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Neuro Exam 2 > Blood Supply and Ventricular Systems > Flashcards

Blood Supply and Ventricular Systems Flashcards

1
Q

CSF has higher concentrations of what ions as compared to blood?

A

Sodium
Chloride
Magnesium

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2
Q

CSF has lower concentrations of what ions as compared to blood?

A

Potassium
Calcium
Glucose
Protein

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3
Q

The ventricular system is a series of communicating cavities lined by _________ which is elaborated into complex vascular folds called _____ _______

A

Ependyma (glial cells); choroid plexuses

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4
Q

What produces CSF and where are the primary areas of production?

A

Choroid plexus

Primarily in lateral ventricles and 4th ventricle

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5
Q

What are the 4 interconnected ventricles that make up the ventricular system? Where are they located?

A 
2 Lateral ventricles (one in each cerebral hemisphere)
3rd ventricle (between thalami)
4th ventricle (between cerebellum and pons)
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6
Q

Trace the path of CSF from lateral ventricles to the superior sagittal venous sinus

A 
Lateral ventricles
Interventricular foramina of monro
3rd ventricle
Cerebral aqueduct
4th ventricle

From 4th ventricle either goes to central canal of spinal cord or via median and lateral aperatures to the subarachnoid space

From subarachnoid space to arachnoid granulations, then superior sagittal sinus

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7
Q

Condition characterized by increase in cerebral mass/size d/t presence of excessive CSF, affecting the ventricular system, subarachnoid space, or both

A

Hydrocephalus

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8
Q

Communicating hydrocephalus is also known as …

A

External hydrocephalus

[other types include supratentorial external hydrocephalus and infratentorial external hydrocephalus]

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9
Q

External hydrocephalus results in excess accumulation of CSF in the ______ space, _____ ventricular size, and compression of the CNS

A

Subarachnoid; normal

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10
Q

Supratentorial external hydrocephalus is most commonly associated with what condition?

A

Senile atrophy of the cortex (alzheimer’s disease)

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11
Q

Noncommunicating hydrocephalus is also known as …

A

Internal hydrocephalus — CSF produced in the ventricular system does NOT drain into the subarachnoid space, resulting in dilation of the ventricle(s) proximal to the obstruction

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12
Q

3 possibilities for internal hydrocephalus obstructions

A

Interventricular foramen = 3rd ventricle choroid plexus ependymoma

Cerebral aqueduct = midbrain astrocytoma

Median and lateral apertures = arnold-chiari malformation or dandy-walker cyst

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13
Q

Communicating hydrocephalus is a combination of infratentorial external hydrocephalus and internal hydrocephalus due to an obstruction where? What causes this obstruction?

A

Narrow space between tentorial notch and midbrain

Obstruction caused by adhesions or fibrosis in subarachnoid spaces from previous inflammation (meningitis), cerebral edema, or uncal herniation

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14
Q

With communicating hydrocephalus, CSF can move through the ventricular system into the infratentorial subarachnoid space, but cannot circulate over the cerebrum to be resorbed at the arachnoid villi near the superior sagittal sinus. What does this result in?

A

Hypertrophy of ventricles (internal hydrocephalus)

Accumulation of CSF in the infratentorial space (external hydrocephalus)

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15
Q

What is the primary sign/symptom of increased intracranial pressure in someone with hydrocephalus?

A

Papillaedema

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16
Q

Difference between infants/young children and adults with hydrocephalus

A

Infants cranial sutures are not fused, so they are able to compensate with enlargement of the cranium

Adults cranial sutures are fused, preventing head enlargement but increased risk of high intracranial pressure

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17
Q

2 other signs of hydrocephalus other than papilledema

A

Internal strabismus/abducens palsy

Mental retardation

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18
Q

What venous system receives drainage from the spinal cord and is located in the epidural space? Where does it drain to?

A

Internal venous plexus of Batson

Drains into intervertebral veins and then segmental veins

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19
Q

Deep venous drainage of cerebral hemispheres is partially due to the ______ v. which runs next to the parahippocampal gyrus, receives the thalamostriate and anterior septal veins, and drains into the great vein of Galen

A

Internal cerebral vein

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20
Q

Deep venous drainage of the cerebral hemispheres is partially due to the _________ v. which runs next to the cerebral peduncle, receives middle deep cerebral and anterior cerebral vv. and drains into the great v. of Galen

A

Basilar v. (Basal v. of Rosenthal)

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21
Q

Deep venous drainage of cerebral hemispheres is partially d/t the _____ v. which runs next to the posterior portion of the corpus callosum and receives the internal cerebral vein and basal vein of rosenthal, eventually draining into the straight sinus

A

Great cerebral v. (Great vein of Galen)

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22
Q

Effects of occlusion of great cerebral v. (Of Galen)

A

Usually fatal, as it drains the deep cerebrum

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23
Q

What condition concerning deep venous drainage of cerebral hemispheres may compress the pineal body and posterior commissure?

A

Great vein varix

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24
Q

Which venous sinus typically empties directly into the right transverse sinus?

A

Superior sagittal sinus

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25
Q

Thrombosis of superior sagittal sinus or right transverse sinus leads to what complications?

A

Cortical ischemia and/or necrosis

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26
Q

The straight sagittal sinus typically empties directly into what venous sinus?

A

Left transverse venous sinus

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27
Q

Thrombosis of straight sagittal sinus or left transverse sinus may lead to what complications?

A

Ischemia and/or necrosis of deep cerebrum — usually fatal

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28
Q

The blood brain barrier is composed of what 4 structures?

A

Endothelial cell layer (w/ tight junctions)

Basement membrane

Pericyte

Foot processes of astrocytes and oligodendrocytes

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29
Q

3 locations where BBB is absent

A

Pineal body
Area postrema
Median eminence of the hypothalamus

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30
Q

What 2 arteries pierce the dura and run in the subarachnoid space before giving off the cerebral arteries that supply blood to the brain?

A

Internal carotid a.

Vertebral aa.

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31
Q

The cerebral arteries run in the ________ space. Branches penetrate into the brain parenchyma and are surrounded by ___________ space (perivascular space) and __________ mater

A

Subarachnoid; virchow-robin; pia

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32
Q

Anterior cerebral circulation comes from the internal carotid aa. what are its main branches?

A

Ophthalmic a.
Anterior choroidal a.
Anterior cerebral a.
Middle cerebral a.

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33
Q

One of the branches of the internal carotid a. supplying anterior circulation to the brain is the anterior choroidal a. What structures does it specifically supply?

A 
Choroid plexus of the lateral ventricle
Internal capsule
Basal ganglia
Thalamus
Rostral midbrain
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34
Q

Which branch of the internal carotid artery is prone to thrombosis d/t its long course in the subarachnoid space?

A

Anterior choroidal a.

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35
Q

The anterior choroidal a. is also frequently a cause of vascular insufficiency to _____ ____ and ______ brain structures in elderly

A

Globus pallidus; hippocampus

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36
Q

The anterior cerebral artery runs next to what 2 cranial nerves?

A

Olfactory n.

Optic n.

37
Q

What artery supplies the anterior 2/3 of the medial side and superolateral portion of the hemisphere, as well as the paracentral lobule region which does sensation+motor to the LEs?

A

Anterior cerebral a.

38
Q

Main branches of anterior cerebral a.

A

Recurrent artery of Heubner
Anterior communicating a.

2 cortical branches:
Anterior pericallosal a.
Callosomarginal a.

39
Q

Occlusion of the anterior cerebral a. has what effects?

A

Contralateral paresis and/or paresthesia of the leg and foot

[due to its supply of paracentral lobule region]

40
Q

What is meant by “watershed areas” of the brain?

A

Areas where both the middle cerebral and anterior cerebral aa. both supply

These areas are more susceptible to ischemia because they require dual blood supply

41
Q

The medial and lateral striate/thalamostriate aa. are branches of the _____ a. that supply the internal capsule, corpus striatum, and thalamus

A

Middle cerebral

42
Q

The ______ a. is a branch of the middle cerebral a. that supplies primary motor and somesthetic cortices

A

Central

43
Q

Frontal branches of the middle cerebral artery supply what structures?

A

Premotor and prefrontal cortices

Broca’s area (usually dominant in left hemisphere)

44
Q

Parietal branches of middle cerebral a. supply what structure(s)?

A

Association cortex

45
Q

Temporal branches of middle cerebral a. supply what structure(s)?

A

Primary auditory cortex (assists in localization of sound)

46
Q

The angular a. branch of middle cerebral supplies what structure(s)?

A

Supramarginal and angular regions

Wernicke’s area (usually dominant in left hemisphere)

47
Q

Occlusion of the frontal branches of the middle cerebral artery could have what unique result?

A

Broca’s aphasia (expressive aphasia — difficulty putting words together to form complete sentences)

48
Q

Occlusion of the angular a. branch of middle cerebral a. could have what unique complication?

A

Wernicke’s aphasia (comprehension aphasia — inability to grasp meaning of spoken words)

49
Q

Result of occlusion of central a. (Branch of middle cerebral)

A

Contralateral spastic paralysis and/or paresthesia of the head and upper 1/2 of body

50
Q

Result of occlusion of parietal branches of middle cerebral a.

A

Variety of interpretive disorders including body neglect, agnosia, and apraxia

51
Q

Result of occlusion of temporal branches of middle cerebral a.

A

Difficulty localizing sounds

52
Q

What 2 arteries supply primary posterior circulation to the brain

A

Vertebral a.

Basilar a.

53
Q

3 branches of vertebral a. supplying posterior circulation to the brain

A

Anterior spinal a.
Posterior spinal aa.
Posterior inferior cerebellar a.

54
Q

4 branches of basilar a. supplying posterior circulation to the brain

A

Anterior inferior cerebellar a.
Labyrinthine a.
Superior cerebellar a.
Posterior cerebral a.

55
Q

Primary blood supply to the spinal cord comes from what 2 arteries?

A

Anterior spinal a.

Posterior spinal aa. (x2)

56
Q

The anterior spinal a. runs deep to the anteromedian sulcus and supplies what structures?

A

Most of the central gray matter

Anteromedial portion of white matter

57
Q

The posterior spinal arteries (x2) are branches of the vertebral a. or PICA and course in the posterolateral sulci on each side. What structures do they supply?

A

Dorsal roots and about 75% of the posterior columns

Also supply peripheral margins of the cord along with radicular aa.

58
Q

Spinal cord trauma may interrupt blood to the spinal cord, especially in areas supplied by 2 arterial supplies. This most frequently occurs adjacent to what areas of the spinal cord?

A

The enlargements — at C2, T1-4, and L1

59
Q

What artery arises from the left inferior intercostal or superior lumbar artery and contributes to the anterior spinal a., serving as the major supply to the inferior 2/3 of the spinal cord?

A

Great anterior artery of Adamkiewicz

60
Q

The great anterior artery of Adamkiewicz can be compromised secondary to thoracolumbar fracture or surgical repair of AAAs. What does this result in?

A

Ischemic necrosis of the spinal cord (partial or complete transection)

61
Q

What causes central cord syndrome?

A

Disruption of blood flow to the anterior spinal a.

[d/t thrombosis or hyperextension of the neck, leading to ischemia of the central region of the spinal cord]

62
Q

Signs/symptoms of central cord syndrome

A

Central necrosis and cavitation of spinal cord —> development of a syrinx

Sensory and motor deficits to UE > LE

Distal musculature > proximal musculature

63
Q

PICA is a branch of the vertebral a. What are the 3 main structures it supplies?

A

Posterior inferior portion of cerebellum

Posterolateral aspect of the medulla

Choroid plexus of the fourth ventricle

64
Q

What happens with occlusion of PICA?

A

Lateral medullar syndrome/wallenberg syndrome

65
Q

The anterior inferior cerebellar artery is located in the ______ sulcus, next to cranial nerves ____, ____, and _____, as well as the ______ of the cerebellum

A

Pontobulbar; VI, VII, VIII; flocculus

66
Q

What structures does the anterior inferior cerebellar artery supply?

A

Anterior inferior portion of cerebellum
Superior and middle cerebellar peduncles
Part of brainstem

67
Q

The superior cerebellar a. is located posterior to CN _____, and supplies what 3 structures?

A

CN III

Supplies:
Superior lateral portion of cerebellum
Deep cerebellar nuclei
Part of pons and midbrain

68
Q

The ______ a. arises as a branch of either basilar a. or AICA and is the main artery to the inner ear

A

Labyrinthine

69
Q

Pontine aa. are branches of the _____ a. that supply the medial and lateral aspects of the pons. Branches distribute to regions of the brainstem in a pie wedge pattern, often een with necrosis in some brainstem lesions

A

Basilar

70
Q

Penetrating branches of the posterior cerebral a. supply what structures?

A

Internal capsule
Thalamus
Choroid plexus of lateral ventricle
Upper midbrain

71
Q

Temporal branches of the posterior cerebral artery supply what structure(s)?

A

Inferior temporal cortex

72
Q

The parieto-occipital a. (branch of the posterior cerebral a.) supplies what structure(s)?

A

Primary visual cortex

73
Q

What branch of the posterior cerebral a. anastomoses with the anterior pericallosal artery of the anterior cerebral a.?

A

Posterior pericallosal a.

74
Q

What are the branches of the posterior cerebral a.?

A 
Penetrating branches
Temporal branches
Parieto-occipital a.
Calcarine a.
Posterior pericallosal a.
75
Q

Posterior cerebral a. occlusion may occur d/t what 2 primary causes?

A

Thrombosis

Compression d/t uncal herniation

76
Q

Results of PCA occlusion

A

Ischemic necrosis of the primary visual cortex —> contralateral homonymous hemianopsia with macular sparing

77
Q

What is falx herniation?

A

Falx cerebri partially separates the cerebral hemispheres

78
Q

Falx herniation may occur if a unilateral space-occupying lesion is present causing herniation of ____ _____ which pushes beneath the free edge of the falx cerebri

A

Cingulate gyrus

79
Q

Clinical symptoms of falx herniation

A

Headache
Contralateral leg weakness
[or may not present clinical deficits]

80
Q

Early clinical sign of acute uncal (tentorial) herniation

A

CN III compression —> oculomotor nerve palsy

81
Q

What happens when there is midbrain involvement in uncal (tentorial) herniation?

A

Contralateral hemiparesis and respiratory compromise

Kernohan’s notch = uncal herniation causes pressure on ipsilateral brainstem causing contralateral limb weakness; increased pressure pushes brainstem into tentorium cerebelli causing ipsilateral limb weakness

82
Q

What type of herniation is acute and rapidly fatal d/t compression upon the medulla leading to respiratory arrest?

A

Tonsilar herniation = cerebellar tonsils herniate through the foramen magnum

83
Q

What is the clinical course of progression with an epidural hematoma?

A

Traumatic history —> initially unconscious —> rapid recovery —> few hours pass —> neurologic symptoms

84
Q

What causes subdural hematoma?

A

Head trauma causes cerebral veins to rupture as they cross the subdural space

Veins are vulnerable to sheer forces between movement of brain vs. dura. Ruptured veins causes slow accumulation of blood in subdural space

85
Q

Compare clinical progression of subdural hematoma vs. epidural hematoma

A

Subdural hematoma has same symptoms as epidural hematoma (lethargy, seizures, or headaches) but onset is more insidious — delayed d/t slower pooling of blood

86
Q

Primary causes of subdural hematoma in children vs. elderly

A

Children = associated with skull fracture

Elderly = associated with fragile blood vessels

87
Q

Presence of erythrocytes in the CSF may indicate what?

A

Subarachnoid hemorrhage

88
Q

To sample CSF, where is lumbar puncture performed?

A

L4-L5

[spinal cord ends ~L2]

Neuro Exam 2 (21 decks)

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