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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
Q

cortical PCA lesion

A

due to occlusion of the cortical branches of the P2 segment

26
Q

P1 (midbrain) syndrome

A

upper alternating hemiplegia (Weber’s syndrome)

  • ipsilateral oculomotor ophthalmoplegia
  • contralateral hemiplegia
27
Q

P1 (thalamic) syndrome

A

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
Q

P2 (cortex) syndrome

A

infarction of the medial temporal and occipital lobes

  • contralateral homonymous hemianopia with macular sparing
  • less extensive lesions may cause higher order visual deficits
29
Q

P2 (hippocampus) syndrome

A

medial temporal lobe and hippocampal lesion

  • acute disturbance in memory
  • would need to be bilateral
30
Q

MCA divisions

A

superior
-spreads out over lateral frontal and parietal cortices above lateral sulcus
inferior
-lateral surface of temporal lobe below lateral sulcus

31
Q

MCA prior to divisions

A

lenticulostriate branches supply the basal ganglia and internal capsule

32
Q

MCA superior division stroke

A

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
Q

FEF lesion

A

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
Q

MCA inferior division stroke

A

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
Q

what is the internal capsule

A

sheets of fibers flowing to/from cortex

V shaped white matter tract

36
Q

posterior limb of internal capsule

A

lateral to thalamus
corticospinal motor fibers
corticopontine fibers (cerebellar movement control loop)
reciprocal thalamocortical sensory connections (somatic sensation)

37
Q

thalamus axons in internal capsule

A

travel through posterior limb

38
Q

genu

A

point in the V shape of the internal capsule

corticobulbar fibers

39
Q

corona radiata

A

fibers that exit the internal capsule and travel to the cortex

40
Q

blood supply to the internal capsule

A

MCA lenticulostriate arteries

41
Q

anterior limb of internal capsule

A

separates caudate from putamen/ globus pallidus
frontopontine fibers
anterior thalamic nuclei, including reciprocal connections between VA and motor areas

42
Q

lenticulostriate arteries

A

penetrating branches of M1 segment of MCA

supply basal ganglia structures: head and body of caudate, globus pallidus, putamen, internal capsule

43
Q

occlusion of lenticulostriate

A

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
Q

bilateral occlusion of the ACA

A

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
Q

unilateral occlusion of ACA

A

distal to anterior communicating

-contralateral sensorimotor deficits mainly involving lower extremities

46
Q

occlusion of ACA proximal to anterior communicating artery

A

well tolerated because of cross flow

BMB Test 3 (21 decks)

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