulation (ICA): Derived from branches of the internal carotid artery, including the anterior cerebral artery (ACA) and the middle cerebral artery (MCA).
    • Posterior Circulation (VA): Derived from branches of the vertebral arteries (joining to form the basilar artery), including the posterior cerebral artery (PCA).

    Circle of Willis - Variations

    • A complete circle is present in only 34% of individuals.

    Main Branches of the Internal Carotid Artery

    • Ophthalmic: Enters the orbit to supply the eyeball, retina, and orbital structures.
    • Anterior Choroidal: Travels posteriorly, supplying the optic tract and deep structures (basal ganglia, amygdala, thalamus, hippocampus, posterior limb of internal capsule).

    Vascular Territories on Cortex

    • Anterior Cerebral Artery: Sensory and motor for lower limb, medial and some superior frontal and parietal lobes, cingulate gyri.
    • Middle Cerebral Artery: Primary motor/sensory for upper limb and face, Broca's and Wernicke's areas (left), frontal and temporal lobes, parietal lobes.
    • Posterior Cerebral Artery: Occipital lobes (visual processing).

    Deep Cerebral Blood Supply

    • Lenticulostriate Arteries: Supply the basal ganglia.
    • Anterior Choroidal: Supply basal ganglia, internal capsule.
    • Recurrent artery of Heubner: Supply adjacent parts of the internal capsule.

    Cerebellar Blood Supply

    • Posterior Inferior Cerebellar Artery (PICA): Provides supply to medial inferior cerebellum, fourth ventricle choroid plexus, and lateral medulla.
    • Anterior Inferior Cerebellar Artery (AICA): Supplies anterior inferior cerebellum, flocculus, and caudal pons.
    • Superior Cerebellar Artery (SCA): Supplies superior cerebellum, rostral pons, and caudal midbrain.
    • Basilar Artery Branches: Supplies pons and midbrain.

    Brainstem Blood Supply

    • Vertebral arteries and branches supply the brainstem with an array of paramedian and lateral branches.

    Lateral Medullary Syndrome (Wallenberg's)

    • Symptoms - ipsilateral loss of pain and temp to face, contralateral loss of pain/temp to body, unilateral Horner's syndrome, ipsilateral eye, CN 9/10
    • Cause - infarct involving PICA
    • Associated findings - Hoarseness, difficulty swallowing, loss of gag reflex etc; alternating syndrome.

    Lesions of the Brain Stem

    • Lesions in the pons/midbrain will typically cause sensory/motor loss from the face, body and cranial nerves (III-XII).
    • STT and descending CN V tracts are close together in the medulla, thus lesions can involve both pathways.
    • Contralateral sensory loss in the medulla when the DC-ML and STT are involved.

    Arteries and Cranial Nerves

    • Arteries' relationship to cranial nerves is important anatomically and clinically.
    • Aneurysms may compress cranial nerves, causing dysfunction.

    Venous Sinuses

    • Dural venous sinuses drain into the internal jugular veins.
    • Superior sagittal sinus drains into the confluence of sinuses.
    • Transverse sinus drains into the confluence of sinuses.
    • Sigmoid sinus drains into internal jugular vein.
    • Inferior sagittal sinus drains into the confluence of sinuses.
    • Deep veins drain into the straight sinus.

    Superficial Cerebral Venous Drainage

    • Superficial veins (e.g., superficial middle cerebral vein) drain into the cavernous sinus or superior sagittal sinus.
    • Anastomotic veins (Dawson's fingers) are present, connecting superficial veins for collateral circulation.

    Deep Cerebral Venous Drainage

    • Internal cerebral veins, basal veins, and the great cerebral vein (of Galen) drain deep structures into the straight sinus.

    Cerebral and Bridging Veins

    • Cerebral veins drain into the superior sagittal sinus.
    • Bridging veins connect cerebral surfaces to the dura mater via the arachnoid.
    • Bridging veins are vulnerable to injury from head trauma.

    Clinical Correlations: Subdural, Epidural, and Subarachnoid Hematomas

    • Subdural Hematoma: Symptoms develop slowly due to venous pressure. Crescent-shaped on CT scans.
    • Epidural Hematoma: Rapid onset of symptoms due to middle meningeal artery rupture. Often associated with skull fractures.
    • Subarachnoid Hemorrhage: Typically caused by cerebral arterial ruptures (aneurysms) resulting in a sudden onset, severe headache.

    Stroke

    • Subarachnoid hemorrhages often have a sudden, severe headache as a presentation.
    • Stroke symptoms often appear quickly due to arterial pressure. Lumbar puncture can detect blood.

    PQ Questions

    • Includes questions on specific anatomical structures and their relation to pathologies.

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    Related Documents

    L3 CNS Blood Flow PDF

    Description

    This quiz explores the arterial supply of the cerebellum and brainstem, along with the significance of various arteries involved. Questions cover the major arteries, their functions, and connections, providing a comprehensive review of neuroanatomy related to vascular supply. Test your knowledge on the Circle of Willis and related vascular structures.

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