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NE Exam 2 > Blood Supply & Hemorrhage > Flashcards

Blood Supply & Hemorrhage Flashcards

1
Q

Anterior circulation to the brain:

A

Internal Carotid A

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2
Q

Posterior circulation to the brain:

A

Vertebral A

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3
Q

4 parts of the Internal Carotid A:

A

(1) Cervical
(2) Petrous
(3) Cavernous
(4) Cerebral

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4
Q

Internal Carotid A: Cervical Part

A
  • Extends from bifurcation (Common Carotid A) to Carotid Canal – when traveling thru the Carotid Canal must turn 90 anteromedially then another 90 superiorly before entering the cranial cavity
  • Travels anterior to Transverse processes of C1-C3
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5
Q

Internal Carotid A: Petrous Part

A
  • Carotid canal in Petrous part of Temporal bone
  • Travels upward and medially above Foramen Lacerum
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6
Q

Internal Carotid A: Cavernous Part

A
  • Located in Cavernous Sinus
  • Surrounded by sympathetic plexus, CN III, CN IV, and V1
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7
Q

Internal Carotid A: Cerebral Part

A
  • After ICA exits Cavernous Sinus, then divides into Anterior and Middle Cerebral As
  • Part that actually comes in contact w/ the brain
  • Contributes to the structures of Circle of Willis
  • Bifurcates into 2 terminal branches: Middle and Anterior Cerebral As
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8
Q

3 parts of Vertebral A:

A

(1) Cervical
(2) Atlantic
(3) Intracranial

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9
Q

Vertebral A: Cervical Part

A
  • Travels thru Transverse Foramina of C1-C6
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10
Q

Vertebral A: Atlantic Part

A
  • Lies on C1 (Atlas)
  • Perforates the dura and arachnoid
  • Passes thru Foramen Magnum then tightly curves into cranium (place where there can be disruption of blood flow)
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11
Q

Vertebral A: Intracranial Part

A
  • Located in cranium
  • Unite at the caudal border of Pons to form the Basilar A
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12
Q

Posterior circulation supplies:

A
  • Brainstem
  • Cerebellum
  • Occipital Lobe
  • Inferomedial Temporal Lobes
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13
Q

Anterior Cerebral A supplies:

A
  • Medial and superior surfaces of Frontal and Parietal Lobes
  • Anterior portions of Basal Ganglia and Internal Capsule
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14
Q

Middle Cerebral A supplies:

A
  • Lateral surface of Frontal and Parietal Lobes
  • Superior surface of Temporal Lobe
  • Insular Cortex
  • Large portion of Basal Ganglia and Internal Capsule
  • Posterior part of Inferior Frontal Gyrus
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15
Q

Posterior Cerebral A supplies:

A
  • Occipital Lobe
  • Inferior Temporal Lobe
  • Splenium of Corpus Callosum
  • Thalamus
  • Hippocampal formation
  • Amygdala
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16
Q

Basilar A supplies:

A
  • Lower Midbrain
  • Anteromedial part of Pons
  • Anterior Medulla
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17
Q

Posterior Inferior Cerebellar A supplies:

A
  • Lateral part of Medulla (Vestibular Nuclei, Spinal Trigeminal Nucleus, Spinothalamic Tract, Nucleus Ambiguus, Inferior Cerebellar Peduncle, Sympathetic Fibers)
  • Regions of Cerebellum
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18
Q

Anterior Spinal A supplies:

A

Rostral Anterior 2/3 of Spinal Cord

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19
Q

Posterior Spinal A supplies:

A

Posterior aspect of Spinal Cord

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20
Q

What are the 4 paired collateral branches of the Basilar A?

A

(1) Anterior Inferior Cerebellar A (AICA)
(2) Labyrinthe A
(3) Pontine Arteries
(4) Superior Cerebellar A

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21
Q

Superior Cerebellar A supplies:

A
  • Posterior aspect of Cerebellum
  • Pineal Gland
  • Part of Pons
  • 3rd Ventricle
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22
Q

What supplies the inner ear?

A

Labyrinthe As

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23
Q

What supplies the Pons?

A

Pontine As

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24
Q

Vertebrobasilar Insufficiency

A
  • Posterior circulation transient ischemic attach
  • Caused by reduced blood flow from the vertebral arteries as a result of extreme head rotation and extension
    **tight turn between C1 and the Occipital!
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25
Q

Another name for Vertebrobasilar Insufficiency

A

Bowhunters Syndrome
(extreme head rotation and extension is common posture in bowhunters; Vertebral A stretched passing thru C1 during head rotation)

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26
Q

Other causes of Vertebrobasilar Insufficiency

A
  • Atherosclerotic Disease
  • Dissection
  • Cervical compression lesions
  • Subclavian Steal Syndrome
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27
Q

Subclavian Steal Syndrome

A
  • Occurs when a Vertebral A on the same side of an occluded Subclavian A “steals” blood from the contralateral Subclavian A
  • Stenosis of Subclavian A proximal to the Vertebral A –> flow reverses on side of occlusion to supply the UE
  • Contralateral Vertebral A flow is normal
  • Blood from contralateral Vertebral A flows to the Basilar A and then continues as retrograde flow thru the ipsilateral Vertebral A to the blockage – allows bloodflow to the area supplied by the occluded vessel
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28
Q

When do clinical features of Subclavian Steal Syndrome often occur?

A

During exercise when blood flow to occluded arm is not enough to meet demand resulting in muscle weakness/pain

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29
Q

Neurological sxs of Subclavian Steal Syndrome

A
  • Vertigo
  • Dizziness
  • Lightheadedness
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30
Q

Location of Circle of Willis

A

Subarachnoid space at base of brain

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31
Q

Function of Circle of Willis

A

Helps created collateral arterial circulation which helps prevent ischemic and hypoxic brain injuries

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32
Q

Basilar A bifurcates into:

A

Right and Left Posterior Cerebral Arteries (P1)

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33
Q

Major branch off of Posterior Cerebral A:

A

Posterior Communicating A

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34
Q

P1

A

Part of Posterior Cerebral A before it gives off Posterior Communicating A

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35
Q

P2

A

Part of Posterior Cerebral A distal to the branching of the Posterior Communicating A

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36
Q

Branch off of Internal Carotid A that runs posteriorly:

A

Anterior Choroidal A

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37
Q

Lateral continuation of Internal Carotid A:

A

Middle Cerebral A (M1)

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38
Q

Anterior branch off Internal Carotid A:

A

Anterior Cerebral A (A1)

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39
Q

Branches off of M1 (Middle Cerebral A):

A

Lenticulostriate Arteries

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40
Q

What connects the R and L A1 (Anterior Cerebral A):

A

Anterior Communicating A

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41
Q

5 Arteries that contribute to Circle of Willis:

A

(1) Posterior Cerebral A (P1)
(2) Posterior Communicating A
(3) Internal Carotid A
(4) Anterior Cerebral A (A1)
(5) Anterior Communicating A

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42
Q

Nerves easily compressed by Circle of Willis:

A

(1) CN II
(2) CN III
(3) CN V
(4) CN VI
(5) CN VII

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43
Q

What vessels can compress CN II (Optic N)? Associated Sxs?

A
  • Internal Carotid A, Anterior Communicating A, & Anterior Cerebral A
  • Results in visual field defects
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44
Q

What vessels can compress CN III (Oculomotor N)? Associated Sxs?

A
  • Posterior Cerebral, Superior Cerebellar, & Posterior Communicating A
  • Oculomotor palsy
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45
Q

What vessels can compress CN V (Trigeminal N)? Associated Sxs?

A
  • Superior Cerebellar A
  • Tic Doulourux aka Trigeminal Neuralgia
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46
Q

What vessels can compress CN VI (Abducent N)? Associated Sxs?

A
  • Labyrinthe & Anterior Inferior Cerebellar A
  • Abducent N palsy
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47
Q

What vessels can compress CN VII (Facial N)? Associated Sxs?

A
  • Anterior Inferior Cerebellar A
  • Bell’s Palsy
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48
Q

Border Zones

A
  • Area between arteries
  • Susceptible to damage underconditions of sudden systemic hypotension or hypoperfusion (inadequate supply of blood) due to lack of anastomoses with other arteries
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49
Q

Anterior Cerebral A: A1 Segment

A
  • Precommunicating segment
  • Part of Circle of Willis
  • ICA to Anterior Communicating A
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50
Q

Anterior Cerebral A: A2 Segment

A
  • Infracallosal Segment
  • Anterior Communicating A to location where Rostrum and Genu of Corpus Callosum meet
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51
Q

Anterior Cerebral A: A3 Segment

A
  • Precallosal segment
  • Arches around the genu of the Corpus Callosum and ends where the vessel turns caudal
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52
Q

Anterior Cerebral A: A4 Segment

A
  • Supracallosal
  • Superior to Corpus Callosum
53
Q

Anterior Cerebral A: A5 Segment

A
  • Postcallosal
  • Caudal to Corpus Callosum
54
Q

Middle Cerebral A: M1 Segment

A
  • Sphenoidal or Horizontal Segment
  • Lenticulostriate Arteries branch from here
  • ICA to bifurcation at Insula
55
Q

Middle Cerebral A: M2

A
  • Insular Segment
  • Bifurcation at Insula to circular Sulcus of Insula (right angle turn)
56
Q

Middle Cerebral A: M3 Segment

A
  • Opercular Segment
  • Circular Sulcus of Insula to external surface of Lateral Fissure
57
Q

Middle Cerebral A: M4 Segment

A
  • Cortical Segment
  • Located on the cortex
58
Q

Posterior Cerebral A: P1 Segment

A
  • Basilar bifurcation (where Vertebral As come together) to Posterior Communicating A
59
Q

Posterior Cerebral A: P2 Segment

A
  • Posterior Communicating A to around the Midbrain
60
Q

Posterior Cerebral A: P3 Segment

A
  • Quadrigeminal Segment
  • Segement within the Quadrigeminal Cistern
61
Q

Posterior Cerebral A: P4 Segment

A

Cortical segment

62
Q

Superficial veins of the brain drain into ___ __ sinuses (located between the periosteal dura layer and the meningeal dura layer)

A

Dural Venous

63
Q

Superior Sagittal Sinus

A
  • Absorbs CSF from the meninges
  • Drains into the Confluence of Sinuses
64
Q

Veins that drain into the Confluence of Sinuses

A
  • Superior Sagittal Sinus
  • Straight Sinus
  • Occipital Sinuses
65
Q

Confluence of Sinuses –> __ Sinuses —> ___ Sinuses –> ___ ___ Veins —> Heart

A
  • Transverse
  • Sigmoid
  • Internal Jugular
66
Q

Purpose of Blood Brain Barrier (BBB)

A

Maintains bloodstream cells, neurotoxic components and regulates microorganisms

67
Q

What substances do not pass through the BBB easily?

A

Large molecules

68
Q

What substance does not penetrate into the brain?

A

Low Lipid (fat) Soluble Molecules

69
Q

What molecules are slowed when crossing thru BBB?

A

Molecules with a high electrical charge

70
Q

What rapidly crosses thru the BBB into the brain?

A

Lipid Soluble Molecules (ex. Barbituate drugs)

71
Q

Structures supplied by Anterolateral branches of Middle and Anterior Cerebral A:

A
72
Q

Structures supplied by the Posterior Spinal A:

A
73
Q

Structures supplied by the Vertebral A:

A
74
Q

Structures supplied by the Posterior Inferior Cerebella A (PICA):

A
75
Q

Structures supplied by the Anterior Inferior Cerebellar A (AICA):

A
76
Q

Structures supplied by the Lateral Striate Branches (Lenticulostriate A) of the Middle Cerebral A:

A
77
Q

Structures supplied by the Thalamogeniculate branches of the Posterior Cerebral A (branch of P1):

A

FOREBRAIN
- Hippocampal Formation
- Tail of Caudate Nucleus
- Optic Tract
- Amygdaloid Nuclear Complex

78
Q

Structures supplied by the Medial Striate branch of Anterior Cerebral A (branch of A2):

A
79
Q

Medial Medullary Syndrome: Cause

A

Caused by infarct of paramedian branches of Anterior Spinal A (this A supplies medial aspect of medulla – lateral corticospinal tract, medial lemniscus, hypoglossal nucleus)

80
Q

Medial Medullary Syndrome: Symptoms

A
  • Ipsilateral paresis of the tongue with deviation toward the lesion (LMN lesion of CN XII)
  • Contralateral hemiplegia with sparing of the face (Corticospinal Tract)
  • Loss of ipsilateral vibration and proprioception (Medial Lemniscus)
81
Q

3 Midline structures that can be damaged in Medial Medullary Syndrome

A

(1) Motor Pathway (Corticospinal Tract)
(2) Medial Lemniscus
(3) Motor fibers of Hypoglossal N

82
Q

Structure supplied by PICA in Medulla:

A
  • Nucleus Ambiguous (motor tracts)
  • Anterolateral System (ALS, sensory tract)
  • Rubrospinal Tract (motor tract)
  • Spinal Trigeminal Nucleus
  • Spinal Trigeminal Tract (sensory tract)
  • Solitary Tract & Nucleus
  • Accessory Cuneate Nucleus
  • Inferior Vestibular Nucleus
  • Medial Vestibular Nucleus
  • Dorsal Motor Nucleus of Vagus N (autonomics)
82
Q

Structures supplied by PICA in Medulla:

A
  • Nucleus Ambiguous (motor tracts)
  • Anterolateral System (ALS, sensory tract)
  • Rubrospinal Tract (motor tract)
  • Spinal Trigeminal Nucleus
  • Spinal Trigeminal Tract (sensory tract)
  • Solitary Tract & Nucleus
  • Accessory Cuneate Nucleus
  • Inferior Vestibular Nucleus
  • Medial Vestibular Nucleus
  • Dorsal Motor Nucleus of Vagus N (autonomics)
83
Q

Structures supplied by Anterior Spinal A in the Medulla:

A
  • Pyramid (motor tract)
  • Medial Lemniscus (sensory tract)
  • Hypoglossal Nucleus
84
Q

Lateral Medullary Syndrome (Wallenberg): Cause

A

Caused by an infarct of the Posterior Inferior Cerebellar A (PICA)

85
Q

Lateral Medullary Syndrome (Wallenberg): Symptoms

A
  • Dysphagia, hoarseness, decreased gag reflex, hiccups (Nucleus Ambiguous; CN IX, CN X, CN XI)
  • Vomiting, vertigo, nystagmus (Vestibular Nuclei)
  • Decreased pain/temperature sensation from contralateral body and ipsilateral face (Lateral Spinothalamic Tract, Spinal Trigeminal Nucleus)
  • Ipsilateral Horner Syndrome (Sympathetic fibers)
    -Ipsilateral ataxia, dysmetria (Inferior Cerebellar Peduncle)
86
Q

Horner’s Syndrome

A
  • Can be caused by infarct to PICA which damages Sympathetic fibers
  • Sxs include: ptosis (drooping of upper eyelid), anhidrosis (absence of sweating of the face), miosis (constricted pupil)
87
Q

Blood Vessel that is an anastomoses between the Posterior Spinal A and the Anterior Spinal A:

A

Arterial Vasocorona (AVC)

88
Q

What supplies the medial aspect of the spinal cord?

A

Anterior Spinal A

89
Q

Structures of Spinal Cord supplied by Sulcal A (branch of Anterior Spinal A):

A
  • Anterior Horn
  • Posterior Horn
  • Cervical & Thoracic regions of Lateral Corticospinal Tract
  • 1/2 Anterolateral System
90
Q

Structures of the Spinal Cord supplied by AVC:

A
  • Fasciculus Gracilis
  • Fasciculus Cuneatus
  • Dorsolateral Tract
  • Lumbar region of Corticospinal Tract
  • Spinocerebellar Tract
  • Reticulospinal and Vestibulospinal Tracts
  • 1/2 of Anterolateral System
91
Q

3 Meningeal Spaces:

A

(1) Epidural (Extradural)
(2) Subdural (Dura-Arachnoid)
(3) Subarachnoid

92
Q

Order of Meninges on Brain (Superficial -> Deep):

A

“DAB”
(1) Dural Mater
(2) Arachnoid Mater
(3) Pia Mater

93
Q

Epidural Space

A
  • Extradural
  • Potential space
  • Located between the cranium and Periosteal Dura
94
Q

Subdural Space

A
  • Dura-Arachnoid Interface
  • Potential space
  • Located between Dura and Arachnoid
95
Q

Subarachnoid Space

A
  • Real space
  • Located between Arachnoid and Pia
  • Contains CSF, arteries (Circle of Willis) and veins
96
Q

Epidural Hematoma: Location of Bleeding

A

Epidural space – between skull and dura; attachment of dura keeps bleeding localized and does not cross suture lines of skull

97
Q

Epidural Hematoma: Common Site

A

Fracture of squamous temporal bone or pterion

98
Q

Epidural Hematoma: Source of Bleeding

A

Middle Meningeal A

99
Q

Epidural Hematoma: Clinical Presentation

A

Momentary unconsciousness followed by lucid period (feel fine) of hours to 1-2 days then unconsciousness

100
Q

Epidural Hematoma: Treatment

A

Surgical

101
Q

Subdural Hematoma: Cause

A

Head strikes fixed object – common in MVAs, Shaken Baby Syndrome

102
Q

Subdural Hematoma: Location of Bleeding

A

Between dura and arachnoid – does cross suture lines

103
Q

Subdural Hematoma: Source of Bleeding

A

Venous, usually cortical veins opening into the Superior Sagittal Sinus

104
Q

Subdural Hematoma: Clinical Presentation

A

Slower accumulation of blood due to pressure (less pressure in venous compared to arterial) and often self-limiting

105
Q

Subdural Hematoma: Treatment

A

Surgical

106
Q

Subarachnoid Hemorrhage: Causes

A
  • Common finding in severe head injury
  • More common is rupture of aneurysm
107
Q

Subarachnoid Hemorrhage: Source of Bleeding

A

Arterial bleeding from Cerebral A (Circle of Willis)

108
Q

Subarachnoid Hemorrhage: Clinical Presentation

A
  • Massive bleeding into CSF comparstment due to arterial source with headaches and deteriorating level of consciousness
  • “Worst headache of your life”
  • 51% chance you die if don’t get immediate medical attention
109
Q

Intracerebral (Subpial) Hemorrhage

A
  • Also known as Hemorrhagic Stroke
  • Bleeding within brain substance (stroke)
  • Complication in 2-3% of head injuries
  • Source: Middle Cerebral A
  • Clinical: hypertension or degenerative arterial disease (commonly found in autopsy)
110
Q

Any type of herniation syndrome causes increases in ___ ____

A

Intercranial Pressure

111
Q

6 causes of Herniation Syndromes:

A

(1) Hemorrhage
(2) Mas/tumor
(3) Trauma
(4) Abscess
(5) Infection
(6) Metabolic conditions

112
Q

Locations where Herniation can occur:

A
  • Supratentorial Compartment
  • Infratentorial Compartment
  • Tentorial Notch
113
Q

Supratentorial Compartment

A

Located above the tentorium, divided into R and L by the Falx Cerebri

114
Q

Infratentorial Compartment

A

Located below the Tentorium Cerebelli

115
Q

Tentorial Notch

A

Continuation of the supra and infratentorial compartment

116
Q

Herniation of the Supratentorial Compartment:

A

Subfalcine Herniation (Cingulate or Falcine or Falx herniation)

117
Q

Subfalcine Herniation

A

(1) mass occupying lesion increases intracranial pressure
(2) pushes brain tissue of frontal or parietal lobe away from the lesion
(3) cingulate gyrus of affected cerebral hemisphere is forced under the falx cerebri
(4) separation of hemispheres

118
Q

What happens as a Subfalcine Herniation progresses?

A

(1) cingulate gyrus pulls ipsilateral ACA together with it under the Falx Cerebri
(2) ACA can now be compressed/occluded
(3) Infarction of regions of the cortex supplied by ACA

  • May also obstruct the Foramen of Monro (CSF from Lateral ventricle to 3rd ventricle) which causes obstructive hydrocephalus
119
Q

Subfalcine Herniation may evolve into a ___ herniation

A

Transtentorial
(Pops thru tentorium)

120
Q

Subfalcine Herniation: Clinical Features

A
  • Hemiplegia
  • Hemisensory loss of contralateral leg
121
Q

Transtentorial Herniation

A
  • Central Herniation
  • Brain displaced downward toward the Tentorial Notch
122
Q

Structures that are comprised in Transtentorial Herniation

A
  • Upper brainstem
  • CN II
  • Basilar A
  • Posterior Cerebral As
123
Q

Transtentorial Herniations start in ___ rigidity and descend into ___ rigidity

A
  • Decorticate
  • Decerebrate
124
Q

Decorticate Posture

A
  • Upper midbrain damage
  • Damage above the Red Nucleus which is responsible for motor coordination
  • Body is rigid, the arms are stiff and bent, the fists are tight, and the legs are straight out
125
Q

Decerebrate Posture

A
  • Upper pontine damage
  • Damage below the Red Nucleus
  • Arms and legs are out straight and rigid, the toes point downward, and the head is arched backward
126
Q

Uncal Herniation

A
  • Uncus and part of parahippocampal gyrus are extruded over the edge of the tentorium cerebelli and through the tentorial notch
  • Iminges on midbrain
  • Leads to damage of cerebral peduncle (motor deficits) and Oculomotor N
127
Q

Tonsillar Herniation

A
  • Cerebellar Tonsils bulge thru Foramen Magnum
  • Leads to compression of the Medulla and upper cervical spinal cord
  • Affects areas that control heart rate and breathing

NE Exam 2 (19 decks)

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