Brain Blood Vessels and Intracerebral Bleeds

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which artery provides blood supply to the choroid plexus and the optic chiasma?

Anterior choroidal artery (correct)

Middle cerebral artery

Posterior communicating artery

Anterior communicating artery

What is the role of the anterior communicating artery in the Circle of Willis?

Connects the anterior cerebral arteries (correct)

Serves as an entry point for the internal carotid artery

Links the middle cerebral artery to the posterior cerebral artery

Supplies blood directly to the pituitary gland

Which of the following arteries is NOT a terminal branch of the internal carotid artery?

Posterior cerebral artery

Anterior communicating artery (correct)

Anterior cerebral artery

Middle cerebral artery

Which structure does the internal carotid artery primarily supply?

Posterior cerebral arteries Signup and view all the answers

What is the significance of the posterior communicating artery in the cerebral arterial circle?

It connects the posterior cerebral arteries with the internal carotid arteries Signup and view all the answers

Which areas are primarily supplied by the anterior cerebral artery?

Medial aspect of the hemisphere, including the lower limb Signup and view all the answers

What is the primary function of the areas supplied by the middle cerebral artery?

Speech and auditory processing Signup and view all the answers

Which statement accurately describes the posterior cerebral artery?

It supplies parts of the occipital lobe and infero-medial temporal lobe. Signup and view all the answers

Which regions are NOT supplied by the middle cerebral artery?

Medial aspect of the frontal lobe Signup and view all the answers

Which arteries branch from the anterior cerebral artery to supply important brain structures?

Medial striate arteries Signup and view all the answers

What area of the brain is primarily supplied by the vertebro-basilar arteries?

Cerebellum Signup and view all the answers

What is the primary role of the Circle of Willis?

To connect the anterior and posterior blood supply systems Signup and view all the answers

What causes an ischaemic stroke?

Reduced blood flow due to a blockage Signup and view all the answers

Which arteries contribute to the anterior spinal artery?

Both vertebral arteries and PICA Signup and view all the answers

What is the correct path of the internal carotid arteries as they enter the skull?

Enter through the carotid canal Signup and view all the answers

Which of the following arteries is NOT part of the posterior system supplying the brain?

Anterior spinal artery Signup and view all the answers

Which vessels supply the areas of the spinal cord?

Radicular arteries from segmental arteries Signup and view all the answers

From which artery do the two vertebral arteries originate?

Subclavian artery Signup and view all the answers

Which area is primarily supplied by the medial striate arteries?

Head of caudate and medial globus pallidus Signup and view all the answers

What type of attack is characterized by temporary neurological symptoms due to ischaemia?

Transient Ischaemic Attack Signup and view all the answers

Which type of stroke refers to a sudden focal neurological deficit due to impaired cerebral blood flow?

Ischaemic Stroke Signup and view all the answers

The lateral striate arteries originate from which cerebral arteries?

Middle cerebral and anterior choroidal arteries Signup and view all the answers

Which is a common cause of ischaemic stroke?

Cerebral thrombosis Signup and view all the answers

What indicates contralateral impaired sensations of position and movement in the context of corticospinal tracts?

Disruption of the dorsal columns Signup and view all the answers

Which cranial nerve nucleus is related to ipsilateral paralysis of the tongue?

Hypoglossal nucleus Signup and view all the answers

Which of the following veins are part of the superficial cerebral veins?

Superior anastomotic vein of Trolard Signup and view all the answers

What is the pathway for venous drainage of the brain?

Dural sinuses empty into internal jugular veins on both sides Signup and view all the answers

What is a characteristic feature of the venous drainage of the spinal cord?

It includes both superficial and deep veins that parallel arterial supply Signup and view all the answers

What is the primary cause of cell death in a stroke?

Lack of oxygen due to blocked blood flow Signup and view all the answers

Which type of stroke is primarily due to the rupture of a blood vessel?

Haemorrhagic stroke Signup and view all the answers

What is a common symptom associated with occlusion of the middle cerebral artery?

Contralateral hemiplegia Signup and view all the answers

How does a PICA syndrome manifest concerning sensory loss?

Ipsilateral loss of pain and temperature from the face Signup and view all the answers

What symptom is NOT typically associated with medial medullary syndrome?

Vertigo and nystagmus Signup and view all the answers

What is a major consequence of thrombosis affecting cerebral arteries?

Contralateral motor and sensory loss Signup and view all the answers

Which physiological impact does an embolism have when generated in a blood vessel outside of the brain?

Blockage that can lead to ischemia Signup and view all the answers

What defining feature characterizes cerebellar symptoms in stroke?

Ipsilateral balance and coordination issues Signup and view all the answers

Study Notes

Course Information

Class: Year 2 Semester 1
Course: Medicine
Lecturer: Dr. Vijayalakshmi S B
Date: 06/11/2024
Topic: Brain blood vessels and intracerebral bleeds

Learning Outcomes

Describe the blood supply to the brain and spinal cord
Identify the areas supplied by individual arteries
Describe the Circle of Willis
Define "stroke" and differentiate between ischaemic and hemorrhagic stroke causes
Explain the effect of focal lesions caused by strokes in major cortical functional areas

Blood Supply to the Brain

Anterior system: Internal carotid arteries supply most of the forebrain, except the occipital lobe.
Posterior system: Vertebro-basilar arteries supply the spinal cord, brainstem, cerebellum, and occipital lobes.
Connecting system: The two systems are connected via the Circle of Willis.

Blood Supply

Internal carotid arteries
Vertebral arteries

Vertebrobasilar System

Two vertebral arteries arise from the subclavian artery.
Ascend in transverse foramina.
Enter foramen magnum.
Release posterior inferior cerebellar artery (PICA)
Release posterior and anterior spinal arteries.
Merge into a single basilar artery.

Vertebral Arteries and Spinal Cord

Anterior spinal arteries unite to form a single anterior spinal artery.
Two posterior spinal arteries travel vertically.
Spinal arteries are supplemented by radicular arteries entering intervertebral foramina arising from segmental arteries.
Artery of Adamkiewicz is located in the lower thoracic or upper lumbar region.

Branches of the Basilar Artery

Formed at the ponto-medullary junction.
Anterior Inferior Cerebellar Arteries (AICA)
Labyrinthine arteries
Pontine arteries
Superior cerebellar arteries
Posterior cerebral arteries
Communicate to internal carotid artery (ICA) via posterior communicating arteries (PCA)

Pontomedullary Junction

Location of the basilar artery formation.
Contains various arteries.

Internal Carotid Artery

Cervical part of the ICA enters the carotid foramen/canal.
Passes through the carotid canal as the petrous part of the ICA.
Opens into the top part of the foramen lacerum and travels through the cavernous sinus (cavernous part).
Cerebral part of the ICA joins the Circle of Willis.

Branches of the Internal Carotid Artery

Ophthalmic
Through the optic canal to the eye.
Anterior choroidal artery
To choroid plexus, enters the inferior tip of the lateral ventricle.
Also supplies optic chiasma, optic tract, lateral geniculate body (thalamus), and part of the internal capsule.
A branch to the pituitary gland.
Posterior communicating artery
Two terminal branches
Leading to communicating arteries and middle cerebral arteries.

Anterior Cerebral Artery

Supplies the orbital surface of the frontal lobe, medial aspect of hemisphere (except occipital lobe), upper border of frontal and parietal lobes.
Supplies the lower limb.
Supplies perineum, micturition, and defecation functions.
Medial striate arteries supply basal ganglia and the anterior limb and genu of the internal capsule.

Middle Cerebral Artery

Supplies the lateral fissure and lateral aspect of the hemisphere (except anterior cerebral strip and occipital lobe).
Supplies the lateral aspects of the frontal, parietal, and temporal lobes.
Medially supplies the anterior temporal lobe.
Supplies speech areas (Broca's and Wernicke's areas) and auditory areas.
Lateral striatal or lenticulostriate arteries supply basal ganglia and internal capsule.

Posterior Cerebral Artery

Supplies the occipital lobe and infero-medial temporal lobe.
Usually a terminal branch of the basilar artery.
Rarely, may receive blood supply via posterior communicating artery.

Blood Supply of Central Cerebral Areas

Basal ganglia, internal capsule.
Anterior choroidal and striate arteries.

Internal Capsule

Anterior limb - frontopontine fibers, thalamus to prefrontal.
Genu - corticobulbar fibers.
Posterior limb - corticospinal and sensory fibers, corticobulbar fibers.
Retrolentiform - fibers to auditory and visual cortex.

Striate Arteries

Various names (lenticulostriate, thalamostriate, long central artery).
Medial striate arteries: anterior cerebral artery, internal capsule, nearby basal ganglia, and parts of the hypothalamus.
Lateral striate arteries: middle cerebral artery and anterior choroidal arteries, nearby basal ganglia, and putamen.
Central branches of posterior cerebral arteries including branches from posterior communicating arteries and supply thalamus and third ventricle.

Stroke

Sudden development of focal neurological deficits due to impaired cerebral blood flow.
Types: ischaemic and hemorrhagic.
Common causes: spontaneous cerebrovascular accidents (CVA), cerebral thrombosis, cerebral hemorrhage, cerebral embolism, subarachnoid haemorrhage.
Transient Ischaemic Attacks (TIAs): neurologic symptoms due to ischemia (e.g., carotid or vertebrobasilar stenosis). Symptoms last a few minutes (but can be up to an hour), with symptoms like staggering, dizziness, light-headedness, fainting, and paraesthesia. TIAs are a risk factor for stroke.

FAST

Face: Has the face fallen on one side? Can they smile?
Arms: Can they raise both arms and keep them there?
Speech: Is their speech slurred?
Time: Time to call 999 immediately if you see any of these signs.

Stroke Symptoms

Cerebral hemispheres: contralateral symptoms.
- Anterior cerebral: contralateral hemiplegia and anaesthesia
- Middle cerebral: contralateral hemiplegia and anaesthesia, possible aphasia
- Posterior cerebral: contralateral hemianopia
Vertebrobasilar: mix of contralateral and ipsilateral symptoms
Brainstem: varies depending on the specific area affected.
Cerebellar hemispheres: ipsilateral symptoms, with cerebellar signs (balance and coordination problems), including involvement of superior cerebellar, AICA and PICA.

Middle Cerebral Artery (MCA) Stroke

Contralateral motor and sensory loss (sparing lower limb and perineum).
Possible speech deficits if the dominant hemisphere is involved.
Supplies lateral striatal or lenticulostriate arteries to basal ganglia and the internal capsule.

PICA Syndrome (Lateral Medullary Syndrome)

Lateral medulla is supplied by the PICA.
Symptoms: ipsilateral pain and temperature loss from the face, vertigo, nystagmus, tinnitus, ipsilateral Horner's syndrome (ptosis, meiosis, anhydrosis), contralateral pain and temperature loss in the body, loss of taste from ipsilateral tongue, hoarseness/dysphagia, and involvement of cranial nerves.

Medial Medullary Syndrome

Medial part of the medulla is supplied by the vertebral artery.
Symptoms: contralateral hemiparesis, impaired position and tactile discrimination, ipsilateral tongue paralysis (involving hypoglossal nerve and nucleus).

Subarachnoid Hemorrhage

High-density blood in the subarachnoid space.

Venous Drainage of the Brain

Drained by a system of veins that empty into dural sinuses.
Sinuses drain into the right and left internal jugular veins.
Cerebral veins are divided into superficial and deep cerebral veins.
- Superficial: superficial middle cerebral vein, superior anastomotic vein of Trolard, inferior anastomotic vein of Labbé
- Deep: great cerebral vein of Galen, basal vein of Rosenthal, internal cerebral vein

Venous Drainage of the Spinal Cord

Posterior lateral spinal veins, posterior median spinal vein, anterior median spinal vein, anterior lateral spinal veins.
Drainage of veins from the spinal cord to the venous system.

Video Links (for further learning)

Provide links to videos about specific stroke types.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz focuses on the anatomy of brain blood vessels, specifically the blood supply to the brain and spinal cord. It covers key topics such as the Circle of Willis, types of strokes, and the impact of focal lesions. Test your understanding of these critical vascular concepts in medicine.