Blood Supply and Hemorrhage

Question 1

What is ischemic penumbra?

Answer 1

when a focal ischemia not only results in neuronal injury to the central core territory of the arterial supply but also varying degrees of dysfunction to the potentially viable tissue in the surrounding marginal area

Question 2

what is the regional cerebral blood flow range that will result in an ischemic penumbra?

Answer 2

10-20 ml/ 100 gm tissue/ min

Question 3

what areas of the brain are consistently damaged in severe ischemic injury?

Answer 3

distal branches of the cerebral arteries and particular neuronal populations (pyramidal cells of the hippocampus)

Question 4

what is stroke therapy directed at rescuing?

Answer 4

the ischemic penumbra

Question 5

what specific drugs might prevent further neuronal damage?

Answer 5

calcium channel and NMDA receptor blocking drugs

Question 6

the internal carotid and vertebral arteries pierce the dura and course in what?

Answer 6

the subarachnoid space

Question 7

as the branches of the internal carotid artery penetrate into the substance of the brain, what are they progressively surrounded by?

Answer 7

perivascular space (Virchow-robin space)

Question 8

where are the terminations of the ICA, vertebral artery, and the circle of willis located?

Answer 8

in the subarachnoid space

Question 9

infarction in the anterior choroidal artery territory may result in what?

Answer 9

triad of hemiplegia, hemianesthesia, and contralateral hemianopia (anterior choroidal artery syndrome)

Question 10

which artery has the highest incidence of cerebral aneurysms?

Answer 10

ACA

Question 11

what is the terminal branch of the ICA?

Answer 11

the anterior cerebral artery (ACA)

Question 12

what supplies the premotor and prefrontal cortices and the broca’s speech area in the dominant hemisphere?

Answer 12

frontal branches of the MCA

Question 13

what does thrombosis of the MCA result in?

Answer 13

expressive or broca’s aphasia

Question 14

what does obstruction of the MCA artery lead to?

Answer 14

wernicke’s aphasia

Question 15

How do you get central cord syndrome?

Answer 15

if there is a disruption of blood flow to the anterior spinal artery

Question 16

what does central cord syndrome lead to?

Answer 16

central necrosis and cavitation of the spinal cord–> development of a syrinx

Question 17

what is the major supply to the inferior 2/3 of the spinal cord?

Answer 17

the great anterior artery of Adamkiewiez

Question 18

What is at risk to be compromised secondary to a thoracolumbar fracture or surgical repair of an AAA?

Answer 18

the great anterior artery of adamkiewiez

Question 19

what does thrombosis of the PICA result in?

Answer 19

lateral medullary (wallenburg) syndrome

Question 20

What artery is responsible for supplying the primary visual cortex?

Answer 20

the posterior cerebral artery (PCA)

Question 21

rupture of the anterior communicating artery results in the presence of blood where?

Answer 21

in the subarachnoid space

Question 22

the superior sagittal sinus usually empties into what?

Answer 22

the right transverse venous sinus

Question 23

what does thrombosis of the posterior portion of the superior venous sinus or right transverse venous sinus result in?

Answer 23

cortical ischemia and/or necrosis

Question 24

what does thrombosis of the posterior portion of the straight venous sinus or left transverse venous sinus result in?

Answer 24

ischemia and/or necrosis of structures in the deep cerebrum- usually fatal

Question 25

what are herniations of the brain secondary to?

Answer 25

a unilateral increase in the volume (mass effect)

Question 26

what type of herniation causes a midline shift?

Answer 26

Falx herniation

Question 27

what herniation compresses and displaces the midbrain and is caused by profuse, high-pressured bleeding that rapidly expands the epidural space

Answer 27

a tentorial/ uncal herniation

Question 28

what herniation is caused by space expanding or occupying masses in the posterior cranial fossa?

Answer 28

tonsillar herniation

Question 29

what herniation is seen in arnold-chiari malformation?

Answer 29

tonsillar herniation

Question 30

a fracture at the pterion may rupture what?

Answer 30

the middle meningeal artery

Question 31

rupture of the middle meningeal artery would result in what?

Answer 31

an epidural hematoma

Question 32

what causes a subdural hematoma?

Answer 32

head trauma may cause the cerebral veins to rupture as they cross the subdural space. Blood seeps out of the ruptured veins and slowly develops a space-occupying heomatoma in the subdural space

Question 33

how is a subarachnoid hemorrhage indicated?

Answer 33

by the presence of erythrocytes in the CSF

Question 34

increase in the intracranial volume can cause what?

Answer 34

subfalcine herniation