22547343 Irrigacion Del Sistema Nervioso Central
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Transcript of 22547343 Irrigacion Del Sistema Nervioso Central
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
Arteria carótida interna Arterias vertebrarles:
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
ARTERIA CAROTIDA INTERNA: Penetra en el canal carótideo sigue un
curso muy tortuoso (6 curvas). Reducción del pulso sanguíneo del encéfalo.
RAMAS : Segmento petroso: arteria
carótidotimpanica y arteria pterigoideoa. Segmento cavernoso: arteria cavernosa
y arteria meningo-hipofisiaria.
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ARTERIA OFTALMICA: es la primera gran rama (visible en
angiografía) de la ACI, desde que sale del seno cavernoso.
irriga las estructuras de la órbita y envía ramas supracocleares y supraorbitarias para irrigar la piel sobre la ceja.
IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
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IRRIGACION DEL SISTEMA NERVIOSSO CENTRAL
ARTERIA COMUNICANTE POSTERIOR:
Arteria comunicante posterior fetal. Se dirige posteriormente hasta su
anastomosis con la arteria cerebral posterior.
Nace de la carótida interna.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
ARTERIA COROIDEA ANTERIOR: Vaso pequeño que envía ramas a los
pedúnculos cerebrales y al cuerpo geniculado externo, antes de entrar al ventrículo lateral para irrigar el pelxo coroideo (junto con arterias coroideas posteriores de la cerebral posterior), envía también ramas a los ganglios basales.
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IRRIGACION DEL SISTEMA NERVIOSOS CENTRAL
ARTERIAS ESTRIADAS:
Arterias perforantes del núcleo lenticular y caudado de la cápsula interna.
La división Terminal de la arteria carótida interna da lugar a las arterias cerebral anterior y cerebral media.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
ARTERIA CERBRAL ANTERIOR: Nace a nivel de la lámina perforada
anterior y se dirige anteriormente por encima del quiasma óptico, rodea la rodilla del cuerpo calloso y retrocede por su cara posterior para irrigar la porción medial y supralateral del hemisferio cerebral, alcanzado la región parietooccipital.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL(ACA)
Arteria recurrente: núcleo lenticular. Arteria comunicante anterior: une arterias
cerebrales anteriores de los lados opuestos. Arteria frontopolar: lóbulo frontal (anterior). Arteria calloso-marginal: región frontoparietal. Arteria pericallosa: continuación de ACA RAMAS CENTRALES: cuerpo calloso, septum
lúcidum, núcleo lenticular y núcleo caudado.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
ARTERIA CEREBRAL MEDIA:
Rama más larga y por lo tanto más propensa a sufrir embolismos.
Se dirige lateralmente, envía ramas al lóbulo de la ínsula, al opérculo y a la superficie lateral del hemisferio cerebral
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL (ACM)
Arterias estriadas (o lenticuloestriadas) medial y lateral:
Se denomina arteria de la hemorragia cerebral por ser la arteria encefálica que rompe con mayor frecuencia. Irrigan los ganglios basales y la porción anterior de la cápsula interna.
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IRRIGACION DEL SISTEMA NERVICOSO CENTRAL (ACM)
Ramas corticales: Nacen en el lóbulo de la ínsula,
irrigan la superficie lateral de los hemisferios:
Ramas frontales. Ramas parietales. Ramos angulares. Ramas temporales superiores.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
SISTEMA VERTERBROBASILAR. Arteria Vertebral: nace de la arteria
subclavia, discurre por agujeros vertebrales acompañados por nervio espinal y nervios simpáticos, entra al cráneo por el agujero magno. Atraviesa la duramadre y por delante del bulbo hasta unirse a la arteria del lado opuesto.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL (A.V.)
Ramas espinales: irrigación de la médula.
Ramas musculares: músculos cervicales profundos. Se anastomosan con las ramas de las arterias occipital y faríngea ascendente.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL (A.V.)
Rama meníngea: fosa y hoz del cerebro. Arteria espinal posterior. Arteria espinal anterior. Ramas pequeñas para el bulbo.
Arteria cerebelosa inferior y posterior (ACIP)
rama medial (arteria vermiana inferior). rama lateral.
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IRRIGACION DEL SISTEMA NERVIOSOS CENTRAL
ARTERIA BASILAR: unión de dos arterias vertebrales, a nivel de la protuberancia.
Arteria pontina: irrigan protuberancia. Arteria del laberinto (auditiva interna) VII y
VIII Arteria cerebelosa inferior anterior ( ACIA)
cerebelo Arteria cerebelosa superior: cerebelo,
protuberancia y glándula pineal. Arterias cerebrales posteriores derecha e
izquierda.
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
ARTERIAS CEREBRALES POSTERIORES:
Arteria comunicante posterior de la carótida interna para completar el PLIGONO ARTERIAL DE WILLIS.
Irriga la cara inferior del lóbulo occipital y lóbulo temporal
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL (ACP)
Ramas pequeñas. Para pedúnculo cerebral, tálamo óptico posterior, cuerpo geniculado medial y lámina cuadrigémina.
Arterias lenticuloestriadas. Tálamo y núcleo lenticular.
Arterias coroideas posteriores medial y lateral
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IRRIGACION DEL SISTEMA NERVIOSO CENTRAL
RAMAS CORTICALES.
Rama temporal posterior. Región posterior del lóbulo frontal.
Rama occipital interna. Va hacia la cara medial occipital y da origen a la arteria parietooccipital y arteria calcarina.
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POLIGONO ARTERIAL DE WILLIS Anastomosis entre carótida interna
derecha e izquierda, ramas y las arterias cerebrales posteriores, forman un circuito que rodea al quiasma y tallo hipofisiario en cisternas supracellar e interpeduncular.
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ARTERIOGRAFIA CEREBRAL
Se introduce medio de contraste hidrosoluble en una arteria carótida o vertebral.
Por arteria femoral o braquial se introduce un fino catéter hasta llegar a la estructura vascular deseada.
Su riesgo más importante es el ICTUS y se debe a un evento embólico o traumátismo del vaso por el catéter.
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ANEURISMAS CEREBRALES
En la mayoría de los aneurismas intracraneales en los que se plantea una intervención quirúrgica requieren una evaluación con Arteriografía.
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ANEURISMAS CEREBRALES
La Arteriografía cerebral no sólo permite identificar el aneurisma, da información prequirúrgica como: orientación del aneurisma, presencia de vasoespasmo, localización de los vasos adyacentes y circulación colateral intracraneal.
Identifica que aneurisma ha sangrado si es que hay más de uno
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ANEURISMAS CEREBRALES
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ANEURISMAS CEREBRALES
Con Angiografía se pueden tratar pacientes no quirúrgicos, colocándoles por vía endovascular algún material trombogénico (alambres) dentro del aneurisma.
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ANEURISMAS CEREBRALES
La mayor parte de los pacientes con aneurismas sintomáticos intracraneales se presentan con una hemorragia subaracnoidea, algunos aneurismas actúan como masas intracraneales.
Se indica IRM, aneurismas de ACP (sintomatología del III par craneal) o aneurismas de carótida interna a nivel del seno cavernoso.
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MALFORMACION ARTERIOVENOSA Paciente con malformación vascular
(MAV, angioma carvenoso, angioma venoso, o telangiectacia capilar), demandan atención médica tras un episodio de hemorragia intracraneal o una crisis.
Se realiza TAC o IMR, con contrate, o bien ARTERIOGRAFIA CEREBRAL.
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ULTRASONIDO
ECO DOPPLER: evaluación de la permeabilidad carótidea y de su flujo en pacientes con ateroesclerosis, vasoespasmo en pacientes con hemorragia subaracnoidea con Doppler transcraneal, en neonatos y niños pequeños.
Alteraciones cerebrovasculares, evalúan velocidad, dirección, amplitud y pulsatilidad
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ULTRASONIDO No tienen ningún riesgo para el paciente,
no utilizan radiación ionizante y son portátiles, pueden llevarse a la cama del paciente.
La calidad de la exploración y presición diagnóstica dependen mucho del operador.
Las estructuras anatómicas y lesiones patológicas vistas en ecografía no son tan aparentes como en imágenes de TC o IRM.
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