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Neuroscience > Blood Supply, Hemorrhage, and Herniation > Flashcards

Blood Supply, Hemorrhage, and Herniation Flashcards

1
Q 
Blood Supply to the Brain:
?
• Cervical part
     - Bifurcation to ?
     - Anterior to transverse processes of ?

• Petrous part

 - Carotid canal in petrous part of temporal
 - Upward and medially above ?

• Cavernous part

 - In the cavernous sinus
 - Surrounded by sympathetic plexus, CN ?

• Cerebral part

A

Internal Carotid
• Cervical part
- Bifurcation to CAROTID CANAL
- Anterior to transverse processes of UPPER 3 VERTEBRAE

• Petrous part

  - Carotid canal in petrous part of temporal
  - Upward and medially above FORAMEN LACERUM

• Cavernous part
- In the cavernous sinus
- Surrounded by sympathetic plexus, CN III, IV, VI,
and V1

• Cerebral part

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2
Q

Blood Supply to the Brain:
?
• Cervical part
- Transverse foramina of ?

• Atlantic part

 - Perforates the ? and ?
 - Pass through ?

• Intracranial part

 - In the cranium
 - Unite at the caudal border of pons to form ?
A

Vertebral Artery

• Cervical part
- Transverse foramina of FIRST 6 CERVICAL VERTEBRAE

• Atlantic part

 - Perforates the DURA and ARACHNOID
 - Pass through FORAMEN MAGNUM

• Intracranial part
- In the cranium
- Unite at the caudal border of pons to form BASILAR
ARTERY

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3
Q

• A ring of 9 arteries supplying blood to the
cerebral hemispheres (6 large arteries
anastomose via 3 small communicating arteries)

A

Circle of Willis
• 2-Anterior Cerebral a. (branch of internal
carotid)
• 2-Internal Carotid a.
• 2-Posterior Cerebral a. (branch of Basilar)
• Anterior Communicating a.
• 2-Posterior Communicating a.

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4
Q

CN near ICA and Anterior communicating

a. ?

A

CN II

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5
Q

CN near posterior cerebral a., superior

cerebellar a., and posterior communicating a. ?

A

CN III

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6
Q

CN near labyrinthine and AICA?

A

CN IV

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7
Q

Supplies most of the medial and superior surface of the frontal and parietal lobes

A

Anterior Cerebral A. (ACA)

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8
Q

Supplies lateral surface of frontal and parietal lobes and the superior part of temporal lobe

A

Middle Cerebral A. (MCA)

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9
Q

Supplies the occipital lobe and the inferior temporal lobe

A

Posterior Cerebral A. (PCA)

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10
Q
  • Border zones: area between arteries

* Susceptible to damage under conditions of sudden systemic hypotension or hypoperfusion

A

Cerebral Arteries

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11
Q

Anterior Cerebral A. Segments:

- ICA to anterior communicating a.

A

A1: (Precommunicating segment)

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12
Q

Anterior Cerebral A. Segments:

- anterior communicating a. to where rostrum and genu of corpus callosum meet

A

A2: (Infracallosal segment)

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13
Q

Anterior Cerebral A. Segments:

- arches around the genu of corpus callosum, ends when vessels turn caudal

A

A3: (Precallosal segment)

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14
Q

Anterior Cerebral A. Segments:

- superior to corpus callosum

A

A4: (Supracallosal)

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15
Q

Anterior Cerebral A. Segments:

- caudal to corpus callosum

A

A5: (Postcallosal)

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16
Q

Middle Cerebral A. Segments:

- ICA to the bifurcation at insula

A

M1: (Sphenoidal or horizontal segment)

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17
Q

Middle Cerebral A. Segments:

- bifurcation at insula to circular sulcus of insula (right angle turn)

A

M2: (Insular segment)

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18
Q

Middle Cerebral A. Segments:

- Circular sulcus of insula to external surface of Lateral Fissure

A

M3: (Opercular segment)

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19
Q

Middle Cerebral A. Segments:

- On the cortex

A

M4: (Cortical segment)

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20
Q

Posterior Cerebral A. Segments:

- Basilar bifurcation to posterior communicating a.

A

P1

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21
Q

Posterior Cerebral A. Segments:

- Posterior communicating a. to around the midbrain

A

P2

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22
Q

Posterior Cerebral A. Segments:

- segment within the quadrigeminal cistern

A

P3: (Quadrigeminal segment)

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23
Q

Posterior Cerebral A. Segments:

- (Cortical segment)

A

P4

24
Q
  • Potential space

* Between cranium and periosteal dura

A

Epidural (extradural)

25
Q
  • Potential space

* Between dura and arachnoid

A

Subdural (dura-arachnoid interface)

26
Q
  • Real space
  • Between arachnoid and pia
  • Contains CSF, arteries (Circle of Willis) and veins
A

Subarachnoid

27
Q

Herniation Syndromes:

Causes ?

A
  • Hemorrhage
  • Mass/tumor
  • Trauma
  • Abscess
  • Infection
  • Metabolic conditions
28
Q

Herniation Syndromes:
- Divisions:
• Supratentorial compartment – above the ? and divided into right and left by the ?
• Infratentorial compartment – below the ?
• Tentorial notch – continuation of the ? and ?

A
  • Supratentorial compartment – above the TENTORIUM and divided into right and left by the FALX CEREBRI
  • Infratentorial compartment – below the TENTORIUM CEREBELLI
  • Tentorial notch – continuation of the SUPRA and INFRATENTORIAL COMPARTMENT
29
Q 
Subfalcine Herniation
• Also called a ? or ? or ? herniation
• ? compartment
    - Displaces brain tissue under the ?
• May compress ?
    - Frontal lobe
    - Parietal lobe
• May evolve into a ?
A

• Also called a CINGULATE or FALCINE or FALX
herniation
• SUPRATENTORIAL compartment
- Displaces brain tissue under the FALX CEREBRI
• May compress ACA
- Frontal lobe
- Parietal lobe
• May evolve into a TRANSTENTORIAL HERNIATION

30
Q 
Transtentorial Herniation
• Also called ?
• Brain displaced downward toward the ?
• Compromises the ? brainstem, CN ? and possibly even ?
• May compress ? and ?
• Decorticate rigidity
• Decerebrate rigidity
A

• Also called CENTRAL HERNIATION
• Brain displaced downward toward the
TENTORIAL NOTCH
• Compromises the UPPER brainstem, CN III and possibly even LOWER STRUCTURES
• May compress BASILAR ARTERY and POSTERIOR CEREBRAL ARTERIES
• Decorticate rigidity
• Decerebrate rigidity

31
Q

Uncal Herniation
• ? and frequently portions of the ? are extruded over the edge of tentorium cerebelli and through the tentorial notch
• Impinge on ?

A

• UNCUS and frequently portions of
the PARAHIPPOCAMPAL GYRUS are extruded over the edge of tentorium cerebelli and through the tentorial notch
• Impinge on MIDBRAIN

32
Q

Tonsillar Herniation
• Cerebellar tonsils through ?
• Compression of the ? and ?

A

Tonsillar Herniation
• Cerebellar tonsils through FORAMEN MAGNUM
• Compression of the MEDULLA and UPPER CERVICAL SPINAL CORD

33
Q

Blood Supply to Medulla:

  • What supplies the medial medulla?
  • get anterior medial syndrome
A

Anterior Spinal A.

34
Q

Blood Supply to Medulla:

  • What supplies the lower levels of the medulla, does fascicule cuneatus and gracilis, does cuneate nucleus
A

Posterior Spinal A.

35
Q

Blood Supply to Medulla:

  • What supplies the lateral medulla?
  • Get lateral medullary syndrome
A

Posterior Inferior Cerebellar A.

36
Q

Blood Supply to Medulla:

  • Does cochlear nuclei (dorsal and ventral cochlear)
A

Anterior Inferior Cerebellar A.

37
Q

Blood Supply to Pons:

  • What supplies the medial aspects of the pons
A

Paramedian branches of basilar A.

38
Q

Blood Supply to Pons:

  • What supplies the lateral pontine and gives lateral pontine syndrome?
A

Long Circumferential branches of Basilar A and branches of AICA

39
Q

Blood Supply to the Midbrain:

  • What supplies the medial portions of the midbrain?
  • Get Weber’s Syndrome
A

Anteriomedial (paramedian ) branches of basilar bifurcation and P1 segment

40
Q

Blood Supply to the Midbrain:

  • What supplies the inferior and superior colliculus of the midbrain?
A

Quadrigeminal and superior cerebellar arteries (level of inferior colliculus), quadrigeminal and posterior medial choroidal arteries (level of superior colliculus)

41
Q

Blood Supply to the Forebrain:

  • Supplies the thalamus; medial and lateral geniculate nuclei/bodies?
A

Thalamogeniculate branches of posterior cerebral A. (branch of P2)

42
Q

Blood Supply to the Forebrain:

  • Hits the optic tract and Hippocampal formation
  • Supplies part of the internal capsule
A

Anterior Choroidal A.

43
Q

Blood Supply to the Forebrain:

  • Supplies the internal capsule
A

Lateral striate branches (lenticulostriate arteries) of the middle cerebral artery

44
Q

Blood Supply to the Spinal Cord:

  • Supplies dorsal fasciuclates (gracile and cuneatus)
A

Posterior Spinal A

45
Q

Blood Supply to the Spinal Cord:

  • Part of the legs of the CST is supplied by?
A

Dorsal Spinal A.

46
Q

Blood Supply to the Spinal Cord:

  • Supplies most of the ventral and dorsal horns
A

Anterior Spinal A.

Gives off Sulcal arteries- if occluded they affect one side of the spinal cord or medulla

47
Q

Blood Supply to the Spinal Cord:

  • What do Posterior and Anterior Spinal A. anastomose with?
A

Arterial Vasocorona (AVC)

48
Q

Bleeding into potential space between skull and dura?

A

Epidural Hematoma

lens shaped

49
Q

Epidural Hematoma

  • Common Site:
  • Source of the bleeding:
  • Clinical:
  • Treatment:
A
  • fracture of squamous temporal bone or pterion
  • Source: middle meningeal artery (2% of all head injuries but more blood to calvaria than dura)
  • Clinical: Momentary unconsciousness followed by lucid
    period of hours to 1-2 days then unconsciousness
  • Treatment - surgical
50
Q

Bleeding between dura and arachnoid?

A

Subdural Hematoma

(cresennt shaped and more jagged than lens_

51
Q

Subdural Hematoma:

  • Occurence:
  • Source of bleeding:
  • Clinical:
  • Treatment:
A
  • Occurence:Head strikes fixed object
  • Source of bleeding: venous, usually cortical veins openings into superior sagittal sinus
  • Clinical: Slower accumulation of blood due to pressure and often self-limiting
  • Treatment: Surgical
52
Q

Subarachnoid Hemorrhage:
• Common finding in severe head injury

  • More common is rupture of aneurysm
  • Source of the bleeding: ?
  • Clinical: ?
A

• Source of the bleeding:
Arterial bleeding from cerebral a

• Clinical: massive bleeding into CSF compartment due to
arterial source with headaches and deteriorating level of
consciousness

“Worse headache of their lives”

53
Q
  • Bleeding within brain substance (stroke)

* Complication in 2-3% of all head injuries

A

Intracerebral (Subpial) Hemorrhage

54
Q

Intracerebral (Subpial) Hemorrhage:

  • Source:
  • Clinical:
A

• Source – usually middle cerebral a.

• Clinical – hypertension or degenerative arterial disease
commonly seen at autopsy

55
Q

Uncal Herniation:

  • Can hit CN ? Which would present with?
A
  • 3

- Present with contralateral hemiplegia and ipsilateral CN 3 problems (Kernohan Syndrome)

Neuroscience (14 decks)

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