9/15 - Blood Supply To Deep Brain Structures

Front 1

Main blood supply to the forebrain?

Back 1

Internal carotid

Front 2

What joints anterior and posterior circulation?

Back 2

Posterior communicating arteries - bridge posterior cerebral arteries w/ internal carotid arteries

Front 3

Variation in the circle of Willis

Back 3

Normally there is no pressure differentialbetween posterior + anterior circulation

Ifperson did depend on communicating arteries → these will be very large

Front 4

Small vessels coming off of circle of Willis?

Back 4

ganglionic/ perforating / striate/central arteries that arise from major vessels in oradjacent to the circle (these penetrate and provide paramedian/short circumferential blood supply)

Front 5

Four groups of perforating arteries

Back 5

Anteromedial

Anterolateral

Posteromedial

Posterolateral

Front 6

Anteromedial group of perforating arteries

Back 6

-Originates from the anterior communicating artery + anterior cerebral artery

-Supplies: anterior hypothalamus, structures in the area of the optic chiasm, inferior part of anterior limb + genu of internal capsule

-Recurrent artery of Heubner: large artery, supplies head of the caudate nucleus

Front 7

Blood supply to head of the caudate nucleus

Back 7

Recurrent artery of Heubner (part of anteromedial group of perforating arteries)

Front 8

Anterolateral group of perforating arteries

Back 8

Originates from lateral part of the anterior cerebral artery + proximal part of middle cerebral artery

Includes Lenticulostriate arteries

Supply: superior part of internal capsule, basal ganglia

Front 9

Posteromedial group of perforating arteries

Back 9

Originate from posterior communicating artery + medial part of posterior cerebral artery and basilar bifurcation

Supplies: crus cerebri, middle and caudal portions of the hypothalamus, thalamus, subthalamic nucleus

Front 10

Posterolateral group of perforating arteries

Back 10

Originates from lateral part of posterior cerebral artery

Supplies: thalamus + choroid plexus

Front 11

Arteries responsible for lacunar infarcts?

Back 11

perforating arteries

Front 12

Course of the anterior choroidal artery

Back 12

Arises distal to the posterior communicating artery and follows the optic tract + cerebral peduncle as far as the lateral geniculate body then enters the choroid plexus of the lateral ventricle

Front 13

What does the anterior choroidal artery supply?

Back 13

Optic tract

Medial temporal cortex

Hippocampal formation

Caudal + inferior parts of lentiform nucleus

Inferior part of posterior limb of internal capsule - retro + sublenticular parts

Front 14

Retro vs sublenticulate fibers

Back 14

Optic radiations = start as retrolenticulatefibers Auditoryradiations = start as sublenticulatefibers

Front 15

Inferior posterior limb of internal capsule supplied by...

Back 15

Anterior choroidal artery

Front 16

Superior part of the internal capsule (all 3 divisions) is supplied by the...

Back 16

lenticulostriate arteries

Front 17

Blood supply to inferior part of anterior limb and genu of IC?

Back 17

Medial striate arteries

Front 18

Medial striate arteries supply...

Back 18

Medial striate arteries supply theinferior part of the anterior limb and the genu of the IC

Front 19

Lenticulostriate arteries supply..

Back 19

ALL superior parts of the internal capsule

Front 20

Fibers extending up into the cortex from the internal capsule?

Back 20

Corona radiata

Front 21

Small strokes in the internal capsule can result in _____

Back 21

majorconsequences and can result in spastic paralysis and hemianesthesia due to the interruption of thecorticospinal and thalamocortical fibers

Front 22

Blood supply to anterior and posterior hypothalamus? Blood supply to subthalamic nuclei?

Back 22

Anterior hypothalamus: anteromedial group

Posterior hypothalamus: posteromedial group

Subthalamic nucleus: posterormedial group

Front 23

Blood supply + structure indicated?

Back 23

Anterior hypothalamus - anteromedial group

Front 24

Blood supply + structure indicated?

Back 24

Posterior hypothalamus - posteromedial group

Front 25

Blood supply to subthalamic nucleus?

Back 25

Posteromedial group of perforating arteries

Front 26

Blood supply to the thalamus

Back 26

Anterior thalamus (more medial): posteromedial group of perforating arteries

Posterior thalamus (more lateral): posterolateral group of perforating arteries

Posterior cerebral is main supplier here

Front 27

Clinical relationship: blood supply to thalamus + internal capsule

Back 27

Bloodsupply to the thalamus is largely separate from the internal capsule supply.However, the edema from vascular lesions may extend from the thalamus into theinternal capsule and vice versa as a result of their close proximity.

Front 28

Transient deficit of thalamus (or other structures) likely due to...

Back 28

compressive lesion from edema (not permanent structure defect)

Front 29

Recurrent artery of Huebner supplies...

Back 29

head of the caudate nucleus (from anteromedial perforating arteries)

Front 30

What supplies the lateral aspect of the lentiform nucleus (putamen and GP) and body of the caudate nucleus?

Back 30

Lateral striate/lenticulostriate arteries

Front 31

What do the lateral striate/lenticulostriate arteries supply in the basal ganglia?

Back 31

Lateral aspect of lentiform nucleus (putamen + GP) and body of the caudate nucleus

Front 32

Anterior choroidal artery supplies what in the basal ganglia?

Back 32

Ventrocaudal portions of the lentiform nucleus and amygdaloid nucleus

Front 33

Posterolateral penetrating branches supply what in the basal ganglia?

Back 33

Posterior thalamus

Front 34

Posteromedial penetrating branches supply what in the basal ganglia?

Back 34

Anterior thalamus

Front 35

The oculomotor nerve travels between...

Back 35

the posterior cerebral artery + the superior cerebellar artery

Front 36

Cortical branches of the ACA

Back 36

Pericallosal and callosomarginal aa. course inferior and superior to thecingulate gyrus respectively; callosomarginal artery supplies supplementary motor cortex (on medial side) and paracentrallobule

Front 37

Blood supply to paracentral lobule?

Back 37

Callosomarginal artery (branch of ACA)

Front 38

Back 38

Front 39

Cortical branching pattern of MCA

Back 39

-STEM: has lenticulostriate arteries

-UPPER DIVISION: middle and inferior frontal gyri, pre and postcentral gyri

-LOWER DIVISION: superior and inferior parietal lobules and temporal gyri

Front 40

Back 40

Front 41

_____ is the main blood supply to the midbrain and the thalamus

Back 41

PCA

Front 42

Cortical supply of the PCA

Back 42

Branches across the inferior and medial surface of the occipital lobe + most of the temporal lobe

Calcarine artery supplies the primary visual cortex

Front 43

Border zone deficits

Back 43

Decreased blood flow or oxygenation (HTN, cardiac arrest, CO poisoning) can lead to infarcts in the border zone or watershed of large arterial territories

Front 44

Common watershed deficit?

Back 44

Between the ACA and MCA cortical branches- affect homunculus at proximal limbs/trunk

Front 45

Man in the barrel syndrome

Back 45

Watershed infarcts can produce proximal arm and leg weakness(“man in the barrel” syndrome) because the regions of homunculus involved ofteninclude the trunk and proximal limbs. (lower extremity and head are fine)

Front 46

Causes of main the barrel syndrome

Back 46

severesystemic hypotension related to CABG , hemorrhagic shock , and severeanaphylaxis

Front 47

Venous drainage in the cortex

Back 47

Capillaries

Intra-axial veins

Superfical veins (remember bridging veins) + Deep veins

Dural venous sinuses

Front 48

Ultimate draining location of venous blood?

Back 48

Ultimately everything is draining intothe jugular bulb which is the commencement of the internal jugular vein (found in jugular fossa)

Front 49

Bridging veins - clinical correlation

Back 49

Subdural hematoma - rupture of bridging vein between arachnoid and dura mater

Can result in extravasation of blood into the potential space between meningeal layers

Will cross suture lines

Front 50

Deep cerebral veins - clinical correlation - venous angle

Back 50

Venous angle - where internal cerebral vein and thalamostriate (terminal) vein meet -- marks the location of the interventricular foramen

Front 51

Deep cerebral veins - clinical correlation - Great Cerebral Vein of Galen

Back 51

Great cerebral vein of Galen - easily torn during blunt trauma to the head; joins inferior sagittal sinus by traveling through the quadrigeminal cistern (where it is vulnerable)

A tear will lead to a slow venous bleed in the SAS (starting in the quadrigeminal cistern)

Front 52

Anterior cerebral artery occlusion - areas affected + signs/sx

Back 52

-Motor area for lower body: paresis or paralysis of contralateral leg and foot

-Somatosensory cortex for lower body: sensory impairment (paresthesia/anesthesia) involving contralateral leg and foot

-Superior frontal gyrus (upper) and anterior cingulate gyrus (lower) bilaterally: urinary incontinence

Front 53

Patient presents with paresis or paralysis of contralateral face, hand, and arm - area affected + blood supply?

Back 53

Motor area for upper body - MCA

Front 54

Patient presents with sensory deficits involving contralateral face, hand, and arm - area affected + blood supply?

Back 54

Somatosensory cortex for upper body - MCA

Front 55

Patient presents with expressive aphasia - area affected + blood supply?

Back 55

Frontal lobe of dominant hemisphere (usually L) related to speech production - Broca's area - MCA

Front 56

Patient presents with receptive aphasia, fluent aphasia - area affected + blood supply?

Back 56

Superior temporal lobe areas of dominant hemisphere (usually L) related to interpretation of speech (Wernicke's)

Front 57

Patient presents with contralateral neglect (hemi-neglect), agnosognosia - area affected + blood supply?

Back 57

Parietal lobe of non-dominant hemisphere - MCA

Front 58

Patients presents w/ transient loss of voluntary saccadic eye movement to contralateral side - area affected + blood supply?

Back 58

Frontal eye fields in frontal lobe - MCA

Front 59

Patient presents with superior quadranticanopsia- area affected + blood supply?

Back 59

Optic radiation within temporal lobe (unilaterally) (Meyer Loop)

OR upper optic radiation unilaterally

MCA

Front 60

Patient presents with homonymous hemianopsia - area affected + blood supply?

Back 60

Optic tract (Anterior choroidal), LGN (Anterior choroidal), Optic radition (upper and lower on one side) - MCA

Front 61

Patient presents with capsular (pure motor) hemiplegia - area affected + blood supply?

Back 61

Upper portion of posterior limb of internal capsule + adjacent corona radiata - MCA

Front 62

Patient presents with homonymous hemianopsia with macular sparing- area affected + blood supply?

Back 62

Primary visual cortex (on contralateral side - superior and inferior) - PCA

Front 63

Patient presents with thalamic syndrome - sensory loss (all modalities), spontaneous pain, dysesthesias- area affected + blood supply?

Back 63

Ventral posterior nucleus of the thalamus (medial + lateral) in the territory of the thalamogeniculate artery - PCA

Front 64

Patient presents with Hemiballismus- area affected + blood supply?

Back 64

Subthalamic nuclei or its connections to globus pallidus (contralateral to side of presentation) - PCA

Front 65

Patient presents with third nerve palsy (describe this appearance)- area affected + blood supply?

Back 65

Eye down and out, ptosis, myosis

Oculomotor nucleus or nerve in midbrain - PCA

Front 66

Patient presents with contralateral hemiplegia- area affected + blood supply?

Back 66

Cerebral peduncle - PCA

Front 67

Patient presents with Paralysis or paresis of vertical eye movement, slowed diminished response to light- area affected + blood supply?

Back 67

Tectum of midbrain - PCA

Front 68

Patient presents with decerebrate posturing - area affected + blood supply?

Back 68

Upper motor neuron tracts in cerebral peduncle caudal to red nucleus of midbrain - PCA

Front 69

Blood supply overlap @ parahippocampal gyrus

Back 69

Posterior cerebral + anterior choroidal

Front 70

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Front 71

Back 71