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Central nervous system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The brain is supplied with blood from two sources. The bilateral internal carotid arteries arise from the bifurcation of the common carotid arteries in the neck and branch off to form the left and right anterior and middle cerebral arteries, which supply the forebrain. The vertebral arteries arise from the subclavian arteries and come together at the level of the pons to form the midline basilar artery. The posterior cerebral, basilar and vertebral arteries supply the posterior circulation of the brain, comprising posterior cortex, the midbrain and the brainstem. Cerebellum is also supplied by dorsolateral arteries such as the posterior inferior cerebellar artery (PICA) and the anterior inferior cerebellar artery (AICA) and superior cerebellar artery. An arterial ring called the circle of Willis connects the anterior and posterior cerebral circulation; thus, in the event of loss of blood supply to one area of the brain, it may be possible for blood to be supplied via a different arterial route.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The vertebral artery gives off the posterior inferior cerebellar artery, which is its largest branch and supplies the cerebellum. The anterior and posterior spinal arteries also arise from the vertebral artery and supply the medulla in addition to the spinal cord.
The Problems
Published in John Greene, Ian Bone, Understanding Neurology a problem-orientated approach, 2007
This includes special attention to the testing of speech, external eye movements, upper and lower limb coordination, assessment of involuntary movements, and observation of gait. The anatomical localization of ataxia is only possible by means of a thorough neurological examination. The degenerative hereditary and familial cerebellar ataxias have cerebellar signs that may be marked or slight but, in addition, patients also show posterior column, corticospinal, and/or neuropathic signs (characteristic of Friedreich’s ataxia). Thrombosis of the posterior inferior cerebellar artery due to vertebral occlusion is the commonest vascular lesion of the cerebellum, and presents with acute vertigo and distinctive medullary signs (cranial nerve IX/X palsy, Horner’s syndrome, impairment of facial and contralateral pain and temperature sensations). These features occur in addition to more obvious cerebellar features of nystagmus and limb ataxia. The same artery also supplies the lateral part of the medulla.
Intracranial collaterals and arterial wall features in severe symptomatic vertebrobasilar stenosis
Published in Neurological Research, 2020
Ming Yang, Ning Ma, Liping Liu, Anxin Wang, Jing Jing, Zhikai Hou, Yifan Liu, Xin Lou, Zhongrong Miao, Yongjun Wang
Several limitations of this study should be addressed when interpreting the results. First, the small sample size may reduce its power and increase the possibility of bias. Second, this study included patients exclusively with severe symptomatic vertebrobasilar stenosis; thus, it may be not applicable to asymptomatic patients or patients with mild and moderate stenosis. Third, the dominance of vertebral artery and the anastomosis between posterior inferior cerebellar artery and anterior inferior cerebellar artery may also influence the progression of vertebrobasilar atherosclerosis and bias our results. Fourth, our evaluation of vulnerable plaques and arterial remodeling is a cross-sectional study. An ideal longitudinal cohort study, detecting cerebrovascular events and the changes of plaque features, vessel wall in response to plaque growth, might better elucidate its relationship.
A hybrid operating room for combined surgical and endovascular procedures for cerebrovascular diseases: a clinical experience at a single centre
Published in British Journal of Neurosurgery, 2019
Euidon Choi, Jong Young Lee, Hong Jun Jeon, Byung-Moon Cho, Dae Young Yoon
Four cases of blood blister aneurysm (BBA) and 1 ruptured aneurysm of the posterior inferior cerebellar artery (PICA) were treated by one-off combined bypass surgery and endovascular trapping of the pathologic segment. In emergency situations, the balloon occlusion test was not performed to evaluate the collateral flow. In cases of blister aneurysm, the carotid compression test was performed to reveal angiographic collateral flow. In all cases of BBA, poor collateral flow was identified. In all cases, bypass surgery was performed first, and subsequently, coil embolisation was performed. During interventional procedure, craniotomy was left open in cases of anterior circulation lesion. After coil embolisation, further dissection was done to identify the lesions. In a case of posterior circulation lesion, craniotomy was closed before coil embolisation because the patient’s position needed to change from prone to supine. All procedures were done without any complication.
Diagnostic value of eye movement and vestibular function tests in patients with posterior circulation infarction
Published in Acta Oto-Laryngologica, 2019
Xia Ling, Wenwen Sang, Bo Shen, Kangzhi Li, Lihong Si, Xu Yang
Among 38 PCI patients, 12 presented with isolated dizziness/vertigo and underwent MRI for analysis of the blood-supply area. Ten patients suffered from cerebellar infarction. One patient experienced medullary infarction and was negative on diffusion-weighted imaging (DWI). One patient had the infarction at the right thalamus, right splenium of corpus callosum, and right occipital lobe. Further analysis showed that among 10 cerebellar infarcts, 2 occurred at flocculus, 1 at nodulus, 1 at tonsil, 5 at cerebellar hemisphere (2 cases of biventral lobule, 3 cases of inferior semilunar lobule), and 1 at cerebellar hemisphere and vermis. Eight cerebellar infarcts occurred at the blood-supply area of the posterior inferior cerebellar artery (PICA) and 2 at the blood-supply area of the anterior inferior cerebellar artery (AICA) (Figure 2).