Chambers, meninges and blood supply of CNS F. H. Netter Anatomický atlas člověka, překlad Grada 2003 cornu frontale pars centralis cornu occipitale cornu temporale Sobotta J, Figge FHJ. Atlas of human anatomy Urban & Schwarzenberg, 1977 F. H. Netter Anatomický atlas člověka, překlad Grada 2003 Sobottův Atlas anatomie člověka, překlad 22. vydání, Urban and Fischer 2006 Sobottův Atlas anatomie člověka, překlad 22. vydání, Urban and Fischer 2006 Sobotta J, Figge FHJ. Atlas of human anatomy Urban & Schwarzenberg, 1977 Sobotta J, Figge FHJ. Atlas of human anatomy Urban & Schwarzenberg, 1977 Sobotta J, Figge FHJ. Atlas of human anatomy Urban & Schwarzenberg, 1977 CT Meninges of CNS pia arachnoidea dura mater endorhachis Derivatives of the dura mater https://www.easynotecards.com Spaces about meninges pia arachnoidea dura mater endorhachis epidural subdural subarachnoidal space epidurální prostor vyplněn vazivem a žílami za fyziologického stavu neexistuje traumaticky-epidurální krvácení Meningeal vessels subdurální prostor fyziologicky nepatrná štěrbina mezi dura mater a arachnoideu subarachnoideální prostor mozkomíšní mok a míšní cévy mozkomíšní mok, cisterny, cévy Willisova okruhu; aneuryzma, subarachnoideální krvácení Epidural administrationSubarachnoid (spinal) block Epidural administration (anaesthesia) Dura mater – blood supplied a. carotis interna a. ophthalmica a. ethmoidalis ant. a. meningea anterior a. carotis externa a. maxillaris a. meningea media a. carotis externa a. pharyngea ascendens a. meningea posterior a. vertebralis rr. meningei Innervation of meninges Supratentorial compartment – n. trigeminus Infratentorial compartment – spinal nerves (branches of C2 and C3) Cerebrospinal fluid - liquor cerebrospinalis (CSF, liquor) - clear and colorless liquid in CNS chambers and subarachnoid space - In contrast to blood plasma – low level of proteins and amount of cells (1 mm3 CSF of a healthy individual contains 1-5 cells) - produced by secretion, about 70% in chorioid plexus of lateral chambers and roof of the IIIrd rest of CSF by metabolism of cells and as capillary ultrafiltrat - 500-800 ml/day - total volume of CSF in chamber system and subarachnoid space is 80-150 ml, but in chambers only 15-40 ml ▪ CSF protects the brain from damage that could cause shocks in sudden head movements ▪ CSF removes metabolic waste products, drugs and other substances diffused from the blood into the CNS ▪ CSF keeps the microenvironment of neurons and glia ▪ CSF has immune function ▪ CSF plays an important role in the integration of brain and endocrine function Cerebrospinal fluid - function Perivaskular Robinn-Virchow‘s space M.J.T. FitzGerald et al. 2007. Clinical Neuroanatomy and Neuroscience. ▪ produced in the lateral ventricles enters the IIIrd ventricle through the interventricular foramen (foramen Monroi) ▪ from the IIIrd ventricle flows through the cerebral aqueduct into the IVth ventricle ▪ from the IVth ventricle into the subarachnoid space through openings in the roof of the IVth ventricle; the larger median foramen Magendii (apertura mediana ventriculi quarti) and two lateral foramina of Luschka (aperturae laterales ventriculi quarti) ▪ most of CSF is absorbed into the venous system through the arachnoid villi (granulationes arachnoideales Pacchioni) Cerebrospinal fluid - circulation foramen Magendie foramina Luschkae F. H. Netter Anatomický atlas člověka, překlad Grada 2003 Lumbar puncture Increased pressure of CSF along the optic nerve – compression of v. centralis retinae – papilledema, papillary edema M.J.T. FitzGerald et al. 2007. Clinical Neuroanatomy and Neuroscience. Increased pressure of CSF increased intracranial pressure - Hydrocephalus Timothy C. Hain 2019 www.dizziness-and-balance.com A. cerebelli inf. post. A. vertebralis A. basilaris A. cerebelli inf. ant. A. labyrinthi Aa. pontis A. cerebri post. A. cerebelli sup. A. communicans post. A. carotis interna A. cerebri media A. cerebri ant. A. communicans ant. Circulus arteriosus cerebri (Willisi), Circle of Willis A. basilaris A. cerebelli sup. A. vertebralis A. cerebelli inf. post. A. cerebelli inf. ant. F. H. Netter Anatomický atlas člověka, překlad Grada 2003 A. cerebri media A. cerebri ant. F. H. Netter Anatomický atlas člověka, překlad Grada 2003 A. cerebri post.A. cerebri media A. cerebri ant. A. pericallosa A. callosomarginalis r. calcarinus Sobotta J, Figge FHJ. Atlas of human anatomy Urban & Schwarzenberg, 1977 aa.centrales anterolaterales (leticulostriatae) A. cerebri media A. cerebri ant. A. pericallosa F. H. Netter Anatomický atlas člověka, překlad Grada 2003 https://radiopaedia.org/articles/cerebral-vascular-territories https://radiopaedia.org/articles/cerebral-vascular-territories O. Volný, R. Mikulík (2013) 1 Mezinárodní centrum klinického výzkumu (ICRC), Brno 2 Anatomický ústav LF MU, Brno 3 I. neurologická klinika LF MU a FN u sv. Anny v Brně Extracranial system of collateral circulation O. Volný, R. Mikulík (2013) 1 Mezinárodní centrum klinického výzkumu (ICRC), Brno 2 Anatomický ústav LF MU, Brno 3 I. neurologická klinika LF MU a FN u sv. Anny v Brně Intracranial system of collateral circulation epidural hematoma subdural hematoma subarachnoid hematoma Bleeding epidural hematoma – into protentional epidural space after head trauma, bleeding from anterior or posterior r. of the medial meningeal a. subdural hematoma – from superficial cerebral veins that run into the superior sagittal sinus subarachnoid bleeding – bleeding from arteries of Willis circuit – frequently from aneurysm M.J.T. FitzGerald et al. 2007. Clinical Neuroanatomy and Neuroscience. po traumatického poranění mozku, mezi dura mater a arachnoideu Subdurální hematom Symptomy.cz Subarachnoid bleeding MR angiography (MRA) CT angiography (CTA) Aneurisma 1. siphon 2. a.cerebri anterior 3. a.cerebri media 4. a.pericallosa 1 2 3 4 RTG of head Angiography - a. carotis interna 1. a.carotis interna 2. siphon 3. a.cerebri media 4. a.cerebri anterior 5. a.pericallosa 1 2 3 4 5 RTG of head Angiography - a. carotis interna 1. A.vertebralis 2. A.basilaris 3. A.cerebri posterior 1 2 3 RTG of head Angiography - a.vertebralis RTG of head Angiography - a.vertebralis 1. A.vertebralis dextra, sinistra 2. A.basilaris 3. Aa.cerebri posteriores 1 2 3 3 1 Plexus venosus vertebralis internus post. Plexus venosus vertebralis internus ant. A. M. Gilroy, B. R. MacPherson, L. M. Ross Atlas of Anatomy. Thieme 2009. Venous drainage of blood Veins and sinuses F. H. Netter Anatomický atlas člověka, překlad Grada 2003 A. M. Gilroy, B. R. MacPherson, L. M. Ross Atlas of Anatomy. Thieme 2009. A. M. Gilroy, B. R. MacPherson, L. M. Ross Atlas of Anatomy. Thieme 2009. A. M. Gilroy, B. R. MacPherson, L. M. Ross Atlas of Anatomy. Thieme 2009. F. H. Netter Anatomický atlas člověka, překlad Grada 2003 A. M. Gilroy, B. R. MacPherson, L. M. Ross Atlas of Anatomy. Thieme 2009.