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BMB Test 3 > B7.057 CNS Vasculature > Flashcards

B7.057 CNS Vasculature Flashcards

1
Q

origin of the posterior circulation

A

vertebral arteries

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2
Q

origin of anterior circulation

A

internal carotid

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3
Q

what does the posterior circulation perfuse

A 
medulla
pons
midbrain
thalamus
occipital lobe and ventromedial temporal lobe
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4
Q

what does the anterior circulation perfuse

A

remaining cerebral cortex
basal ganglia
hypothalamus

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5
Q

why is the orientation of the circle of willis important

A

dual blood supply ensures less chance of interruption due to occlusion

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6
Q

describe the structure of the circle of willis

A

posterior portion arises from basilar artery and branches into superior cerebellar, posterior cerebral and posterior communicating arteries
posterior communicating loops backward and meets with the internal carotid, anterior choroidal and MCA comes off of this meeting
ACA extends the opposite direction from MCA and the two branches are eventually joined by the anterior communicating artery before they course into the frontal lobe

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7
Q

interruption of the posterior circulation

A

damages the brainstem

  • body symptoms contralateral
  • head symptoms ipsilateral
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8
Q

where are sensory and motor structures for the body located in the brainstem

A

medial (except ALS)

contralateral

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9
Q

where are sensory and motor structures for the head located in the brainstem

A

motor- medial
sensory- lateral (in general more lateral than body tracts)
ipsilateral

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10
Q

blood supply to medulla

A 
medial = anterior spinal
lateral = PICA
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11
Q

medial medullary structures

A

DCML
corticospinal
hypoglossal
~climbing fibers to cerebellum (inferior nucleus)

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12
Q

lateral medullary structures

A 
ALS
nucleus ambiguous
dorsal nucleus X
solitary nucleus
descending tract of CN V
vestibular nuclei
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13
Q

blood supply to pons

A 
medial = penetrators from basilar
lateral = AICA and circumferential basilar
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14
Q

medial pontine structures

A

DCML
corticospinal
abducens
MLF

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15
Q

lateral pontine structures

A

ALS
proper nucleus CN V
facial nerve VII
vestibular nuclei VIII

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16
Q

blood supply to midbrain

A 
medial = top of basilar
lateral = paramedian penetrators, proximal PCA
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17
Q

medial midbrain structures

A

oculomotor nucleus
some DCML
some corticospinal
some red nucleus

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18
Q

lateral midbrain structures

A

some DCML
some corticospinal
some red nucleus

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19
Q

hallmark of brainstem blood supply deficits

A

alternating hemiplegia

long tract and CN deficits on opposite sides of body

20
Q

cortical blood supply

A 
posterior circulation
-posterior cerebral
anterior circulation
-middle cerebral
-anterior cerebral
21
Q

branches of MCA

A

superior (frontal)

inferior (temporal)

22
Q

course of the PCA

A

terminal branches of the basilar artery
perforating branches supply the midbrain and posterior thalamus
cortical branches supply the undersurface of the temporal lobe and occipital and visual cortex

23
Q

syndromes observed in PCA disruption

A

midbrain signs

cortical temporal and occipital signs

24
Q

midbrain PCA lesion

A

due to disruption of the P1 segment or penetrating branches of the PCA

25
cortical PCA lesion
due to occlusion of the cortical branches of the P2 segment
26
P1 (midbrain) syndrome
upper alternating hemiplegia (Weber's syndrome) - ipsilateral oculomotor ophthalmoplegia - contralateral hemiplegia
27
P1 (thalamic) syndrome
thalamogeniculate branch contralateral hemisensory loss (all info from face and body travels through thalamus) burning pain in affected areas hemiparesis, hemiballismus, choreoathetosis (due to connections with cerebellum) intention tremor ataxia
28
P2 (cortex) syndrome
infarction of the medial temporal and occipital lobes - contralateral homonymous hemianopia with macular sparing - less extensive lesions may cause higher order visual deficits
29
P2 (hippocampus) syndrome
medial temporal lobe and hippocampal lesion - acute disturbance in memory - would need to be bilateral
30
MCA divisions
superior -spreads out over lateral frontal and parietal cortices above lateral sulcus inferior -lateral surface of temporal lobe below lateral sulcus
31
MCA prior to divisions
lenticulostriate branches supply the basal ganglia and internal capsule
32
MCA superior division stroke
contralateral hemiparesis of face, hand, arm with sparing of leg and foot (bc these are central) contralateral hemisensory deficit with same distribution ipsilateral deviation of head/eyes (FEF) with dominant hemisphere lesion motor (expressive) aphasia is due to damage of broca's area
33
FEF lesion
the L FEF serves to move eyes to the R | SO if L FEF is damaged, there is a gaze preference to the L
34
MCA inferior division stroke
less common dominant hemisphere leads to Wernicke's aphasia nondominant hemisphere may lead to a L visual neglect and an agitated and confused state superior quadrantanopsia or homonymous hemianopsia depending on extent of infaraction (due to damage of optic radiations)
35
what is the internal capsule
sheets of fibers flowing to/from cortex | V shaped white matter tract
36
posterior limb of internal capsule
lateral to thalamus corticospinal motor fibers corticopontine fibers (cerebellar movement control loop) reciprocal thalamocortical sensory connections (somatic sensation)
37
thalamus axons in internal capsule
travel through posterior limb
38
genu
point in the V shape of the internal capsule | corticobulbar fibers
39
corona radiata
fibers that exit the internal capsule and travel to the cortex
40
blood supply to the internal capsule
MCA lenticulostriate arteries
41
anterior limb of internal capsule
separates caudate from putamen/ globus pallidus frontopontine fibers anterior thalamic nuclei, including reciprocal connections between VA and motor areas
42
lenticulostriate arteries
penetrating branches of M1 segment of MCA | supply basal ganglia structures: head and body of caudate, globus pallidus, putamen, internal capsule
43
occlusion of lenticulostriate
contralateral hemiparesis and sensory deficit due to damage of corticospinal fibers and thalamosensory fibers to sensory cortex that run in the posterior limb of internal capsule contralateral ataxia due to damage of frontopontine fibers in anterior limb contralateral lower face hemiparesis due to damage of corticobulbar fibers in the genu
44
bilateral occlusion of the ACA
results in infarction of the anteromedial surface of the cerebral hemispheres - paraplegia affecting the lower extremities and sparing hands/face - frontal lobe syndrome (no decision making) - urinary incontinence
45
unilateral occlusion of ACA
distal to anterior communicating | -contralateral sensorimotor deficits mainly involving lower extremities
46
occlusion of ACA proximal to anterior communicating artery
well tolerated because of cross flow

BMB Test 3 (21 decks)

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