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Clinical Anatomy Circle Of Willis & Cavernous Sinus
 

Clinical Anatomy Circle Of Willis & Cavernous Sinus

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This presentation will guide you through the basic anatomy of the Cirlce of Willis and Cavernous Sinus

This presentation will guide you through the basic anatomy of the Cirlce of Willis and Cavernous Sinus

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    Clinical Anatomy Circle Of Willis & Cavernous Sinus Clinical Anatomy Circle Of Willis & Cavernous Sinus Presentation Transcript

    • Circle of Willis and Cavernous Sinus Clinical Anatomy Dr. Ankit M. Punjabi Dept of Ophthalmology, KIMS Hospital, Bangalore Karnataka, INDIA [email_address]
    • CIRCLE OF WILLIS
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    • TERRITORIES OF MAJOR ARTERIES OF BRAIN
    • TERRITORIES OF MAJOR ARTERIES OF BRAIN
    • TERRITORIES OF MAJOR ARTERIES OF BRAIN
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      • Representation
      • to show
      • major arterial supply
      • in the Circle of Willis
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    • TERRITORIES OF MAJOR ARTERIES OF BRAIN
    • Branches and distribution of MIDDLE CEREBRAL ARTERY
    • Branches and distribution of ANTERIOR CEREBRAL ARTERY and some branches of POSTERIOR CEREBRAL ARTERY
    • Branches and distribution of POSTERIOR CEREBRAL ARTERY
    • Deep brain structure supply
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      • Cerebral Infarction
      • Transient Ischemic Attacks
      • Vascular Malformations (Aneurysm, etc)
      • Intracranial Hemorrhage
      • Tumors of adjacent structures
      • Inflammatory Diseases of Arteries
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    • Common Sites for Plaque Formation
      • Internal Carotid
        • Ipsilateral blindness
        • Contralateral hemiparesis
        • Contralateral hemianesthesia
        • Hemianopia
        • Aphasia, hemineglect
      • Middle Cerebral
        • Main trunk : Hemiplegia, hemianesthesia,
        • hemianopia, Aphasia
        • Upper division : Hemiparesis &
        • sensory loss ( arm/face > leg)
        • Lower division : Wernicke Aphasia
        • Penetrating Artery : pure motor hemiparesis
    • Common Sites for Plaque Formation
      • Anterior Cerebral
        • Hemiparesis & sensory loss (leg>arm)
        • Impaired responsiveness
      • Posterior Cerebral
        • Cortical (U/L) : isolated hemianopia
        • (or quadrantic defect),
        • color anomia
        • Cortical (B/L) : cerebral blindness
        • (+/- macular sparing)
        • Thalamic : Pure sensory stroke
        • Subthalamic : Hemiballism
        • B/L inf temporal lobe : Amnesia
        • Midbrain : Oculomotor &
        • other Cr. N. palsy
    • 30-35% 30-35% 20% 5% 5%
    • Site of Aneurysm Impaired Visual Sensory Structures (Frequency) Impaired Ocular Motor Structures (Frequency) Cavernous carotid artery Ipsilateral optic nerve, anterior chiasm (rare) Ipsilateral cranial nerves III, IV, VI, V 1 , and oculosympathetic complex (common and early) Carotid-ophthalmic artery Ipsilateral optic nerve, lateral chiasm (common) Exceptional Supraclinoid carotid artery Ipsilateral optic nerve, lateral chiasm, optic tract (common) Exceptional Posterior communicating artery Ipsilateral optic nerve, lateral chiasm, optic tract (rare) Ipsilateral cranial nerve III Anterior communicating artery Contralateral > ipsilateral optic nerves, chiasm (common) Exceptional Posterior circulation Basilar artery Chiasm (rare); occipital cortex (uncommon emboli) Unilateral or bilateral cranial nerve III, midbrain, pons (common) Posterior inferior cerebellar-vertebral artery None Unilateral cranial nerve VI
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    • Watershed Infarctions Resulting from Occlusion of the Internal Carotid Artery Anterior Contralateral hemiparesis predominating in the leg and sparing the face Contralateral decrease in superficial and deep sensation in the same distribution Mutism/aphasia if dominant hemisphere Posterior Contralateral homonymous hemianopia, incomplete, with macular sparing Contralateral brachiofacial cortical hypoesthesia Contralateral motor weakness rare and mild Fluent aphasia if dominant hemisphere Contralateral hemispatial neglect and anosognosia if nondominant hemisphere Supranuclear horizontal gaze paresis with reduced or no spontaneous eye movements toward the side of the lesion Subcortical Contralateral brachiofacial hemiparesis Contralateral hemisensory deficit Expressive speech disturbances if dominant hemisphere
    • Hemispheric Infarctions Resulting from Occlusion of the Anterior Cerebral Artery Proximal to its junction with the anterior communicating artery Asymptomatic if good anterior communicating artery Optic chiasmal syndrome Entire territory infarcted Severe contralateral hemiplegia, Cortical anesthesia over the leg Apraxia affecting the left arm (damage to corpus callosum) Behavioral changes (see below) Distal to the anterior communicating artery Contralateral hemiplegia predominating on the leg Apraxia of left arm Contralateral forced grasping and groping if motor deficit mild Alien hand sign Intermanual conflict Transcortical aphasia if left lesion Abulia, Incontinence, Dementia Distal occlusion (caudate nucleus) Slight transient hemiparesis Dysarthria Behavioral and cognitive disturbances (abulia, agitation, contralateral neglect, difficulties with language)
    • Hemispheric Infarctions Resulting from Occlusion of the Middle Cerebral Artery
    • Thalamic Arterial Supply and Principal Clinical Features of Focal Infarction
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      • Macular area is
      • watershed area
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    • CAVERNOUS SINUS
    • CAVERNOUS SINUS
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    • Structures in lateral wall
        • Oculomotor nerve
        • Trochlear nerve
        • Ophthalmic nerve
          • Lacrimal
          • Frontal
          • Nasociliary
        • Maxillary nerve
        • Trigeminal ganglion
      Structures in centre of sinus
        • Internal carotid artery
          • Men.Hypo. A
          • Capsular A
          • A. to Cav sinus
        • Sympathetic plexuses
        • Abducent nerve
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      • VENOUS
      • VASCULATURE
      • OF BASE OF SKULL
      • Sup. Oph. Vein
      • Ant. Int. Cav. Sinus
      • Inf. Oph. Vein
      • Pterygoid Plexus
      • Mid. Menng. Vein
      • Sup. Petr. Sinus
      • Inf. Petr. Sinus
      • Basilar plexus
      • Transverse Sinus
      • Post. Int. Cav. Sinus
      • Cavernous Sinus
      • Sphenoparietal Sinus
      • Fig. 1A. —Anatomic diagrams of cavernous sinus. Drawings of coronal ( A ) and lateral ( B ) views show structure of cavernous sinus. 1 = carotid artery, 2 = oculomotor nerve, 3 = trochlear nerve, 4 = ophthalmic nerve, 5 = maxillary nerve, 6 = abducens nerve, 7 = pituitary gland, 8 = sympathetic nerve, 9 = mandibular nerve.
      • Fig. 1B. —Anatomic diagrams of cavernous sinus. Drawings of coronal ( A ) and lateral ( B ) views show structure of cavernous sinus. 1 = carotid artery, 2 = oculomotor nerve, 3 = trochlear nerve, 4 = ophthalmic nerve, 5 = maxillary nerve, 6 = abducens nerve, 7 = pituitary gland, 8 = sympathetic nerve, 9 = mandibular nerve.
    • CAVERNOUS SINUS SYNDROMES
      • Multiple cranial neuropathies:
        • Unilateral & isolated 3 rd ,4 th ,5 th , 6 th nerve palsy
        • Conbimation patterns of ophthalmoplegia
        • Painful ophthalmoplegia
        • Proptosis
        • Ocular & cranial bruits
        • Conjunctival congestion, arterialization of conjunctival veins
        • Ocular hypertension
        • Optic disc edema/pallor
        • Retinal hemorrhage
        • Anaesthesia in ophthalmic division of trigeminal
        • Horner’s syndrome
    • CAVERNOUS SINUS SYNDROMES
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    • Carotico-Cavernous Fistula
    • Cavernous Hemangioma
    • Intra-Cavernous Carotid Aneurysm
      • Thank You