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Blood Supply, Hemorrhage, And Herniation Flashcards

1
Q

What is the circle of willis?

A

Ring of 9 arteries supplying blood to the cerebral hemispheres

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2
Q

What is the circle of willis composed of?

A

6 large arteries anastomoses via 3 small communicating as.

Communicating (ant.) -1
Anterior cerebral a. -2
Internal carotid -2
Communicating (posterior) -2
Posterior cerebral a. -2
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3
Q

what comes off of basilar a?

A

S.P.A.

Superior cerebellar a.
Pontine as.
Anterior cerebellar a.

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4
Q

What makes the basilar a.?

A

United vertebral arteries

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5
Q

What comes off the vertebral as?

A

Posterior inferior cerebellar a. (PICA)

1 anterior spinal a.

2 posterior spinal a.

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6
Q

What comes off the ICA?

Are they part of circle of willis?

A

Anterior cerebral a. - yes

Middle cerebral a. - no
Ophthalmic a. - no
Anterior choroidal as. - no

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7
Q

What supplies the superior, middle and inferior cerebellar peduncles?

A

Superior — Superior cerebellar a.

Middle — anterior inferior cerebellar a. (And some superior cerebellar a.)

Inferior — posterior inferior cerebellar a. (From Vert. A.)

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8
Q

What vasculature is CN 2 close to?

A

ICA
Ant. Comm. a.
Ant. Cerebral a.

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9
Q

What happens if there is an aneurysm in ICA, Ant. Comm. a. Or ACA?

A

Compression of CN2 - visual deficits

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10
Q

What vasculature is CN 3 close to?

What happens to compress CN 3? Result?

A

B/w Posterior cerebral a. & Superior cerebellar a.

(Post communicating also close)

Aneurysm can compress- Oculomotor pasly (down and out)

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11
Q

What vasculature is CN 6 close to?

What can cause compression of CN 6? Result?

A

B/w labyrinthine and AICA

Aneurysms - Abducens nerve palsy

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12
Q

What vasculature is CN 5 close to?

What can cause irritation of CN5? result?

A

Superior cerebellar a.

Aberrant loops can cause trigeminal neuralgia or Tic Douloureux

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13
Q

What vasculature is CN 7 close to?

What can cause irritation of CN 7? Result?

A

Close to AICA

Aberrant loops - CN 7 palsy with all effects from origin

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14
Q

What are the four parts of the internal carotid a.?

A

Cervical part
Petrous part
Cavernous part
Cerebral part

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15
Q

What does the cervical part of the ICA do?

A

Anterior circulation

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16
Q

When does the cervical part bifurcate?

What does it travel thru?

A

Carotid canal

Anterior to Transverse processes of upper 3 vertebrae

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17
Q

Where is the petrous part of the ICA?

Where does it course?

A

Carotid canal in petrous part of temporal bone

Upward and medially above foramen lacerum

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18
Q

Where is the cavernous part of the ICA located?

What surrounds it?

A

In cavernous sinus

Sympathetic plexus surround it - CN 3, 4, 5, 6 (6 is the closest)

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19
Q

What does the vertebral a. Do?

A

Posterior circulation

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20
Q

What are the 3 parts of the vertebral a. ?

A

Cervical part
Atlantic part
Intracranial part

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21
Q

Where is the cervical parts of Vertebral As. Found?

A

In the transverse foramina of the 1st six cervical vertebrae

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22
Q

Where do you find the Atlantic part of the vertebral a. ?

What does it go thru?

A

Laying on C1 making an Acute angle

Thru perforated dura and arachnoid thru foramen magnum

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23
Q

Where is the intracranial part of the vertebral a. Found?

A

In cranium

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24
Q

What does the intracranial parts of the vertebral As. Do?

A

Unites at caudal border of pons to form basilar a.

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25
Q

When does vertebral basilar insufficiency occur?

A

Occurs when there is reduced blood flow from Vertebral A. To brain

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26
Q

What can cause Vertebral Basilar insufficiency?

A
  1. Hyperextension of head
    (compressing vertebral A. B/w C1 and occipital bone at that angle)
  2. Extreme head rotation “Bow-hunter’s syndrome”
    (Causes torsion of Vert. A. And narrows it)
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27
Q

What is subclavian steal syndrome?

A

Subclavian a. Steals blood from vertebral as.

Blood will go up and down to other subclavian a.

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28
Q

When does Subclavian steal syndrome occur?

A

If there is an occlusion of the subclavian a. PROXIMAL to where the vertebral arteries come off

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29
Q

What does the ACA supply?

A

Most medial and superior surface of frontal and temporal lobes

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30
Q

How many segments does the ACA have?

A

5

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31
Q

What is A1 called?

Where is it from?

A

Precommunicating

ICA to ant. Communicating

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32
Q

What is A2 called?

Where is it from?

A

Infracallosal segment

Ant. Comm. a. To where rostrum and genus of corpus callosum meet

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33
Q

What is A3 called?

Where is it from?

A

Precallosal

Attaches around Genu of corpus callosum - ends when vessels turn caudal

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34
Q

What is A4 called?

Where is it from?

A

Supracallosal

Superior to corpus callosum

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35
Q

What is A5 called?

Where is it from?

A

Postcallosal

Caudal to corpus callosum

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36
Q

Where is the peri colossal a.?

A

Up against the corpus callosum

37
Q

Where is the callosomarginal a.?

A

Around cingulate gyri

38
Q

What does the MCA supply?

A

Lateral surface of frontal and parietal lobes

Superior part of temporal lobe

39
Q

How many segments of the MCA are there?

A

4

40
Q

What is M1 called?

Where is it from?

A

Sphenoidal (horiz.) segment

ICA to bifurcation at insula

41
Q

What comes off of M1? What do they supply?

A

Lenticulostriate arteries

Supply internal capsule

42
Q

What is M2 called?

Where is it from?

A

Insular segment

Bifurcation at insula to circular sulcus of insula (makes a right turn)

43
Q

What is M3 called?

Where is it from?

A

Opercular segment

Circular sulcus of insula to external surface of lateral fissure

44
Q

What is M4 called?

Where is it?

A

Cortical segment

Out on cerebral cortex

45
Q

What does PCA supply?

A

Occipital lobe and inferior temporal lobe

46
Q

Where is P1 from and to?

A

Basilar bifurcation to PCA

47
Q

Where is P2 from and to?

A

PCA to around midbrain

48
Q

What is P3 called?

Where is P3 from and to?

A

Quadrigeminal segment

Segment w/in quadrigeminal cistern

49
Q

Where is P4 from and to?

A

Cortical segment

Out on cerebral cortex

50
Q

What are the border zones?

A

Areas between cerebral arteries that are susceptible to damage under conditions of sudden systemic hypotension or hypoperfusion

51
Q

What happens if there is damage in the border zone between:

ACA and MCA?

A

Motor/sensory deficits
Language issues
Behavioral problems

52
Q

What happens if there is damage in the border zone between:

MCA and PCA?

A

Vision and language deficits

53
Q

What is the blood supply to the medulla?

A

Vetebral a.
2 posterior spinal a.
1 anterior spinal a.
Posterior inferior cerebellar a.

(Plus paramedian branches of caudal portions of basilar a.)

54
Q

What do the posterior spinal As. Supply?

A

Spinal cord

Dorsal aspect of medulla

55
Q

What does PICA supply?

A

Lateral aspect of medulla

56
Q

What does AICA supply?

A

Medulla

***Cochlear nuclei for CN 8

57
Q

What does the Anterior Spinal a. Supply?

A

Medial aspect of the medulla

58
Q

What is the blood supply to the pons?

A

All basilar branches

Paramedian branches
Lon circumferential 
Short circumferential 
Branches of AICA
Branches of Superior Cerebellar a.
59
Q

What is the blood supply to the midbrain?

A

P1’s anteriomedial branches of basilar bifurcation

P3 - anterolateral branches of P3 and posteiror medial choroidal as. (At level of superior colliculus)

P3 and superior cerebellar as. - at level of inferior colliculus

quadrigeminal branches of P3 and Posterior medial choroidal As. At level of superior colliculus

Thalamogeniculate as.

60
Q

What are some major arteries to the forebrain?

A

Thalamogeniculate branches of PCA

Anterior choroidal a.

Lenticulostriate as.

61
Q

In the medulla:

What is supplied by Anterior spinal a.?

A

Hypoglossal nucleus

Medial lemniscus (sensory tract)

Pyramid (motor tract)

62
Q

In the medulla, what is supplied by the posterior inferior cerebellar a.?

A 
Nucleus ambiguus 
ALS
Rubrospinal tract
Spinal trigeminal nucleus
Spinal trigeminal tract
Solitary nucleus and tract
Accessory cuneate nucleus 
Inferior vestibular nucleus
Medial vestibular nucleus 
Dorsal motor nucleus of vagus
63
Q

In the pons what is supplied by

Paramedian branches of basilar a.?

A 
Abducens nucleus 
Medial longitudinal fasciculus
Abducens n. 
Medial lemniscus 
Corticospinal fibers
64
Q

In the pons, what is supplied by the

Long circumferential branches of the basilar a.

A 
Facial n. 
Mesencephalic nucleus and tract
Spinal trigeminal tract and nucleus
Facial motor nucleus
ALS
65
Q

In the midbrain, what is supplied by P1 segment of PCA?

A

CN 3 nucleus and nerve
Medial longitudinal fasciculus
Red nucleus
Substantia nigra

66
Q

What are the spinal cord arteries?

A

(1) Anterior spinal a.
(2) Posterior spinal a.

Ant. spinal medullary
Post. Spinal medullary
Post. Radicular a. (To post. Root)
Ant. Radicular a. (To ant. Root) 
Arterial vasocorona
Segmental a.
67
Q

What comes off the anterior spinal a. And what does it supply?

A

Sulcal artery

Dorsal/ventral horns

68
Q

What is supplies the corticospinal tract?

A

Anterior spinal a.

Posterior spinal as.

69
Q

What space is the circle of willis in?

A

Subarachnoid space

70
Q

Epidural hematoma:

Bleeds into? 
Common site? 
Source? 
Clinical? 
Ct shape?
A
  • potential space b/w skull and dura mater
  • fx of squamous temporal bone or pterion
  • middle meningeal a.
  • lucid period of hours to 1-2 days
  • lens
71
Q

Subdural hematoma:

Bleeds into? 
When?
Common site? 
Source? 
Clinical? 
Ct shape?
A
  • Subdural space
  • when head strikes fixed object or after lumbar punctures
  • venous- usually cortical veins opening into superior sagittal sinus (bridging veins)
  • slower accumulation of blood due to pressure and often self limiting
  • crescent
72
Q

Subarachnoid hemorrhage:

Bleeds into? 
Occurs when? 
Source? 
Clinical? 
Ct shape?
A
  • subarachnoid space
  • rupture of aneurysm or severe head injury
  • arterial bleeding from cerebral As.(circle of willis)
  • massive bleeding into CSF compartment;
  • ”worst headache of my life”*; detoriorating level of consciousness; seen in older people or those postmenopausal

-spiderweb

73
Q

Intracerebral (subpial) hemorrage:

Bleeds into?
Source?
Clinical?

A
  • bleeding w/in brain substance (stroke)
  • middle cerebral a.

-complication in 2-3% of all head injuries; common w/ hypertension or degenerative arterial disease; increase risk w/ smoking or genetic FHx
Commonly seen at autopsy

74
Q

What are the causes of herniations?

A 
Hemorrhage
Mass/tumor
Trauma
Abscess
Infection
Metabolic conditions
75
Q

Where is the supratentorial compartment?

A

Above tentorium

Falx cerebri divides it left and right

76
Q

Where is the infratentorial compartment?

A

Below tentorium cerebelli

77
Q

What is the tentorial notch?

A

Continuation of Supra and infratentorial compartment

78
Q

What is a subfalcine herniation?

A

Herniation in supratentorial compartment that displaces brain tissue under falx cerebri

79
Q

What does a subfalcine herniation compress?

A

Compress ACA

Affects the frontal and parietal lobes and lower limbs (via homunculus)

80
Q

What can a subfalcine herniation evolve into?

A

Transtentorial herniation

81
Q

What is a transtentorial herniation?

A

Brain is displace downward toward tentorial notch

Aka a central herniation

82
Q

What can a transtentorial herniation compromise?

Causes?

A

Upper brainstem
CN 3
Some lower structure (basilar artery and posterior cerebral a.)

Decorticating rigidity
Decerebrate rigidity

83
Q

Where is the uncus located?

A

Most anterior part of parahippocampal gyrus next to temporal lobe

84
Q

What is an uncal herniation?

A

Uncus and parts of parahippocampal gyrus extrude over edge of tentorium cerebelli and thru tentorial notch

85
Q

What will an uncal herniation impinge on and cause?

A

Impinges on midbrain

Damage cerebral peduncle and motor tracts going thru that

CN 3 palsy -ipsilaterally
motor deficits - contralaterally

86
Q

What is the Kernoham phenomena?

A

Uncal herniation that shifts the midbrain left to right
-compressed cerebral peduncle on the opposite side

CN 3 palsy ipsilaterally
Motor deficits IPSIlaterally

87
Q

What is a tonsillar herniation?

A

Cerebellar tonsils go thru foramen magnum

88
Q

What can a tonsillar herniation compress?

What can this cause?

A

Medulla and upper cervical spinal cord

Since the cardiac and respiratory centers are in the medulla, it can cause no heart beat =death

89
Q

Where else will you see a tonsillar herniation?

A

Chiari Type II

.. (19 decks)

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