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Term 5: Neuro > 6/10- Cerebrovascular Anatomy > Flashcards

6/10- Cerebrovascular Anatomy Flashcards

1
Q

What is a stroke?

A

Damage to the brain due to vascular causes; interruption of blood flow in a cerebral vessel

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2
Q

What are the 2 different types of strokes?

A
  • Ischemic (decreased flow)
  • Hemorrhagic
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3
Q

Cerebrovascular disease tends to produce ____ (gradual/rapid), ____ (focal/generalized) neurologic deficit

A

Cerebrovascular disease tends to produce rapid, focal neurologic deficit

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4
Q

What is the main source for anterior circulation?

What areas does this cover?

A

Internal carotid arteries

Most of cerebral hemispheres

  • Cortex
  • White matter
  • Diencephalic structures
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5
Q

What is the main source for posterior circulation?

What areas does this cover?

A

Vertebral arteries

  • Brainstem
  • Cerebellum
  • Occipital
  • Mesial temporal lobe
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6
Q

What connects the anterior and posterior circulation?

A

Posterior communicating arteries

(provide collateral circulation; variable amounts)

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7
Q

Picture of vasculature

A

Dotted lines = Circle of Willis

FACTS:

  • Vertebral arteries ascend in bony cervical vertebrae
  • PICA come off single vertebral a’s
  • Vertebral a’s joint to form basilar a.
  • Basilar branches = AICA and SCA before it terminates as PCA
  • Smaller basilar branches = Labyrinthine (internal auditory) a, pontine arteries (variable)
  • Post communicating comes off PCA to connect into internal carotids
  • Internal carotids give off MCA and ACA (connected by ant communicating)
  • Smaller carotid branch = ophthalmic a.
  • Branches off MCA = anterior choroidal a, lenticulostriate a’s
  • Branches off ACA = medial striate a. (Recurrent a. of Heubner)
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8
Q

What provides circulation to the brainstem?

A
  • Medial arteries (midline parts of medulla, pons, and midbrain)
  • Lateral arteries (lateral parts of medulla, pons, and midbrain)
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9
Q

What provides circulation to the cerebellum? Defects from occlusion?

A
  • Posterior and anterior inferior arteries supply inferior cerebellum
  • Superior cerebellar a. supplies superior cerebellum

Defects: Ipsilateral ataxia/hypotonia

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10
Q

What does posterior cerebral artery supply?

Defects from occlusion?

A
  • Occipital lobe: visual field defect/complex visual agnosia
  • Inferior medial temporal lobe: defects in recognition of things and people (prosopagnosia- facial recognition)
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11
Q

What is the most common stroke of posterior circulation?

A

Lateral medullary infarct (Wallenberg syndrome)

  • Brown, cystic area in left medulla from lack of circulation in one of the lateral arteries (branches of vertebral or posterior cerebellar, possibly)
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12
Q

What is this?

A

Medial pontine infarct

  • Cystic area in midline area (right side of the picture)
  • Affected basilar perforating arteries
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13
Q

What is the order of severity/”badness” of arteries in anterior circulation (ICA, ACA, MCA, branches)?

A

In order of severity:

Internal carotid > Ant/middle cerebral > branch occlusion of ACA/MCA

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14
Q

What is the most detailed way to image these arteries?

A

Cerebral arteriogram

  • Femoral catheter run up to aortic arch to inject the carotids (although, can also inject vertebrals)
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15
Q

How can you differentiate internal and external carotids on arteriogram?

A

Internal is relatively straight/smooth running up to brain (may see sinus)

External has many branches (recall: head and neck)

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16
Q

What is another (non-arteriogram) method of imaging these arteries?

A

Carotid ultrasound

  • Structural imaging
  • Flow imaging (velocity; laminar vs. turbulent)

(Can see plaque on the wall inducing slow flow and turbulence)

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17
Q

Where does the anterior cerebral artery go? Branches? Supplies?

A

Anterior cerebral artery goes up/around corpus callosum (“pericallosal a”) and supplies superior, mesial lobes

Branches:

  • Orbital
  • Frontopolar a. (rostral end of cerebral hemisphere)
  • Callosomarginal a. (big branch off pericallosal a.)
  • Pericallosal a. (big terminal branch)
18
Q

Big deficits due to loss of anterior cerebral artery?

A

Contralateral UMN disorder, especially of leg

19
Q

Big deficits due to loss of middle cerebral artery?

A

Contralateral UMN disorder, especially of face and arm

20
Q

What is the most common source of anterior strokes?

A

Middle cerebral artery

21
Q

Branches of middle cerebral artery?

A

(Deep)

  • Lenticulostriate arteries (supply striatum)
  • Temporal branches

(Superficial)

  • Precentral (pre-Rolandic a.)
  • Central (Rolandic) a.
  • Parietal branches
22
Q

What is this? What is biggest artery?

A

Cerebral angiogram (contrast injected into artery from femoral threaded up to internal carotid)

  • Largest here is internal carotid

(Structures seen depends on length of time after injection)

23
Q

Risks of angiogram procedure?

A
  • Hemorrhage at catheter site
  • Dislodgment of atherosclerotic plaque (-> stroke)
24
Q

What is this?

A

CT angiogram (CTA)

  • Not quite as good of detail as angiogram, but good
  • Arch M bit is the posterior cerebral arteries
  • Can’t visualize posterior communicating
  • Middle cerebral arteries coming off each side
25
Q

What is this?

What key features allow you to identify?

A

Proximal MCA infarct

  • ACA territory spared
  • Internal carotid occlusion would involve both territories (anterior cerebral artery as well as middle)
  • Area infarcted is darker than normal
  • Can see cracking (split in living/dead white matter)
26
Q

What symptoms would be seen with a proximal MCA infarct?

A
  • Contralateral UMN weakness affecting face and arm
  • Aphasia if in left hemisphere
  • Possible contralateral visual field issues (clipping visual radiations)- homonomous heminaopsia and possible dysfunction of higher visual function
27
Q

What is this? Results in (broadly)?

A

CTA showing MCA occlusion (causes ischemic stroke)

28
Q

Branches of middle cerebral artery (superficial)?

A
  • Anterior temporal a.
  • Middle temporal a.
  • Posterior temporal a.
  • Orbitofrontal a.
  • Precentral (pre-Rolandic) a.
  • Central (Rolandic) a.
  • Anterior parietal a.
  • Posterior parietal a.
  • Angular a.
29
Q

What is this?

A

Multiple emoblic hemorrhagic infarcts due to branch occlusions

  • Most likely have cardiac source (bad valve, ventricular assist device)
  • May not occur all at the same time
30
Q

Branches of posterior cerebral a?

A
  • Anterior temporal branches (supply mesial temporal lobe)
  • Posterior temporal branches
  • Parieto-occipital branch
  • Calcarine branch
31
Q

What is this?

A

Acute posterior cerebral artery stroke (territory infarcts)

32
Q

Acute stroke on CT looks ___ (bright/dark)?

A

Acute stroke on CT looks dark

33
Q

Brain vascular regions (picture)- LEARN

A
34
Q

What areas are susceptible to poor perfusion (as opposed to actual occlusion of artery)?

A

Watershed areas

  • Parts of the brain between ACA, MCA, and PCA; these are perfused poorly by several arteries (“last meadow” or end of the garden hose territory)
35
Q

What causes Watershed infarcts?

A

Hypoperfusion

  • Cardiac arrest
  • Inadequate perfusion during cardiopulmonary bypass
36
Q

Describe venous drainage of the brain

A
  • Lateral portion of the hemispheres drain to the superior sagittal sinus
  • Posterior fossa structures drain to transverse sinus, which drains into internal jugular vein
  • Medial hemisphere and deep structures drain to straight sinus to confluence of sinuses to transverse sinuses to IJV
37
Q

Another pic of venous drainage (just look)

A
38
Q

What do hypercoaguable states cause?

A

Venous sinus thrombosis; variable symptoms

39
Q

What supplies circulation to the spinal cord? Defects cause what?

A

Spinal arteries

  • Anterior spinal a. (causes anterior spinal a. syndrome)
  • Posterior spinal a. (usually no infarct)

Spinal veins

  • Similar organization to arteries
40
Q

Picture of spinal veins (just look)

A

Term 5: Neuro (24 decks)

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