Blood Supply, Hemorrhage, and Herniation

Question 1

Blood supply to the anterior cerebrum arises from what large vessel?

Answer 1

Internal Carotid A.

Question 2

Blood supply to the posterior cerebrum arises from what large vessel?

Answer 2

Vertebral A.

Question 3

What arteries form the Circle of Willis?

Answer 3

Anterior Cerebral A. x2

Internal Carotid A. x2

Posterior Cerebral A. x2

Anterior communicating A.

Posterior Communicating A. x2

Question 4

Compression of CN III can occur by what arteries of the Circle of Willis?

Answer 4

Posterior communicating A.

Posterior Cerebral A.

Superior Cerebellar A.

Question 5

Compression of oculomotor N. will affect what autonomic division first? Resulting in what symptoms?

Answer 5

Parasympathetic

Dilation of pupil, motor issues with eyes

Question 6

Compression by what cranial A. can cause trigeminal neuralgia?

Answer 6

Superior Cerebellar A.

Question 7

Abberant branches from the anterior inferior cerebellar A. can compress what nerve?

Answer 7

CN VII Facial

Question 8

What is the clinical significance of border zones?

Answer 8

Watershed areas susceptible to damage in times of hypotension or hypoperfusion

Question 9

An anterior watershed infarct can result in what?

Answer 9

Motor and sensory defects, especially in lower limbs

Question 10

A posterior watershed infarct can result in what?

Answer 10

Visual disturbance and language issues

Question 11

What arteries is the posterior watershed area located between?

Answer 11

Middle cerebral A.

Posterior cerebral A.

Question 12

What structures are contained within the medial medulla?

Answer 12

Pyramids

Medial meniscus

Hypoglossal nucleus

Question 13

What does the posterior spinal A. supply?

Answer 13

Gracile and Cuneate fasciculi and nuclei

Question 14

What does the posterior inferior cerebellar A. supply?

Answer 14

Lateral medulla

Question 15

What is the blood supply to the medial pons?

Answer 15

Paramedian branches of basilar A.

Question 16

What is the blood supply to the superior and inferior colliculi?

Answer 16

Superior: Quadreminal and posterior medial choroidal As.

Inferior: Quadreminal and superior cerebellar As.

Question 17

What does the posterior spinal artery supply?

Answer 17

Gracile and cuneate fasciculi

Question 18

What is the source of bleeding for an epidural hematoma?

Answer 18

Middle Meningeal A.

Question 19

Pt presents after MVC, states he hit the left side of his head and had momentary unconsciousness before waking up. After 6 hours in the ED, pt starts feeling nauseous and sleepy. What should you be concerned for?

Answer 19

Epidural or subdural hematoma

Question 20

What is this?

Answer 20

Epidural hematoma

Question 21

What is this?

Answer 21

Subdural Hematoma

Question 22

What is the source of bleeding for an intracerebral hemorrhage?

Answer 22

Middle Cerebral A.

Question 23

Rupture of cerebral veins can result in what kind of hemorrhage?

Answer 23

Subdural

Question 24

What is this?

Answer 24

Intracerebral Hemorrhage

Question 25

What artery may be compressed in a Subfalcine herniation?

Answer 25

Anterior Cerebral A.

Question 26

What is this?

Answer 26

Subfalcine Herniation

Question 27

A subfalcine herniation would manifest sx where?

Answer 27

Opposite lower extremity

Question 28

What structures are compressed in a transtentorial herniation?

Answer 28

Upper brainstem

CN III

Maybe basilar A. and posterior cerebral As

Question 29

Patient presenting with contralateral hemiplesia and ipsilateral CN III palsy most likely has a hernia where?

Answer 29

Uncus (and portions of parahippocampal gyrus)

Question 30

What is Kernohan’s syndrome?

Answer 30

Uncal herniation that shifts the midbrain

Disrupts ipsilateral CN III and bilateral hemiplesia

Question 31

What structures can be compressed in a tonsillar herniation?

Answer 31

Medulla

Upper cervical SC

Question 32

What structures are compressed in uncal herniations?

Answer 32

CN III

Cerebral peduncles