Scribd Logo
Upload

Welcome to Scribd!

  • 95 views

    Arteri Cerebellar: Presenter: Dr. Andre Lona Moderator: Dr. Iskandar Nasution, SP.S, FINS

    Uploaded by

    Alon Rider
    The document discusses the vascularization of the cerebellum, focusing on three main arteries: 1. The superior cerebellar artery (SCA) which supplies the superior aspect of the cerebellar hemisphere, superior vermis, and dentate nuclei. Infarction can cause ipsilateral cerebellar ataxia and pseudobulbar speech issues. 2. The anterior inferior cerebellar artery (AICA) which supplies structures like the middle cerebellar peduncle and flocculus. Infarction typically causes vertigo, deafness, and facial weakness on the ipsilateral side. 3. The posterior inferior cerebellar artery (PICA) which has a highly variable

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Arteri Cerebellar: Presenter: Dr. Andre Lona Moderator: Dr. Iskandar Nasution, SP.S, FINS

    Uploaded by

    Alon Rider
    95 views40 pages
    The document discusses the vascularization of the cerebellum, focusing on three main arteries: 1. The superior cerebellar artery (SCA) which supplies the superior aspect of the cerebellar hemisphere, superior vermis, and dentate nuclei. Infarction can cause ipsilateral cerebellar ataxia and pseudobulbar speech issues. 2. The anterior inferior cerebellar artery (AICA) which supplies structures like the middle cerebellar peduncle and flocculus. Infarction typically causes vertigo, deafness, and facial weakness on the ipsilateral side. 3. The posterior inferior cerebellar artery (PICA) which has a highly variable

    Original Title

    Arteri Cerebellar.pptx

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses the vascularization of the cerebellum, focusing on three main arteries: 1. The superior cerebellar artery (SCA) which supplies the superior aspect of the cerebellar hemisphere, superior vermis, and dentate nuclei. Infarction can cause ipsilateral cerebellar ataxia and pseudobulbar speech issues. 2. The anterior inferior cerebellar artery (AICA) which supplies structures like the middle cerebellar peduncle and flocculus. Infarction typically causes vertigo, deafness, and facial weakness on the ipsilateral side. 3. The posterior inferior cerebellar artery (PICA) which has a highly variable

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    95 views40 pages

    Arteri Cerebellar: Presenter: Dr. Andre Lona Moderator: Dr. Iskandar Nasution, SP.S, FINS

    Uploaded by

    Alon Rider
    The document discusses the vascularization of the cerebellum, focusing on three main arteries: 1. The superior cerebellar artery (SCA) which supplies the superior aspect of the cerebellar hemisphere, superior vermis, and dentate nuclei. Infarction can cause ipsilateral cerebellar ataxia and pseudobulbar speech issues. 2. The anterior inferior cerebellar artery (AICA) which supplies structures like the middle cerebellar peduncle and flocculus. Infarction typically causes vertigo, deafness, and facial weakness on the ipsilateral side. 3. The posterior inferior cerebellar artery (PICA) which has a highly variable

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 40

    MODUL VASKULER

    Arteri Cerebellar

    Presenter : dr. Andre Lona


    Moderator : dr. Iskandar Nasution, Sp.S, FINS
    Vaskularisasi Serebellum
    • Arteri Cerebellum berasal dari cabang arteri
    vertebralis dan arteri basilaris :

    1. Arteri Serebelaris Superior (SCA)


    2. Arteri Serebelaris Anterior Inferior (AICA)
    3. Arteri Serebelaris Posterior Inferior (PICA)
    5
    Segments SCA

    • Segments
    • prepontine segment
    • ambient segment
    • quadrigeminal segment
    Cabang SCA
    Perforating branchespons
    • midbrain
    • inferior colliculus
    Lateral (marginal) cabang cabang terbesar SCA
    • biasanya muncul dari segmen ambien
    • berjalan posterior di wilayah celah
    interhemispheric
    • mengeluarkan cabang-cabang hemisferik yang
    tentu saja paling atas di atas belahan serebelum
    superior
    Cabang SCA
    Cabang hemisfer
    • Timbul dari cabang lateral (marginal) dan dari
    SCA distal ke asal cabang lateral juga dari
    segmen ambienSupplies dentate nucleus
    • Vermis superior
    • Lobulus quadrigeminal medial
    • Lobus semilunar superior
    Cabang SCA
    Vermian superior
    • Cabang terminal dari SCA
    • Anastomose dengan cabang vermia inferior
    dari PICA
    Clinical significance of SCA

    • The SCA is often the cause of the trigeminal


    neuralgia, where it presses on the trigeminal
    nerve which causes worsening pain in this
    nerve distribution on the patient's face.
    However, at autopsy, 50% of people without
    trigeminal neuralgia will also be noted to have
    nerve vascular compression.
    SCA Syndrome
    (superior cerebellar artery syndrome).
    Main symptoms are ipsilateral cerebellar ataxias (middle and/or superior cerebellar peduncles),
    nausea and vomiting, slurred (pseudobulbar) speech, loss of pain and temperature over the
    opposite side of the body. Partial deafness, tremor of the upper extremity, an ipsilateral Horner
    syndrome and palatal myoclonus have been reported. Clinically, this stroke may be impossible to
    distinguish from a partial AICA or PICA territory stroke. It is much rarer than either one. Ocular
    pulsion away from the side of lesion has been reported in SCA syndrome.

    SCA territory infarction due to basilar artery thrombosis


    SCA Syndrome
    (superior cerebellar artery syndrome).

    SCA infarct includes the entire superior aspect of the cerebellar hemisphere, the ipsilateral
    superior vermis, and variable amounts of the deep white matter. Most of the dentate nuclei are
    also involved.
    Anterior Inferior Cerebellar Arteri
    (AICA)
    • The anterior inferior cerebellar artery (AICA) is
    one of three blood vessels that provide arterial
    blood supply to the cerebellum. The number of
    networks supplied by AICA is a variable (AICA-
    PICA dominance) but usually includes:
    • middle cerebellar peduncle
    • inferolateral part of the punch
    • flocculus
    • anteroinferior surface of the cerebellum
    AICA
    anterior inferior cerebellar artery syndrome
    The AICA syndrome is usually accompanied by vertigo and unilateral ipsilateral
    deafness from labyrinthine artery ischemia, ipsilateral facial weakness and ataxia. It is
    the second most common brainstem stroke, after PICA stroke. The distribution of the
    classical AlCA infarction involves the lateroinferior pons; middle cerebellar peduncle;
    flocculus; and a small portion of the anterior, medial, and inferior aspects of the
    cerebellar hemisphere. The extent of this stroke is extremely variable. S/S: fluctuating
    hearing, tinnitus, vertigo. Bilaterality of hearing fluctuation suggests a vascular cause.
    POSTERIOR INFERIOR CEREBELLAR
    ARTERY (PICA)
    • Posterior inferior cerebellar artery (PICA) is one
    of the three vessels that provide arterial supply to
    the cerebellum. It is the most variable and
    tortuous cerebellar artery.
    • Segments :
    • anterior medullary segment
    • lateral medullary segment
    • posterior medullary segment
    • supratonsillar segment
    Branch of PICA
    • anterior and lateral medullary segments
    – small perforating medullary branches (absent in
    50%)
    • supratonsillar segment
    – tonsillohemispheric branch
    – inferior vermian branch
    • Note: occasionally a small vertebral will
    terminate into a common PICA/AICA trunk.
    • Supply
    Has a variable territory depending on the size of
    the AICA (AICA-PICA dominance). Typically it
    supplies:
    • posteroinferior cerebellar hemispheres (up to the
    great horizontal fissure)
    – cerebellar tonsils: 85% of the time
    – biventral lobule: 80%
    – nucleus gracilis: 85%
    – superior semilunar lobule: 50%
    • inferior portion of the vermis
    • lower part of the medulla: 50%
    • inferior cerebellar peduncles
    PICA INFARCT
    Clinical presentation
    (PICA INFARCT)
    • Vertigo, nausea and truncal ataxia are the
    most common presenting features. Signs of
    a lateral medullary syndrome may coexist in
    ~30%
    Differential diagnosis for PICA
    MRI at acute presentation

    MRI after 4 weeks

    PRES involving cerebellar hemispheres bilaterally. Bilateral almost symmetrical hyperintensities


    involving postero-inferior aspect of cerebellum. Findings completely resolved after 4 weeks on
    follow up MRI
    Case 1
    • Laki-laki 55 tahun datang ke IGD dengan keluhan mulut
    mencong ke kanan mendadak sejak 6 jam yang lalu. Pasien
    masih dapat menutup mata kirinya. Pada pemeriksaan fisik
    didapatkan GCS 14, pupil bulat isokor 3mm/3mm, refleks
    cahaya positif, kesan deviasi konjugee ke kiri, hemiparese
    sinistra, gangguan proprioseptif sinistra dan dismetria pada
    sisi kanan. Mekanisme apakah yang paling mungkin
    mendasari kelainan di atas :
    • a. Oklusi arteri serebeli anterior inferior (AICA) kanan
    • b. Oklusi arteri serebeli anterior inferior (AICA) kiri
    • c. Oklusi arteri serebeli posterior inferior (PICA) kiri
    • d. Oklusi arteri paramedian atas kanan
    • e. Oklusi arteri paramedian atas kiri
    Case 2
    • Laki-laki 60 tahun datang dengan keluhan sulit menelan
    mendadak, disertai pelo. Pemeriksaan fisik = ipsilateral
    gangguan cerebellar, Horner’s syndrome, gangguan nyeri
    menyilang antara wajah dan badan (face-body
    dissociation). Arteri manakah yang mengalami gangguan
    pada pasien tersebut?

    • a. Arteri cerebellar anterior inferior


    • b. Arteri cerebellar superior
    • c. Arteri pons paramedian
    • d. Arteri cerebellar posterior inferior: wallenberg
    • e. Arteri vertebro-basiler
    Case 3
    • Pasien laki-laki 50 tahun datang ke UGD dengan keluhan rasa tebal
    wajah kiri, terjadi mendadak saat bangun tidur, selain itu disertai
    juga dengan hipestesi nyeri wajah kiri, hipestesi lengan dan tungkai
    kanan, paralisis parsial palatum mole dengan faring sisi kiri, ataksia
    kiri serta hiccups. Pasien mempunyai riwayat hipertensi, diabetes
    mellitus, dan dislipidemia. Setelah dilakukan CT Scan kepala
    didapatkan area hipodense. Dari temuan klinis yang didapatkan
    kira-kira terjadi penyumbatan pembuluh darah dimana?
    • A. Arteri Basiler
    • B. PICA kanan
    • C. PICA kiri
    • D. SCA kanan
    • E. SCA kiri
    TERIMA KASIH

    40

    You might also like