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NE Exam 2 > Blood Supply & Hemorrhage > Flashcards

Blood Supply & Hemorrhage Flashcards

(128 cards)

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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
Another name for Vertebrobasilar Insufficiency
Bowhunters Syndrome (extreme head rotation and extension is common posture in bowhunters; Vertebral A stretched passing thru C1 during head rotation)
26
Other causes of Vertebrobasilar Insufficiency
- Atherosclerotic Disease - Dissection - Cervical compression lesions - Subclavian Steal Syndrome
27
Subclavian Steal Syndrome
- 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
28
When do clinical features of Subclavian Steal Syndrome often occur?
During exercise when blood flow to occluded arm is not enough to meet demand resulting in muscle weakness/pain
29
Neurological sxs of Subclavian Steal Syndrome
- Vertigo - Dizziness - Lightheadedness
30
Location of Circle of Willis
Subarachnoid space at base of brain
31
Function of Circle of Willis
Helps created collateral arterial circulation which helps prevent ischemic and hypoxic brain injuries
32
Basilar A bifurcates into:
Right and Left Posterior Cerebral Arteries (P1)
33
Major branch off of Posterior Cerebral A:
Posterior Communicating A
34
P1
Part of Posterior Cerebral A before it gives off Posterior Communicating A
35
P2
Part of Posterior Cerebral A distal to the branching of the Posterior Communicating A
36
Branch off of Internal Carotid A that runs posteriorly:
Anterior Choroidal A
37
Lateral continuation of Internal Carotid A:
Middle Cerebral A (M1)
38
Anterior branch off Internal Carotid A:
Anterior Cerebral A (A1)
39
Branches off of M1 (Middle Cerebral A):
Lenticulostriate Arteries
40
What connects the R and L A1 (Anterior Cerebral A):
Anterior Communicating A
41
5 Arteries that contribute to Circle of Willis:
(1) Posterior Cerebral A (P1) (2) Posterior Communicating A (3) Internal Carotid A (4) Anterior Cerebral A (A1) (5) Anterior Communicating A
42
Nerves easily compressed by Circle of Willis:
(1) CN II (2) CN III (3) CN V (4) CN VI (5) CN VII
43
What vessels can compress CN II (Optic N)? Associated Sxs?
- Internal Carotid A, Anterior Communicating A, & Anterior Cerebral A - Results in visual field defects
44
What vessels can compress CN III (Oculomotor N)? Associated Sxs?
- Posterior Cerebral, Superior Cerebellar, & Posterior Communicating A - Oculomotor palsy
45
What vessels can compress CN V (Trigeminal N)? Associated Sxs?
- Superior Cerebellar A - Tic Doulourux aka Trigeminal Neuralgia
46
What vessels can compress CN VI (Abducent N)? Associated Sxs?
- Labyrinthe & Anterior Inferior Cerebellar A - Abducent N palsy
47
What vessels can compress CN VII (Facial N)? Associated Sxs?
- Anterior Inferior Cerebellar A - Bell's Palsy
48
Border Zones
- 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
49
Anterior Cerebral A: A1 Segment
- Precommunicating segment - Part of Circle of Willis - ICA to Anterior Communicating A
50
Anterior Cerebral A: A2 Segment
- Infracallosal Segment - Anterior Communicating A to location where Rostrum and Genu of Corpus Callosum meet
51
Anterior Cerebral A: A3 Segment
- Precallosal segment - Arches around the genu of the Corpus Callosum and ends where the vessel turns caudal
52
Anterior Cerebral A: A4 Segment
- Supracallosal - Superior to Corpus Callosum
53
Anterior Cerebral A: A5 Segment
- Postcallosal - Caudal to Corpus Callosum
54
Middle Cerebral A: M1 Segment
- Sphenoidal or Horizontal Segment - Lenticulostriate Arteries branch from here - ICA to bifurcation at Insula
55
Middle Cerebral A: M2
- Insular Segment - Bifurcation at Insula to circular Sulcus of Insula (right angle turn)
56
Middle Cerebral A: M3 Segment
- Opercular Segment - Circular Sulcus of Insula to external surface of Lateral Fissure
57
Middle Cerebral A: M4 Segment
- Cortical Segment - Located on the cortex
58
Posterior Cerebral A: P1 Segment
- Basilar bifurcation (where Vertebral As come together) to Posterior Communicating A
59
Posterior Cerebral A: P2 Segment
- Posterior Communicating A to around the Midbrain
60
Posterior Cerebral A: P3 Segment
- Quadrigeminal Segment - Segement within the Quadrigeminal Cistern
61
Posterior Cerebral A: P4 Segment
Cortical segment
62
Superficial veins of the brain drain into ___ __ sinuses (located between the periosteal dura layer and the meningeal dura layer)
Dural Venous
63
Superior Sagittal Sinus
- Absorbs CSF from the meninges - Drains into the Confluence of Sinuses
64
Veins that drain into the Confluence of Sinuses
- Superior Sagittal Sinus - Straight Sinus - Occipital Sinuses
65
Confluence of Sinuses --> __ Sinuses ---> ___ Sinuses --> ___ ___ Veins ---> Heart
- Transverse - Sigmoid - Internal Jugular
66
Purpose of Blood Brain Barrier (BBB)
Maintains bloodstream cells, neurotoxic components and regulates microorganisms
67
What substances do not pass through the BBB easily?
Large molecules
68
What substance does not penetrate into the brain?
Low Lipid (fat) Soluble Molecules
69
What molecules are slowed when crossing thru BBB?
Molecules with a high electrical charge
70
What rapidly crosses thru the BBB into the brain?
Lipid Soluble Molecules (ex. Barbituate drugs)
71
Structures supplied by Anterolateral branches of Middle and Anterior Cerebral A:
FOREBRAIN - MIDBRAIN - PONS - MEDULLA -
72
Structures supplied by the Posterior Spinal A:
FOREBRAIN - MIDBRAIN - PONS - MEDULLA -
73
Structures supplied by the Vertebral A:
FOREBRAIN - MIDBRAIN - PONS - MEDULLA -
74
Structures supplied by the Posterior Inferior Cerebella A (PICA):
FOREBRAIN - MIDBRAIN - PONS - MEDULLA -
75
Structures supplied by the Anterior Inferior Cerebellar A (AICA):
FOREBRAIN - MIDBRAIN - PONS - MEDULLA -
76
Structures supplied by the Lateral Striate Branches (Lenticulostriate A) of the Middle Cerebral A:
FOREBRAIN - MIDBRAIN - PONS - MEDULLA -
77
Structures supplied by the Thalamogeniculate branches of the Posterior Cerebral A (branch of P1):
FOREBRAIN - Hippocampal Formation - Tail of Caudate Nucleus - Optic Tract - Amygdaloid Nuclear Complex MIDBRAIN - PONS - MEDULLA -
78
Structures supplied by the Medial Striate branch of Anterior Cerebral A (branch of A2):
FOREBRAIN - MIDBRAIN - PONS - MEDULLA -
79
Medial Medullary Syndrome: Cause
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
Medial Medullary Syndrome: Symptoms
- 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
3 Midline structures that can be damaged in Medial Medullary Syndrome
(1) Motor Pathway (Corticospinal Tract) (2) Medial Lemniscus (3) Motor fibers of Hypoglossal N
82
Structure supplied by PICA in Medulla:
- 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
Structures supplied by PICA in Medulla:
- 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
Structures supplied by Anterior Spinal A in the Medulla:
- Pyramid (motor tract) - Medial Lemniscus (sensory tract) - Hypoglossal Nucleus
84
Lateral Medullary Syndrome (Wallenberg): Cause
Caused by an infarct of the Posterior Inferior Cerebellar A (PICA)
85
Lateral Medullary Syndrome (Wallenberg): Symptoms
- 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
Horner's Syndrome
- 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
Blood Vessel that is an anastomoses between the Posterior Spinal A and the Anterior Spinal A:
Arterial Vasocorona (AVC)
88
What supplies the medial aspect of the spinal cord?
Anterior Spinal A
89
Structures of Spinal Cord supplied by Sulcal A (branch of Anterior Spinal A):
- Anterior Horn - Posterior Horn - Cervical & Thoracic regions of Lateral Corticospinal Tract - 1/2 Anterolateral System
90
Structures of the Spinal Cord supplied by AVC:
- Fasciculus Gracilis - Fasciculus Cuneatus - Dorsolateral Tract - Lumbar region of Corticospinal Tract - Spinocerebellar Tract - Reticulospinal and Vestibulospinal Tracts - 1/2 of Anterolateral System
91
3 Meningeal Spaces:
(1) Epidural (Extradural) (2) Subdural (Dura-Arachnoid) (3) Subarachnoid
92
Order of Meninges on Brain (Superficial -> Deep):
"DAB" (1) Dural Mater (2) Arachnoid Mater (3) Pia Mater
93
Epidural Space
- Extradural - Potential space - Located between the cranium and Periosteal Dura
94
Subdural Space
- Dura-Arachnoid Interface - Potential space - Located between Dura and Arachnoid
95
Subarachnoid Space
- Real space - Located between Arachnoid and Pia - Contains CSF, arteries (Circle of Willis) and veins
96
Epidural Hematoma: Location of Bleeding
Epidural space -- between skull and dura; attachment of dura keeps bleeding localized and does not cross suture lines of skull
97
Epidural Hematoma: Common Site
Fracture of squamous temporal bone or pterion
98
Epidural Hematoma: Source of Bleeding
Middle Meningeal A
99
Epidural Hematoma: Clinical Presentation
Momentary unconsciousness followed by lucid period (feel fine) of hours to 1-2 days then unconsciousness
100
Epidural Hematoma: Treatment
Surgical
101
Subdural Hematoma: Cause
Head strikes fixed object -- common in MVAs, Shaken Baby Syndrome
102
Subdural Hematoma: Location of Bleeding
Between dura and arachnoid -- does cross suture lines
103
Subdural Hematoma: Source of Bleeding
Venous, usually cortical veins opening into the Superior Sagittal Sinus
104
Subdural Hematoma: Clinical Presentation
Slower accumulation of blood due to pressure (less pressure in venous compared to arterial) and often self-limiting
105
Subdural Hematoma: Treatment
Surgical
106
Subarachnoid Hemorrhage: Causes
- Common finding in severe head injury - More common is rupture of aneurysm
107
Subarachnoid Hemorrhage: Source of Bleeding
Arterial bleeding from Cerebral A (Circle of Willis)
108
Subarachnoid Hemorrhage: Clinical Presentation
- 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
Intracerebral (Subpial) Hemorrhage
- 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
Any type of herniation syndrome causes increases in ___ ____
Intercranial Pressure
111
6 causes of Herniation Syndromes:
(1) Hemorrhage (2) Mas/tumor (3) Trauma (4) Abscess (5) Infection (6) Metabolic conditions
112
Locations where Herniation can occur:
- Supratentorial Compartment - Infratentorial Compartment - Tentorial Notch
113
Supratentorial Compartment
Located above the tentorium, divided into R and L by the Falx Cerebri
114
Infratentorial Compartment
Located below the Tentorium Cerebelli
115
Tentorial Notch
Continuation of the supra and infratentorial compartment
116
Herniation of the Supratentorial Compartment:
Subfalcine Herniation (Cingulate or Falcine or Falx herniation)
117
Subfalcine Herniation
(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
What happens as a Subfalcine Herniation progresses?
(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
Subfalcine Herniation may evolve into a ___ herniation
Transtentorial (Pops thru tentorium)
120
Subfalcine Herniation: Clinical Features
- Hemiplegia - Hemisensory loss of contralateral leg
121
Transtentorial Herniation
- Central Herniation - Brain displaced downward toward the Tentorial Notch
122
Structures that are comprised in Transtentorial Herniation
- Upper brainstem - CN II - Basilar A - Posterior Cerebral As
123
Transtentorial Herniations start in ___ rigidity and descend into ___ rigidity
- Decorticate - Decerebrate
124
Decorticate Posture
- 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
Decerebrate Posture
- 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
Uncal Herniation
- 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
Tonsillar Herniation
- 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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