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Ipsilateral Subclavian Steal in Association with Aberrant Origin of the Left Vertebral Artery from the Aortic Arch
411 Ipsilateral Subclavian Steal in Association with Aberrant Origin of the Left Vertebral Artery from the Aortic Arch John Holder1 Five cases are reported of left subclavian steal syndrome associated with anomalous Eugene F. Binet2 origin of the left vertebral artery from the aortic arch. In all five instances blood flow at Bernard Thompson3 the origin of the left vertebral artery was in an antegrade direction contrary to that usually reported in this condition. The distal subclavian artery was supplied via an extensive collateral network of vessels connecting the vertebral artery to the thyro cervical trunk. If a significant stenosis or occlusion is present within the left subc lavi an artery proximal to the origin of the left vertebral artery, the direction of the bl ood fl ow within the vertebral artery will reverse toward the parent vessel (retrograde flow). This phenomenon occurs when a negative pressure gradient of 20-40 torr exists between the vertebral-basilar artery junction and th e vertebral-subc lavian artery junction [1-3]. We describe five cases of subclavian steal confirmed by angiography where a significant stenosis or occlusion of the left subclavian artery was demonstrated in association with anomalous origin of th e left vertebral artery directly from the aortic arch. In all five cases blood flow at the origin of the left vertebral artery was in an antegrade direction contrary to that more commonly reported in the subclavian steal syndrome. Materials and Methods The five patients were all 44- 58-year-old men. Three sought medical attention for symptoms specificall y related to th e left arm . -
A Unique Temporary Collateral Pathway Between Carotid-Vertebrobasilar
Liu et al. BMC Neurology (2020) 20:97 https://doi.org/10.1186/s12883-020-01651-1 CASE REPORT Open Access A unique temporary collateral pathway between carotid-vertebrobasilar arteries in a carotid dissection patient Xiaogang Liu1†, Bing Li2†, Ying Liu3, Hongliang Wu2* , Huilong Zhang2, Lianwei Dou2 and Chuanyu Liu2 Abstract Background: In adults, the anastomosis between carotid and vertebrobasilar arteries is usually the posterior communicating artery, sometimes the primitive trigeminal artery. In this case, the basilar artery fed the internal carotid artery through the pontine-to-tentorial artery anastomosis after severe stenosis from traumatic carotid dissection. Case presentation: A 32-year-old female was diagnosed with ischemic stroke caused by traumatic carotid artery dissection. Aspirin (100 mg/day) and clopidogrel (75 mg/day) were prescribed. Digital subtraction angiography performed 6 days after stroke onset showed a dissection in the cervical segment of left internal carotid artery with severe local stenosis, and a collateral pathway from BA to the cavernous segment of internal carotid artery through the lateral pontine and tentorial artery. Without interventional therapy, clinical symptoms improved significantly within 10 days after onset. At 3-month follow-up, left common carotid artery angiography showed the stenosis had been significantly improved with a residual aneurysm. There was no collateral pathway between carotid-vertebrobasilar arteries, and a residual small artery originated from the posterior vertical segment of cavernous internal carotid artery. The small artery was clearly visualized by 3-dimensional rotational angiography and identified the tentorial artery. Conclusion: To the author’s knowledge, this is the first report of a collateral pathway between carotid vertebrobasilar arteries through the pontine-to-tentorial artery anastomosis. -
17 Blood Supply of the Central Nervous System
17 Blood supply of the central nervous system Brain Lateral aspect of cerebral hemisphere showing blood supply Central sulcus Motor and sensory strip Visual area Broca area Circle of Willis Anterior cerebral artery Anterior communicating artery Optic chiasm IIIrd cranial nerve Middle cerebral artery IVth cranial Internal carotid artery nerve Pons Posterior communicating artery Posterior cerebral artery Auditory area and Vth cranial Wernicke's area in left nerve Superior cerebellar artery dominant hemisphere VIth cranial Pontine branches nerve Basilar artery Anterior cerebral Posterior cerebral artery supply artery supply VII and Anterior inferior cerebellar artery Middle cerebral VIII cranial artery supply nerves Vertebral artery Coronal section of brain showing blood supply IX, X, XI Anterior spinal artery cranial nerves Posterior inferior cerebellar artery XII cranial nerve Caudate Globus Cerebellum nucleus pallidus Lateral ventricle C3/C4 Branch of left Spinal cord cord thyrocervical trunk Thalamus Cervical Red nucleus Subthalamic T5/T6 Intercostal nucleus cord branch area of damage Thoracic ischaemic Watershed T10 Great-anterior L2 Anterior choroidal medullary artery artery (branch of of Adamkiewicz internal carotid cord Hippocampus Lumbar artery to lower two thirds of Reinforcing internal capsule, cord inputs globus pallidus and Penetrating branches of Blood supply to Sacral limbic system) middle cerebral artery spinal cord Posterior spinal arteries Dorsal columns Corticospinal tract supply Anterior Spinothalamic tract spinal artery Medullary artery— Anterior spinal artery replenishing anterior spinal artery directly 42 The anatomical and functional organization of the nervous system Blood supply to the brain medulla and cerebellum. Occlusion of this vessel gives rise to the The arterial blood supply to the brain comes from four vessels: the right lateral medullary syndrome of Wallenberg. -
The Variations of the Subclavian Artery and Its Branches Ahmet H
Okajimas Folia Anat. Jpn., 76(5): 255-262, December, 1999 The Variations of the Subclavian Artery and Its Branches By Ahmet H. YUCEL, Emine KIZILKANAT and CengizO. OZDEMIR Department of Anatomy, Faculty of Medicine, Cukurova University, 01330 Balcali, Adana Turkey -Received for Publication, June 19,1999- Key Words: Subclavian artery, Vertebral artery, Arterial variation Summary: This study reports important variations in branches of the subclavian artery in a singular cadaver. The origin of the left vertebral artery was from the aortic arch. On the right side, no thyrocervical trunk was found. The two branches which normally originate from the thyrocervical trunk had a different origin. The transverse cervical artery arose directly from the subclavian artery and suprascapular artery originated from the internal thoracic artery. This variation provides a short route for posterior scapular anastomoses. An awareness of this rare variation is important because this area is used for diagnostic and surgical procedures. The subclavian artery, the main artery of the The variations of the subclavian artery and its upper extremity, also gives off the branches which branches have a great importance both in blood supply the neck region. The right subclavian arises vessels surgery and in angiographic investigations. from the brachiocephalic trunk, the left from the aortic arch. Because of this, the first part of the right and left subclavian arteries differs both in the Subjects origin and length. The branches of the subclavian artery are vertebral artery, internal thoracic artery, This work is based on a dissection carried out in thyrocervical trunk, costocervical trunk and dorsal the Department of Anatomy in the Faculty of scapular artery. -
Camelus Dromedarius, Linnaeus 1758)
Int. J. Morphol., 37(3):1095-1100, 2019. Morphological Configuration and Topography of the Brain Arterial Supply of the One-humped Camel (Camelus dromedarius, Linnaeus 1758) Configuración Morfológica y Topografía del Suministro Arterial del Encéfalo del Camello de una Joroba (Camelus dromedarius, Linnaeus 1758) Hassen Jerbi1; Noelia Vazquez2 & William Pérez2 JERBI, H.; VAZQUEZ, N. & PÉREZ, W. Morphological configuration and topography of the brain arterial supply of the one-humped camel (Camelus dromedarius, Linnaeus 1758). Int. J. Morphol., 37(3):1095-1100, 2019. SUMMARY: This study investigated the anatomy of the arteries of the brain, including the arterial circle of the brain, its branches and junctions, in five camel (Camelus dromedarius, Linnaeus 1758) following intravascular injection of colored latex via common carotid artery. The course and distribution of the arterial supply to the brain was described and morphological analysis was made. The basilar artery contributed to the blood supply of the brain in the camel in contrast to the situation in other Artiodactyla order. KEY WORDS: Anatomy; Blood vessels; Camelidae; Circulatory system; Cerebral arterial circle. INTRODUCTION Nearly 400 years ago, Thomas Willis gave the most the cerebral arterial circle (circle of Willis) (Kanan, 1970; Smuts detailed anatomic description of the arterial anastomosis at & Bezuidenhout, 1987; Ocal et al., 1999). the base of the brain, surrounded by cerebrospinal fluid. The arterial anastomotic ring that connects the internal carotid The most detailed description of circulus arteriosus arteries, and vertebrobasilar circulation by communicating cerebri was published by Kanan, but this work don´t showed arteries is called circle arteriosus cerebri. In humans and black photographs and topography by sections of these vessels in bears, blood supply to the brain is provided by two internal relation to the different parts of the head and encephalon. -
Vertebrobasilar Contribution to Cerebral Arterial System of Dromedary Camels (Camelus Dromedarius)
ORIGINAL RESEARCH published: 11 June 2021 doi: 10.3389/fvets.2021.696707 Vertebrobasilar Contribution to Cerebral Arterial System of Dromedary Camels (Camelus dromedarius) Ahmad Al Aiyan 1*, Preetha Menon 1, Adnan AlDarwich 1, Moneeb Qablan 1, Maha Hammoud 1, Turke Shawaf 2 and Ken Richardson 3 1 Department of Veterinary Medicine, College of Food and Agriculture, United Arab Emirates University, Al Ain, United Arab Emirates, 2 Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Hasa, Saudi Arabia, 3 College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia It is hypothesized that in the “more highly evolved” mammals, including the domesticated mammals, that the brainstem and the cerebellum receive arterial blood through the vertebrobasilar system whilst the internal carotid arteries primarily supply the forebrain. Edited by: In camels, the arterial blood supply to the brain differs from that of ruminants since the George M. Strain, internal carotid artery and the rostral epidural rete mirabile (RERM) are both present and Louisiana State University, United States the basilar artery contributes a significant proportion of cerebral afferent blood. In this Reviewed by: study, we described the anatomical distribution of the vertebrobasilar system arterial Michelle Osborn, supply in the dromedary. Secondly, we determined the direction of blood flow within the Louisiana State University, vertebral and basilar arteries using transcranial color doppler ultrasonography. Thirdly, we United States Louis R. Caplan, quantified the percentage arterial contributions of the carotid and vertebrobasilar systems Harvard Medical School, to the dromedary brain. Fifty-five heads of freshly slaughtered male Omani dromedaries United States aged 2–6 years were dissected to determine the distribution and topography of the *Correspondence: Ahmad Al Aiyan arterial distribution to the brain. -
Notably the Posterior Cerebral Artery, Do Not Develop Fully Until the Embryo
THE EMBRYOLOGY OF THE ARTERIES OF THE BRAIN Arris and Gale Lecture delivered at the Royal College of Surgeons of England on 27th February 1962 by D. B. Moffat, M.D., F.R.C.S. Senior Lecturer in Anatomy, University College, Cardiff A LITTLE OVER 300 years ago, Edward Arris donated to the Company of Barbers and Surgeons a sum of money " upon condicion that a humane Body be once in every yeare hearafter publiquely dissected and six lectures thereupon read in this Hall if it may be had with conveniency, and the Charges to be borne by this Company ". Some years later, Dr. Gale left an annuity to the Company for a similar purpose and it is interesting to note that the first Gale lecturer was a Dr. Havers, whose name is still associated with the Haversian canals in bone. The study of anatomy has changed in many ways since those days and it must be a long time since an Arris and Gale lecturer actually took his text from the cadaver. However, in deference to the wishes of our benefactors, I should like at least to com- mence this lecture by showing you part of a dissection (Fig. 1) which a colleague, Dr. E. D. Morris, and I prepared some years ago for use in an oral examination. We found that in this subject the left internal carotid artery in the neck gave off a. large branch which passed upwards and back- wards to enter the skull through the hypoglossal canal. In the posterior cranial fossa this artery looped caudally and then passed forwards in the midline to form the basilar artery which was joined by a pair of very small vertebral arteries. -
Parts of the Body 1) Head – Caput, Capitus 2) Skull- Cranium Cephalic- Toward the Skull Caudal- Toward the Tail Rostral- Toward the Nose 3) Collum (Pl
BIO 3330 Advanced Human Cadaver Anatomy Instructor: Dr. Jeff Simpson Department of Biology Metropolitan State College of Denver 1 PARTS OF THE BODY 1) HEAD – CAPUT, CAPITUS 2) SKULL- CRANIUM CEPHALIC- TOWARD THE SKULL CAUDAL- TOWARD THE TAIL ROSTRAL- TOWARD THE NOSE 3) COLLUM (PL. COLLI), CERVIX 4) TRUNK- THORAX, CHEST 5) ABDOMEN- AREA BETWEEN THE DIAPHRAGM AND THE HIP BONES 6) PELVIS- AREA BETWEEN OS COXAS EXTREMITIES -UPPER 1) SHOULDER GIRDLE - SCAPULA, CLAVICLE 2) BRACHIUM - ARM 3) ANTEBRACHIUM -FOREARM 4) CUBITAL FOSSA 6) METACARPALS 7) PHALANGES 2 Lower Extremities Pelvis Os Coxae (2) Inominant Bones Sacrum Coccyx Terms of Position and Direction Anatomical Position Body Erect, head, eyes and toes facing forward. Limbs at side, palms facing forward Anterior-ventral Posterior-dorsal Superficial Deep Internal/external Vertical & horizontal- refer to the body in the standing position Lateral/ medial Superior/inferior Ipsilateral Contralateral Planes of the Body Median-cuts the body into left and right halves Sagittal- parallel to median Frontal (Coronal)- divides the body into front and back halves 3 Horizontal(transverse)- cuts the body into upper and lower portions Positions of the Body Proximal Distal Limbs Radial Ulnar Tibial Fibular Foot Dorsum Plantar Hallicus HAND Dorsum- back of hand Palmar (volar)- palm side Pollicus Index finger Middle finger Ring finger Pinky finger TERMS OF MOVEMENT 1) FLEXION: DECREASE ANGLE BETWEEN TWO BONES OF A JOINT 2) EXTENSION: INCREASE ANGLE BETWEEN TWO BONES OF A JOINT 3) ADDUCTION: TOWARDS MIDLINE -
The Common Carotid Artery Arises from the Aortic Arch on the Left Side
Vascular Anatomy: • The common carotid artery arises from the aortic arch on the left side and from the brachiocephalic trunk on the right side at its bifurcation behind the sternoclavicular joint. The common carotid artery lies in the medial part of the carotid sheath lateral to the larynx and trachea and medial to the internal jugular vein with the vagus nerve in between. The sympathetic trunk is behind the artery and outside the carotid sheath. The artery bifurcates at the level of the greater horn of the hyoid bone (C3 level?). • The external carotid artery at bifurcation lies medial to the internal carotid artery and then runs up anterior to it behind the posterior belly of digastric muscle and behind the stylohyoid muscle. It pierces the deep parotid fascia and within the gland it divides into its terminal branches the superficial temporal artery and the maxillary artery. As the artery lies in the parotid gland it is separated from the ICA by the deep part of the parotid gland and stypharyngeal muscle, glossopharyngeal nerve and the pharyngeal branch of the vagus. The I JV is lateral to the artery at the origin and becomes posterior near at the base of the skull. • Branches of the ECA: A. From the medial side one branch (ascending pharyngeal artery: gives supply to glomus tumour and petroclival meningiomas) B. From the front three branches (superior thyroid, lingual and facial) C. From the posterior wall (occipital and posterior auricular). Last Page 437 and picture page 463. • The ICA is lateral to ECA at the bifurcation. -
Spontaneous Arteriovenous Malformations in the Cervical Area
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.33.3.303 on 1 June 1970. Downloaded from J. Neurol. Neurosurg. Psychiat., 1970, 33, 303-309 Spontaneous arteriovenous malformations in the cervical area J. GREENBERG, M.D. From the Department of Neurology, Episcopal Hospital, Philadelphia, Pennsylvania 19125, U.S.A. SUMMARY Four patients with spontaneous arteriovenous malformations of cervical vessels have been presented. The embryology of these vessels has been discussed in order to suggest an ex- planation for the apparent difference in the incidence of arteriovenous malformations involving the internal carotid artery and those involving either the vertebral or the external carotid arteries. A fifth case (S.T.) is presented as a probable iatrogenic arteriovenous fistula and is to be added to the steadily growing reports of this phenomenon. Trauma is the most common cause of arteriovenous had sustained a minor injury to the posterior aspect communications between the blood vessels in of the right ear. Routine skull films at the time did not the cervical area (Aronson, 1961). Iatrogenic reveal a fracture, and there was no evidence of local Protected by copyright. deep tissue injury noted. fistulae occurring after carotid or vertebral angio- On the present admission, a slight prominence of the graphy are being reported with regularity in the right retroauricular region was noted and a thrill and recent literature (Sutton, 1962). Spontaneous mal- bruit were present. The bruit could be obliterated by formations in this area also occur. Thus far, eight local pressure. cases have been reported involving the vertebral The neurological examination was within normal vessels (Norman, Schmidt, and Grow, 1950; limits. -
Ascending and Descending Thoracic Vertebral Arteries
CLINICAL REPORT EXTRACRANIAL VASCULAR Ascending and Descending Thoracic Vertebral Arteries X P. Gailloud, X L. Gregg, X M.S. Pearl, and X D. San Millan ABSTRACT SUMMARY: Thoracic vertebral arteries are anastomotic chains similar to cervical vertebral arteries but found at the thoracic level. Descending thoracic vertebral arteries originate from the pretransverse segment of the cervical vertebral artery and curve caudally to pass into the last transverse foramen or the first costotransverse space. Ascending thoracic vertebral arteries originate from the aorta, pass through at least 1 costotransverse space, and continue cranially as the cervical vertebral artery. This report describes the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Being located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries can have important implications during spine inter- ventional or surgical procedures. Because they frequently provide radiculomedullary or bronchial branches, they can also be involved in spinal cord ischemia, supply vascular malformations, or be an elusive source of hemoptysis. ABBREVIATIONS: ISA ϭ intersegmental artery; SIA ϭ supreme intercostal artery; VA ϭ vertebral artery he cervical portion of the vertebral artery (VA) is formed by a bral arteria lusoria8-13 or persistent left seventh cervical ISA of Tseries of anastomoses established between the first 6 cervical aortic origin.14 intersegmental arteries (ISAs) and one of the carotid-vertebral This report discusses 9 angiographic observations of descend- anastomoses, the proatlantal artery.1-3 The VA is labeled a “post- ing thoracic VAs and 2 cases of ascending thoracic VAs. costal” anastomotic chain (ie, located behind the costal process of cervical vertebrae or dorsal to the rib itself at the thoracic level) to CASE SERIES emphasize its location within the transverse foramina. -
THE SYNDROMES of the ARTERIES of the BRAIN AND, SPINAL CORD Part II by LESLIE G
I19 Postgrad Med J: first published as 10.1136/pgmj.29.329.119 on 1 March 1953. Downloaded from - N/ THE SYNDROMES OF THE ARTERIES OF THE BRAIN AND, SPINAL CORD Part II By LESLIE G. KILOH, M.D., M.R.C.P., D.P.M. First Assistant in the Joint Department of Psychological Medicine, Royal Victoria Infirmary and University of Durham The Vertebral Artery (See also Cabot, I937; Pines and Gilensky, Each vertebral artery enters the foramen 1930.) magnum in front of the roots of the hypoglossal nerve, inclines forwards and medially to the The Posterior Inferior Cerebellar Artery anterior aspect of the medulla oblongata and unites The posterior inferior cerebellar artery arises with its fellow at the lower border of the pons to from the vertebral artery at the level of the lower form the basilar artery. border of the inferior olive and winds round the The posterior inferior cerebellar and the medulla oblongata between the roots of the hypo- Protected by copyright. anterior spinal arteries are its principal branches glossal nerve. It passes rostrally behind the root- and it sometimes gives off the posterior spinal lets of the vagus and glossopharyngeal nerves to artery. A few small branches are supplied directly the lower border of the pons, bends backwards and to the medulla oblongata. These are in line below caudally along the inferolateral boundary of the with similar branches of the anterior spinal artery fourth ventricle and finally turns laterally into the and above with the paramedian branches of the vallecula. basilar artery. Branches: From the trunk of the artery, In some cases of apparently typical throm- twigs enter the lateral aspect of the medulla bosis of the posterior inferior cerebellar artery, oblongata and supply the region bounded ventrally post-mortem examination has demonstrated oc- by the inferior olive and medially by the hypo- clusion of the entire vertebral artery (e.g., Diggle glossal nucleus-including the nucleus ambiguus, and Stcpford, 1935).