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)</p> Signup and view all the answers

    How is the Basilar artery formed?

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

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

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

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

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

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

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

    What characterizes the blood supply to the dorsal medulla?

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

    Which condition is associated with a PICA infarct?

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

    Which arteries supply the pons and midbrain?

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

    Which clinical feature is NOT associated with Lateral Medullary Syndrome?

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

    Which artery supplies the rostral pons and caudal midbrain?

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

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

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

    What do the posterior spinal arteries supply?

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

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

    <p>Straight sinus</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</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</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</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.</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</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</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</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</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</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</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</p> Signup and view all the answers

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

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

    What anatomical structures do the bridging veins course between?

    <p>The dura mater and arachnoid</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</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</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</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</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.</p> Signup and view all the answers

    The great cerebral vein is primarily fed by which vein?

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

    Which vein runs alongside the septum pellucidum?

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

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

    <p>Multiple Sclerosis</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</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</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</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</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</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</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</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</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</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.</p> Signup and view all the answers

    Which region does the middle cerebral artery primarily supply?

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

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

    <p>Anterior choroidal artery</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.</p> Signup and view all the answers

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

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

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

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

    What does damage to the posterior spinal artery lead to?

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

    Which sinuses drain into the internal jugular veins?

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

    What anatomical structures do the bridging veins connect?

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

    Which area does the anterior spinal artery primarily supply?

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

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

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

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

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

    What percentage of individuals have a complete Circle of Willis?

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

    Which artery primarily supplies the lateral frontal lobes?

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

    What is the primary function of the Ophthalmic artery?

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

    Which arterial territory is associated with visual deficits when damaged?

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

    What does the Lenticulostriate supply primarily provide blood to?

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

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

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

    Which artery supplies the posterior limb of the internal capsule?

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

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

    <p>Cerebellum</p> Signup and view all the answers

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

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

    Which artery is primarily responsible for supplying the basal ganglia?

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

    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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    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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