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Subarachnoid haemorrhage and cerebrovascular traumatic pathology
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Daniel du Plessis, Paul Johnson
A next essential step is that of careful clearing of the basal subarachnoid haemorrhage from the vertebrobasilar arterial system, permitting exposure of these vessels prior to fixation. Such clearing should also include the circle of Willis and its major proximal branches. Clearing should be carried out using gentle irrigation by water. It must be emphasised that the posterior inferior cerebellar arteries must be preserved as part of this exercise. In those regrettable cases where a brain has been referred fixed without adequate or any clearing of the basal subarachnoid haemorrhage, the relevant vessels encased in firm blood clots require exposure, a far more difficult exercise which can be assisted by immersion (which may require several hours) and irrigation by water containing domestic dishwashing soapy detergents which assist in softening formalin-fixed blood clots. The vertebrobasilar arterial system, including the proximal posterior inferior cerebellar arteries, should be carefully dissected off the brainstem (preferably after fixation). Further examination before and after fixation should be undertaken for the presence of an aneurysm or other vascular abnormality.
Vascular Assessment and Management
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Joe J. Leyon, Kurdow Nader, Swarupsinh Chavda
All paragangliomas are supplied by branches of the ascending pharyngeal artery. Its inferior tympanic branch supplies glomus tympanicum tumours, the neuromeningeal branch supplies glomus jugulare tumours and the musculospinal branch supplies glomus vagale and carotid body tumours. The latter acquire an additional blood supply from the carotid body artery that arises directly from the carotid bifurcation. These tumours splay the ICA and ECA. Glomus vagale tumours, on the other hand, displace both ICA and ECA anteriorly and receive additional blood supply from muscular branches of the occipital artery. Contributions from meningeal arteries such as the mastoid artery, a meningeal branch of the occipital artery, indicate intracranial extradural extension. Supply from the anterior inferior or posterior inferior cerebellar arteries indicates intradural spread, and in these cases the risk of posterior fossa stroke precludes embolization.
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
Although Villiger (1912) and Herrick (1916) did not cover the vasculature of the brain in their textbooks of neuroanatomy, Tilney and Riley (1921) did. They described two sets of arteries in the medulla, comparable to the two sets of Gowers; but they labelled them as “median” and “radicular.” The latter included some branches of the posterior inferior cerebellar arteries (p. 267–268). For the pons, however, they described the arterial supply as consisting solely of “median branches of the basilar artery” and branches from the anterior inferior and the superior cerebellar arteries (p. 364). For the midbrain, they distinguished between two sets of ganglionic (= central) branches from the posterior cerebral arteries—a "postero-mesial set supplying the crus cerebri from the medial side and a “postero-lateral" set supplying the crus cerebri from the lateral side, as well as the corpora quadrigemina (p. 718–719).
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
A sign of transtentorial herniation from a supratentorial mass lesion is ipsilateral third nerve palsy with early pupil dilation, but a less commonly reported FLS is contralateral third nerve palsy.65 The supratentorial mass lesion, such as an acute large frontal intraparenchymal hemorrhage may cause a contralateral third nerve palsy, with contralateral pupil dilation and ptosis, that slowly resolves following neurosurgical intervention.65 While the pathophysiological mechanism remains unclear, anomalous anatomy may be involved.65 Contralateral uncal herniation can occur before ipsilateral uncal herniation if the patient has a narrow ipsilateral and wide contralateral tentorial opening.65 Lateral displacement of the midbrain can also cause compression of the opposite third nerve between the posterior cerebral and superior cerebellar arteries. When the hematoma is located inferiorly, initial upward displacement of the brainstem can occur.65 If there is also coronal rotation of the midbrain such that the contralateral side is raised compared with the ipsilateral side, there can be traction on the third nerve as it passes under the posterior cerebral artery, leading to contralateral pupillary dilation.65 It has been experimentally shown that frontal extradural compression produces bilateral uncal herniation, whereas temporal compression causes unilateral herniation.11 Thus, the particular location of lesion should be taken into account in the diagnosis and treatment of such cranial nerve palsies.
Ocular ischaemia: signs, symptoms, and clinical considerations for primary eye care practitioners
Published in Clinical and Experimental Optometry, 2022
Michael Kalloniatis, Henrietta Wang, Paula Katalinic, Angelica Ly, Warren Apel, Lisa Nivison-Smith, Katherine F Kalloniatis
The vertebral arteries give rise to their respective posterior cerebellar arteries before converging to form the basilar artery at the base of the skull (Figure 1(b). The posterior and anterior inferior cerebellar arteries and branches from the basilar artery supply the midbrain. The superior cerebellar artery followed by the posterior cerebral artery terminate in the midbrain, supplying the region including cranial nerves III and V (oculomotor and trigeminal). Branches of the posterior cerebral artery also supply the midbrain and the inferior region of the temporal lobe. They also extend to the lateral geniculate nucleus while the parieto-occipital branch terminates in the calcarine sulcus supplying the primary visual cortex.
Morphologic characterization of the anterior inferior cerebellar artery: a direct anatomic study
Published in Neurological Research, 2020
L.E. Ballesteros, P.L. Forero, H.Y. Estupiñan
The territory irrigated by the AICA and the superior cerebellar artery (SCA) are in dynamic equilibrium, which is expressed in scenarios in which the petrous surface and the upper part of the cerebellum are irrigated by AICA, the territory of the SCA is smaller or vice versa. Furthermore, in the presence of an agenesis or hypoplastic artery, the other cerebellar arteries modify their trajectory to irrigate the territory that would correspond to the variant vascular structure. These morphological characteristics should be taken into account in the diagnostic imaging, as well as for the surgical approaches and for the interpretation and management of the clinical events that can compromise these structures [4,8,10].