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Generalitati
4 artere magistrale: 2 ACI si 2 a.vertebrale; ACI: iriga 2/3 ant.ale emisf.cerebrale; a.vertebrale+tr.bazilar: iriga 1/3 post.emisf.cerebrale, cerebelul si tr.cerebral; linia de separare intre cele 2 sist.: c.mamilari scizura parieto-occipitala int.; cele 2 sist. sunt unite la baza creierului prin poligonul Willis; a. trimit 2 tipuri de ramificatii: sist.vaselor corticale(superficial) si sist.vaselor centrale(profund); cele 2 sist. de ramificatii sunt independente si nu se suplinesc; in subst.cerebrala arterele au caracter terminal;
2. a.orbito-frontala: lat.lob orbito-frontal si f.lat.lob prefrontal; 3. r.din M2: precentral, postcentral, parietal ant. si parietal post.; se
gasesc in triunghiul sylvian;
Sistemul vertebro-bazilar
A.vertebrale converg la marg.caudala a puntii si form.tr.bazilar; tr.bazilar sta pe mijl. f.ventrale a puntii marg.sup.a puntii se bifurca in a.cerebrale post;
Artera vertebrala
Origine: a.subclaviculara; Traiect: ascendent si medial spre foramen apf.transverse C6 urca impr.cu n.vertebral pana la niv.gaurii transverse a axisului curba spre inafara catre gaura transvera a atlasului strabate gaura atlas ocoleste masa lat atlas in sus si med si strab.mb.occipito-atloidiana si foramen magnum in craniu sp.subarahnoid.(strab.dura si arahnoida) f.lat bulb(ant. de n XII) si aj.pe f.ventrala a bulb la marg.caudala punte se uneste cu opusa si form.tr.bazilar;
Artera vertebrala
Ramuri colaterale:
Cervicale: r.musculare si rahidiene; Intracraniene: a.spinale ant.si post.; a.bulbare; a.cerebeloasa post.-inf.;
Trunchiul bazilar
sit.in cisterna prepontina, post.clivusului; la marg.sup.a puntii se bifurca in cele 2 a.cerebrale post.;
Ramuri colaterale:
A.paramedienepunte; A.cerebeloase ant-inf si sup.; A.radicularen VI, VII, VIII; A.labirinticameat auditiv int.urechea interna;
Ramuri terminale:
1. a.temp.post. iriga f.inf.lobi temp si occipit.; 2. a.occipit.int. 2 r. de bifurc.: r.parieto-occipit si r.calcarin; iriga f.int.lob occipit.si splenium; a.calcarina iriga cortexul vizual;
Venele cerebelului
real.o bogata retea piala, drenata de mai multe vene; V.vermiana sup. v.cerebrala mare; V.vermiana inf. confluens sinuum; 2 v.ventrale sinus.pietroase; 2 v.dorsale sinus.transverse;
Spinal Cord
Vascular Supply
Arterial Supply
- Spinal Arteries Anterior (1) & Posterior (2) Spinal Artery from Vertebral artery - Radicular Arteries ----- Segmental arteries from Vertebral, Ascending Cervical, Intercostal and Lumbar Artery
Venous Drainage
- Longitudinal & Radicular Veins to Intervertebral veins ---- to Internal Vertebral Venous Plexus to external vertebral venous plexus ---- to segmental veins
5. Adamkiwicz artery
segmental arteries
The brain receives its blood from two pairs of arteries, the carotid and vertebral. About 80% of the brains blood supply comes from the carotid, and the remaining 20% from the vertebral.
The Medulla, Pons and Midbrain areas receive their major sources of blood supply from several important branches of the Basilar artery
Runs down the ventral median fissure the length of the cord.
Distribution: a. supplies the ventral 2/3 of the spinal cord.
Ventral
Dorsal
One radicular artery, noticeably larger than the others, is called the artery of Adamkiewicz, or the artery of the lumbar enlargement. Usually located with the lower thorasic or upper lumbar spinal segment on the left side of the spinal cord
The spinal cord lacks adequate collateral supply in some areas, making these regions prone to ischemia after vascular occlusions. The upper Thorasic (T1-T4) and first lumbar segments are the most vulnerable regions of the cord.
Distribution:
a. paramedian pontine - basal pons b. circumferential pontine - lateral pons and middle cerebellar peduncle, floor of fourth ventricle and pontine tegmentum
1. Anterior spinal artery, sends blood to the paramedian region of the caudal medulla.
2. Posterior spinal artery, supplies rostral areas, including the gracile and cuneate fasiculi and nuclei, along with dorsal areas of the inferior cerebellar peduncle. 3. Vertebral artery, bulbar branches supply areas of both the caudal and rostral medulla. 4. Posterior inferior cerebellar artery, supplies lateral medullary areas.
4. Hornors syndrome, (miosis [contraction of the pupil], ptosis [sinking of the eyelid], decreased sweating), due to damage to the descending hypothalamolspinal tract
1. The Basilar artery, contributions of this main artery can be further subdivided; a. paramedian branches, to medial pontine region b. short circumferential branches, supply anterolateral pons c. long circumferential branches, run laterally over the anterior surface of the Pons to anastomose with branches of the anterior inferior cerebellar artery (AICA).
2. Some reinforcing contributions by the anterior inferior cerebellar and superior cerebellar arteries
Additional branches of the Basilar artery can be found branching off within the region of the Pons; 1. Anterior Inferior Cerebellar Arteries (AICA), originates near the lower border of the Pons just past the union of the vertebral arteries.
Distribution: a. supplies anterior inferior surface and underlying white matter of cerebellum b. contributes to supply of central cerebellar nuclei c. also contributes to upper medulla and lower pontine areas
2. Labyrynthine arteries, may branch from the basilar, but variable in its origin. Supplies the region of the inner ear. Divides into two branches; a. anterior vestibular b. common cochlear The labyrinthine has a variable origin, according to a study done by Wende et. al., 1975, (sample size of 238) the artery originated from; 1. Basilar (16%) 2. AICA (45%) 3. Superior cerebellar (25%) 4. PICA (5%) 5. Remaining 9% were of duplicate origin
4. Posterior communicating artery, derived from the internal carotid, joins the posterior cerebral to form portions of the circle of Willis (arterial circle). Contributes to the interpeduncular plexus
5. Branches of these arteries are best understood when grouped into paramedian, short circumferential and long circumferential
Substantial infarcts within the Pons are generally rapidly fatal, due to failure of central control of respiration Infarcts within the ventral portion of the Pons can produce paralysis of all movements except the eyes. Patient is conscious but can communicate only with eyes. LOCKED-IN-SYNDROME
Vertebral-Basilar System
Supplies the brainstem and parts of the cerebrum and spinal cord. Gets blood supply from the subclavian artery.
Basilar Artery
Vertebral Aretries
Vertebral-Basilar System
The Vertebral Arteries are responsible for supplying the spinal cord, medulla, and parts of the cerebellum. The Basilar Arteries supply the internal ears, pons, as well as cerebellum.
Vertebral-Basilar System
The Vertebral Arteries give rise to 3 branches the posterior and anterior spinal arteries and the posterior inferior communicating artery (PICA).
** PICA supplies much of the inferior surface of the cerebellum, choroid plexus of the 4th ventricle, and the lateral medulla.
Vertebral-Basilar System
The Basilar Artery gives rise to the Anterior Inferior Communicating Artery (AICA).
Vertebral-Basilar System
The basilar arteries branches out into the posterior cerebral arteries which supply the midbrain, occipital lobe, and medial surfaces of the temporal lobe.
Circle of Willis
The Posterior Communicating Artery links the Internal Carotid System to the Vertebral-Basilar System.
Circle of Willis
Surrounds the optic chiasm, infundibulum, and mammillary bodies and is important for the mechanism for collateral circulation following occlusion of blood flow.
Venous System
Cerebral veins are divided into Superficial and Deep groups. Cerebral veins are valveless and eventually empty into the internal jugular veins and then to the right atrium of the heart.
Venous System
Superficial veins empty into the Superior Sagittal Sinus.
Has three veins that are common from one brain to another--Superficial Middle Cerebral Vein, Vein of Trolard, and the Vein of Labbe`.
Venous System
Deep veins ultimately empty into the Straight Sinus The major deep vein is the Internal Cerebral Vein.
Blood Flow
The brain is very active metabolically yet there is no way for the brain to effectively store oxygen and glucose. The brain is 2% of total body weight yet accounts for 15% of cardiac output and 25% of oxygen consumption. Without oxygen damaging effects can happen---10 secs. of brain ischemia we lose conciousness, 20 secs. electrical activity ceases, after a few minutes irreversible brain damage begins (think Terri Schiavo)!!!! Brain damage can also happen if brain goes without glucose for 10-15 minutes.
Types of Strokes
Ischemic stroke- (those caused by vascular insufficiencies) are most commonly caused by a thrombus (a blood clot formed within the vessel) or an embolus (a bit of foreign matter such as a plaque that is carried along in the bloodstream).
Types of Strokes
Transient Ischemic attack- is like an ischemic attack but only last a few minutes to a few hours and usually has a complete recovery. Hemorrhage-results from the rupture of the small perforating arteries (lenticulostriate arteries). Greatly increased through hypertension. Aneurysms-balloon-like swellings of the arterial walls. Can cause damage by compressing brain structures and by rupturing the subarachnoid space.
Good Luck !