2. Blood Supply, Hemorrhage and Herniation Flashcards by Andrew Niemann

What are the 4 parts of the interal carotid A?

cervical part (anterior to TP of upper 3 vertebrae)
petrous part
cavernous part
cerebral part

How well did you know this?

Not at all

Perfectly

What three As does the cerebral part of the Internal carotid A divide into?

opthalmic A
anterior cerebral A
middle cerebral A

How well did you know this?

Not at all

Perfectly

What are the 3 parts of the vertebral A?

cervical part (through transverse foramina)
atlantic part
intracranial part

How well did you know this?

Not at all

Perfectly

What is special about the atlantic and intracranial parts of the vertebral A?

atlantic: perforates dura and arachnoid and passes thru foramen magnum
intracranial: unites in cranium at the caudal border of pons, forming basilar A

How well did you know this?

Not at all

Perfectly

What are the four components of the circle of willis?

anterior communicating artery
posterior communicating A
2- anterior cerebral As

How well did you know this?

Not at all

Perfectly

What is NOT part of the circle of willis?

middle cerebral A

How well did you know this?

Not at all

Perfectly

What would be in jepordy if there was an aneurysym of the anterior cerebral, ICA, or anterior communicating arteries?

CN II - optic

How well did you know this?

Not at all

Perfectly

What would be at jepordy if there was an aneurysym of the posterior cerebral or superior cerebellar A (off basilar)?

CN III (would affect parasympathetics first)

How well did you know this?

Not at all

Perfectly

What are two important branches off the vertebral A?

posterior inferior cerebellar A

anterior spinal A

How well did you know this?

Not at all

Perfectly

If there was an abberant branch off the superior cerebellar A, what N could be affected?

CN V TRIGEMINAL

How well did you know this?

Not at all

Perfectly

What arteries could compress CN VI (abducens)?

labyrinthine (internal acoustic) A

anterior inferior cerebellar A

How well did you know this?

Not at all

Perfectly

What nerve could be compressed by an abberant (extra) branch off the anterior inferior cerebellar A?

CN VII Facial

How well did you know this?

Not at all

Perfectly

What two branches comes off the middle cerebral A?

lenticulostriate As

anterior choroidal A

How well did you know this?

Not at all

Perfectly

What artery supplies medial and superior surfaces of the frontal and parietal lobes?
What about the lateral surface of frontal and parietal lobes and superior temporal?

Anterior cerebral A

Middle cerebral A

How well did you know this?

Not at all

Perfectly

What artery supplies the occipital lobe and infeiror temporal lobe?
What is unique about the three arteries to the cortex of the brain?

posterior cerebral A (off basilar)

anterior/middle/posterior don’t anastomose!

How well did you know this?

Not at all

Perfectly

What are the areas that are border zones between arteries, which are susceptible to damage under conditions of hypotension or hypoperfusion?

anterior (motor/sensory to LL) and posterior (visual/language) watershed infarcts

How well did you know this?

Not at all

Perfectly

What are the 5 segments of the anterior cerebral A, which are named according to their relation to the corpus callosum?

A1: Precommunicating segment (ICA to ant. communicating)
A2: infracallosal segment where rostrum and genu meet
A3: precallosal segment (arch around front)
A4: Supracallosal (above)
A5: Postcallosal (behind)

After A3 of anterior cerebral A, it splits into two A, which are the?

pericallosal and callosomarginal branches

what are the 4 segments of the middle cerebral A.?

M1: Sphenoidal/horizontal (ICA to bifurcation at insula)
M2: Insular Segment (bifurcation to circular sulcus)
M3: Opercular Segment (circular sulcus to surface of lateral fissure)
M4: Cortical Segment

what are the four branches of the posterior cerebral A?

P1: basilar bifurcation to posterior communicating
P2: post communicating to midbrain
P3: Quadrigeminal Segment: within quadrigeminal cistern
P4: Cortical Segment

What are the four main blood supplies to the medulla?

anterior spina A
posterior spinal A
posterior inferior cerebellar A
Anterior inferior cerebellar A

What are the two main supplies to the pons and what are the syndromes associated with their occlusion?

Paramedian branches of basilar A (medial pontine synd)

Long circumferential branches of basilar A/branches of anterior inferior cerebellar A (lateral pontine syndrome)

What are the two main supplies to the midbrain and the syndrome?

Paramedian branches of basilar bifurcation and P1 segment (webers syndrome)
Quadrigeminal and superior cerebellar A and posterior medial choroidal A (inf/sup colliculus)

What are the three main supplies to the forebrain?

Thalamogeniculate branches of posterior cerebral A (thalamus, medial/lateral geniculate bodies)
Anterior choroidal A
Lenticulostriate As (internal capsule)

The anterior spinal A supplies the dorsal and ventral horns (anterior/posterior) completely via which branch?

sulcal artery

The posterior spinal A anastomoses with the anterior spinal artery to supply blood to the cortical spinal tract via which artery?

arterial vasocorona

Epidural is between cranium and periosteal layer of the dura while the subdural and subarachnoid spaces are where?

Subdural between dura and arachnoid | Subarachnoid between arachnoid and pia where CSF, arteries and veins are found

What artery is most commonly affected by trauma to pterion, leading to an epidural hematoma causing momentary unconsciousness followed by lucid period of hours to 1-2 days then unconsciousness and death?

middle meningeal A

What types of hematoma occurs between dura and arachnoid mater due to head strike with fixed object? with a source of venous blood from cortical veins to superior saggital sinus?

subdural hematoma

What is commonly seen upon MRI with epidural hematomas?

Lens shaped and smooth between bone and periosteal layer near foramen spinosum

What type of hematoma can be seen on MRI as crescent shapped with jagged border, presenting with HA, nausea and vomitting?

subdural hematoma

Subarachnoid hemorrhage is more common d/t rupture of aneurysm in circle of willis, with massive bleeding into CSF, what is the source of bleeding??

arterial bleed from cerebral A

What type of hemorrhage is bleeding within the brain (stroke) usually due to middle cerebral A, hypertension or degernerative arterial disease?

intracerebral (Subpial) hemorrhage

Herniation of the brain occurs due to increase intracranial pressure and are commonly caused by hemorrhage, tumors, trauma, abscess, or infection. What are the divisions of the brain (3)?

``` supratentorial compartment (above cerebelli tentorium and divided into right and left by falx cerebri) infratentorial compartment (below tentorium cerebelli) tentorial notch (continuation of supra and infratentorial compartments) ```

What herniation displaces brain tissue under the falx cerebri in the supratentorial compartment, compressing what (3)?

subfalcine/cingulate/falcine/falx herniation | can compress ACA, frontal and parietal lobes

What herniation displaces the brain down toward the tentorial notch, compressing upper brainstem, CN III, basilar and posterior cerebral As?

Transtentorial/ Central herniation | occipital lobe problems such as vision

What herniation is when the parahippocampal gyrus are extruded over the edge of the tentorium cerebelli and throuhg the tentorial notch, impinging the midbrain?

Uncal Herniation (uncus)

Kernohan Syndrome occures with uncal herniation with shifting of midbrain, leading to what symptoms?

CNIII impinged, opposite cerebral peduncle compressed causing same side hemiplegia

What is normally affected with uncus herniation without kernohan syndrome?

ipsilateral CNIII problems | contralateral hemiplegia

What hernia occurs when cerebellar tonsils go through the foramen magnum, compressing the medulla and upper cervical spinal cord and can effect breathing and HR?

tonsillar herniation