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Neuroendocrine Exam 2 > 02. Blood Supply, Hemorrhage, and Herniation (Keim) > Flashcards

02. Blood Supply, Hemorrhage, and Herniation (Keim) Flashcards

1
Q

What two vessels supply the internal capsule of the basal nuclei?

A

Lenticulostriate arteries of the middle cerebral A.

Anterior choroidal A.

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2
Q

In the medulla, what is supplied by the posterior spinal artery?

A

Fasciculus cuneatus

Fasiculus gracilis

Gracile and cuneate nuclei

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3
Q

What is the common source of bleeding in an epidural hematoma?

A

Middle meningeal A

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4
Q

Diagnosis?

A

Bright white irregular blood = intracerebral hemorrhage

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5
Q

Name the sections of the vertebral A.

A
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6
Q

Diagnosis?

A

Lens shape = epidural hematoma

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7
Q

An aneurysm in which arteries can cause compression of the oculomotor nerve?

A

Posterior cerebral A

Superior cerebellar A

Posterior communicating A

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8
Q
A
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9
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A
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10
Q

What deficits might we expect to find in a patient with a subfalcine herniation?

A

Motor and sensory loss to the lower extremity.

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11
Q

What artery connects the posterior and anterior circulation of the circle of Willis?

A

The posterior communicating A.

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12
Q

What is the clinical significance of “border zones” in the blood supply of the cortex?

What are the clinical symptoms associated with each?

A

Border zones are the areas between the regions of the anterior and middle, and middle and posterior cerebral arteries. These exist because of a lack of anastomosis between the anterior, middle, and posterior cerebral arteries – and are the areas most easily damaged by a hypotension / hypoperfusive event.

Because the lower limb portion of the homunculus is on the medial portion of the frontal and parietal lobes, anterior border zone ischemia can cause loss of motor control and sensation to the lower limb.

Likewise, damage to the posterior border zone causes visual disturbances and language issues.

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13
Q

What artery supplies the lateral pons?

A

The long circumferential branches of the basilar artery.

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14
Q

What artery may be compressed in a subfalcine herniation?

A

Anterior cerebral A.

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15
Q

What sx would we expect to see in a patient with a transtentorial herniation?

A

Vision issues due to ischemia of the occipital lobe – itself due to compression of the posterior cerebral A. and superior cerebellar A.

Also compression of CN III

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16
Q

What arteries make up the anterior circulation of the circle of Willis?

A
  • Internal carotid A.
  • Anterior cerebral A. (A1)
  • Anterior communicating A.
  • Anterior cerebral A. (A2
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17
Q

In the midbrain, what is supplied by the quadrigeminal and superior cerebellar arteries?

A

Superior and inferior colliculi

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18
Q

What are the four parts of the internal carotid A?

Where are they located?

A

Cervical part – from the bifurcation to the cervical canal, anterior to the first three vertebrae.

Petrous part – in the petrous part of the temporal bone.

Cavernous part – in the cavernous sinus

Cerebral part

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19
Q

An aneurysm in which arteries can cause compression of the abducens nerve?

A

Anterior inferior cerebellar A

Labyrinthine A (aka internal acoustic A).

(Also the internal carotid A if the aneurysm occurs in the cavernous sinus.)

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20
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A
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21
Q
A
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22
Q

What major structures might be compressed by a transtentorial herniation?

A

Oculomotor N.

Basilar A.

Posterior cerebral A.

also-upper brainstem and lower structures

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23
Q

What five arteries contribute to the anastomosis of the circle of Willis?

A

Anterior communicating A

Anterior cerebral A

Internal carotid A

Posterior communicating A

Posterior cerebral A

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24
Q

Diagnosis?

A

Aneurysm of a subarachnoid hemorrhage.

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25
Q

What portions of the cortex are supplied by the anterior, middle, and posterior cerebral arteries respectively?

A
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26
Q

In the medulla, what is supplied by the posterior inferior cerebellar artery?

A

The lateral medulla

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27
Q

What can cause Weber’s syndrome?

A

Damage to the anteromedial branches of the basilar artery and posterior cerebral artery (P1), causing ischemia to the medial portions of the midbrain.

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28
Q

An aneurysm in which arteries can cause compression of the optic nerve?

A

Internal carotid A

Anterior cerebral A

Anterior communicating A

29
Q

What happens in an uncal herniation?

What sx would we expect to see?

A

Uncus and parahippocampal gyrus are pushed over the edge of the tentorium cerebelli and into the tentorial notch.

This compresses the cerebral peduncle (recall that motor axons travel through there), and the oculomotor nerve. This causes contralateral hemiplegia and ipsilateral vision disturbances.

OR

Kernohan syndrome – which is a shift of the midbrain to the side, which causes a compression of the contralateral cerebral peduncle. This makes the hemiplagia appear on the same side as the vision disturbance.

30
Q

What artery supplies the medial pons?

A

The paramedian branches of the basilar artery.

31
Q

What arteries make up the posterior circulation of the circle of Willis?

A
  • Basilar A.
    • Anterior inferior cerebellar A.
    • Superior cerebellar A.
    • Posterior cerebral A.
32
Q

Diagnosis?

A

Crescent shape = subdural hematoma

33
Q

An aberration of what vessel can cause trigeminal nerve compression / neuralgia?

A

Superior cerebellar A.

34
Q

What are the three parts of the vertebral A, and where are they located?

A

Cervical part – runs through the transverse foramina.

Atlantic part – perforates dura and arachnoid maters, as well as the atlantooccipital membrane.

Intracranial part – L and R vertebral As unite at the caudal border of the pons and forms the basilar artery.

35
Q

In the medulla, what is supplied by the anterior inferior cerebellar artery?

A

Dorsal and ventral cochlear nuclei.

36
Q
A
37
Q
A
38
Q

In the forebrain, what is supplied by the anterior choroidal artery?

A

Optic tract

Hippocampal formation

Internal capsule

39
Q

What is a tonsilar herniation?

What sx would we expect a patient to exhibit?

A

This is where the cerebellar tonsils press through foramen magnum.

This causes compression of the medulla and upper cervical spinal cord.

Since cardiac and respiratory centers are located in the medulla, breathing and heart rate can be affected, as well as the cranial nerves that are associated with the medulla.

40
Q

Aberrent branches of what artery can compress the facial nerve?

A

Anterior inferior cerebellar A.

41
Q
A
42
Q

What is the common site of impact in patients with an epidural hematoma?

A

Squamous temporal bone or pterion.

43
Q

What vessel supplies the thalamus and geniculate nuclei of the forebrain?

A

The thalamogeniculate branches of the posterior cerebral artery.

44
Q

In the medulla, what is supplied by the anterior spinal artery?

A

Lemniscus

Pyramids

Hypoglossal nucleus

45
Q

Vertebral Basilar Insufficiency

A

Reduced blood glow thru vertebral A.

  • caused by either hyperextension of head or extreme rotation (Bow hunter’s)
  • acute angle compresses Vertebral A. between C1 and occ. bone
46
Q

Subclavian Steel Syndrome

A

Blood from Vertebral A. goes into Subclavian A.

Occlusion of subclavian A. proximal to where vertebral A. comes off

47
Q

CN II location in regards to Arteries

A

ICA

Anteiror cerebral A.

Anterior communicating A.

Compression can cause vision issues

48
Q

CN III location in regards to arteries

A

Between posterior cerebral A. and superior superior cerebellar A., near posterior communicating A.

Compression can cause Oculomotor palsy, down and out

49
Q

CN VI location in regards to arterial supply

A

Between labyrinthine and AICA

can cause Abducens Nerve Palsy (can’t abduct)

50
Q

CN V location and arterial supply

A

near superior cerebellar A.

abberant arterial loops can irritate nerve and cause trigeminal neuralgia

51
Q

CN VII location in regards to arterial supply

A

Near AICA

abberant arterial loop can irritate-facial nerve palsy

52
Q

Middle Cerebral A.

A

NOT PART of the CIRCLe of WILLIS

53
Q

ACA supplies what

A

most of medial and superiorl surface of frontal and parietal lobes

54
Q

MCA supplies

A

lateral frontal and parietal lobes

superior temporal lobe

55
Q

PCA supplies

A

occipital lobe and inferior temporal lobe

56
Q

Border zones

A

between arteries and susceptible to damage under systemic hypotension or hypoperfusion

because the brain is a bad/not an anastomosis

57
Q

Precallosal A. location

Callosomarginal A. location

A

up against corpus callosum

near cingulate gyrus

58
Q

ACA portions

A

A1-ICA to anterior communicaing A.

A2-anterior communicating a. to where rostrum and genu of C.C. meet

A3-arches around the genu of C.C, ends when vessels turn caudal

A4-superior to C.C.

A5-caudal to corpus callosum

59
Q

MCA portions

A

M1-ICA to the bifurcation at the insula

M2-bifurcation at insula to circular sulcus of insula

M3-circular sulcus of insula to external surface of lateral fissure

M4-on the cortex

60
Q

PCA portions

A

P1-Basilar bifurcation to posterior comminicating A.

P2-posterior communicating A. to around the midbrain

P3-segment within the quadrigeminal cistern (colliculi)

P4-cortical segment

61
Q

Corticospinal Tract

A

blood from ASA and PSA

62
Q

Subfalcine Herniation

A
  • cingulate or falcine or falx herniation
  • supratentorial compartment -displaces brain tissue under falx cerebri
  • compresses ACA and frontal/parietal lobe–>lower limb motor and sensation deficits
  • can cause transtentorial herniation
63
Q

Transtentorial Herniation

A
  • AKA central herniation
  • brain displaced down toward tentorial notch
  • issues with upper brainstem, CN III, possibly lower structures as well
  • decorticate and cecerebrate rigidity
64
Q

Uncal Herniation

A

uncus and portions of parahippocampal gyrus are extruded over the edge of tentorium cerebelli and through the tentorial notch

impinge on midbrain

damage cerebral peduncle, motor tracts, CN III damage

65
Q

Kernoham Phenomen

A

Uncal herniation shifts midbrain

ipsilateral CN III Palsy

Contralaterl peduncle compresed, ipsilateral motor def.

66
Q

What is the blood supply to the medulla?

A

ASA-medulla specifically

PSA-dorsal aspedt

AICA-cochlear nuclei

PICA-lateral aspect

(i think, slides not clear-should get more info in later lectures)

67
Q

What is the blood supply to the pons?

A

paramedian branches of basilar artery (medial)

long circumferential branches of basilar A. (lateral)

68
Q

What is the blood supply to the midbrain?

A

paramedian branches of basilar A. and P1 (medial)

lateral branches of qudrigeminal and posterior emdial choroidal A. (lateral)

Neuroendocrine Exam 2 (25 decks)

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