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(OMS1) Neuro exam 2 > Blood Supply, Hemorrhage and Herniation (Keim) > Flashcards

Blood Supply, Hemorrhage and Herniation (Keim) Flashcards

1
Q

Anterior circulation is through…

A

ICA

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2
Q

Cervical part of the ICA:

A

Bifurcation to carotid canal

Anterior to the transverse process of upper 3 vertebrae

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3
Q

Petrous part of the ICA:

A

Carotid canal in petrous part of temporal

Upward and medially above the foramen lacerum

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4
Q

Cavernous part of the ICA:

A

In the cavernous sinus

Surrounded by sympathetic plexus, CN II, IV, VI and V1

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5
Q

Cerebral part of the ICA:

A

Once it exits the cavernous sinus

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6
Q

Posterior circulation comes from…

A

2 vertebral arteries

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7
Q

Vertebral Artery:
Cervical part
Atlantic part
Intracranial part

A
  • Transverse foramina of 1st 6 Cervical vertebrae
  • the artery on laying on the groove on C1. Perforates the dura and arachnoid and passes through foramen magnum
  • In the cranium, unite at the caudal border of pons to form basilar artery
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8
Q

Vertebral Basilar insufficiency:

A

Reduce blood flow from vertebral arteries into the brain.
Could be due to severe hyperextension of head or extreme head rotation/Bow hunter’s syndrome.
Both could compress the arteries.

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9
Q

Subclavian Steal syndrome:

A

Subclavian arteries are “stealing” blood from the vertebral arteries
Blood goes to the other side (opposite subclavian a.*) instead of the vertebral a.
Occurs when there is occlusion of the subclavian a. proximal to where the vertebral a. branches out

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10
Q

What includes the Circle of Willis?

A 
2 ICAs
2 ACAs
1 Anterior communicating artery
2 Posterior communicating arteries
2 Vertebral arteries 
1 Basilar artery
2 PCAs
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11
Q

Is middle cerebral a. part of the circle of Willis?

A

No

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12
Q

Anterior spinal artery supplies…

Labyrinthine (internal acoustic) artery supplies …

A

Spinal cord and medulla

Inner ear

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13
Q

Optic N. relationships

A

Close proximity to ICA, ACA and the anterior communicating artery
Aneurysm in these vessels can compress the optic nerve and cause visual deficits

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14
Q

Oculomotor N. relationships

A

Sandwiched between Posterior Cerebral a. And superior cerebellar a.
Close to posterior communicating artery
Aneurysm here could compress CN III and get oculomotor palsy

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15
Q

Trigeminal N. relationships

A

Close to Superior Cerebellar A.

Aberrant Loops irritate the trigeminals and cause neuralgia

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16
Q

Facial N. relationships

A

Close to Anterior Inferior Cerebellar a.

Aberrant loops can irritate CN VII

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17
Q

Identify the Circle of Willis branches in this imaging study:

A

Ok

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18
Q

Border zones (areas of coverage between Cerebral arteries) are susceptible to damage under …

A

Conditions of sudden hypotension or hypoperfusion

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19
Q

ACA (Anterior cerebral artery supplies)
MCA supplies
PCA supplies

A
  • medial and superior frontal and parietal lobes
  • lateral frontal and parietal lobes and superior temporal lobe
  • occipital lobe and inferior temporal lobe
20
Q 
Boundaries of the segments of the ACA: 
A1
A2
A3
A4
A5
A
  • ICA to anterior communicating a. (precommunicating segment)
  • anterior communicating a. to where rostrum and genu corpus callosum meet (infracallosal segment)
  • arches around the genu of corpus callosum, ends when vessels turn caudal (pericallosal segment)
  • superior to corpus callosum (A4)
  • caudal to corpus callosum (A5)
21
Q

Label the segments of the ACA:

A

Ok

22
Q

Label the arteries in this imaging study

A

Ok

23
Q

Identify the segments of the MCA

A

OK

24
Q 
Middle Cerebral Artery segments 
M1
M2
M3
M4
A
  • ICA to bifurcation at insula (sphenoidal or horizontal segment)
  • bifurcation to circular sulcus of insula/right angle turn (insular segment)
  • circular sulcus of insula to external surface of lateral fissure (opercular segment)
  • on the cortex (cortical segment)
25
Q

Identify the arteries in this imaging study:

A

Ok

26
Q 
Posterior cerebral artery segments
P1
P2
P3
P4
A
  • basilar bifurcation to posterior communicating a.
  • posterior communicating a. to around the midbrain
  • segment within the quadrigeminal cistern (Quadrigeminal segment)
  • cortical segment
27
Q

Identify the segments of the PCA in this image

A

Ok

28
Q

Identify the segments of the PCA in this imaging study

A

Ok

29
Q

Medulla blood supply:
Anterior spinal artery supplies …
Posterior inferior cerebellar artery supplies ….
Anterior inferior cerebellar artery supplies ….
Posterior spinal artery supplies …

A

Medial aspect of the medulla
Lateral aspect of the medulla
Nuclei for CN VIII
Dorsal parts

30
Q

Blood supply to pons:
Paramedian branches of basilar supply….
Long circumferential branches of basilar supply

A

Medial pons

Lateral pons

31
Q

Blood supply to the Midbrain: PCA branches
Anteromedial branches supply…
Lateral branches of quadrigeminal supply ….

A

Medial Midbrain

Lateral midbrain

32
Q

Blood supply to forebrain:
Thalamogeniculate branches of posterior cerebral artery supplies…
Lenticulostriate arteries supply ….
Anterior choroidal arteries supply ….

A 
Lateral geniculate (vision) and medial geniculate nucleus (hearing)
Internal capsule  
Portions of internal capsule
33
Q

Blood supply to spinal cord
Posterior spinal arteries supply …
Sulcal Arteries supply ….
Anterior and Posterior spinal arteries supply….

A

Dorsal columns
Most of the dorsal and ventral horns
Corticospinal tract

34
Q

Meningeal spaces
Epidural/extradural
Subdural/dura-arachnoid interface
Subarachnoid

A
  • potential space between cranium and periosteal dura
  • potential space between dura and arachnoid mater
  • real space between arachnoid and pia mater, contains CSF, arteries (circel of willis) and veins
35
Q

Epidural hematoma
Where is the bleeding?
Common source?
Clinical?

A

Bleeding between skull and dura in the middle cranial fossa
Source is Middle meningeal a.
Momentary unconsciousness followed by lucid period for 1-2 days, then unconsciousness.
Lens image CT

36
Q

Subdural hematoma:
Where is the bleeding?
Common source?
Clinical?

A

Bleeding between dura and arachnoid.
Source is bridging vein
Usually happens after head strikes fixed object
Slower accumulation of blood due to pressure and often self limiting
Crescent image on CT

37
Q

Subarachnoid hemorrhage:
Where is the bleeding?
Common source?
Clinical?

A

Most common cause is rupture of aneurysm
Source Is arterial circle of Willis
Massive bleeding into CSF compartment with headaches and LOC
Spider image on CT

38
Q

Intracerebral (subpial) hemorrhage
Where is the bleeding?
Common source?
Clinical?

A

Bleeding within brain substance (stroke)
Source is usually the middle cerebral a.
Caused by hypertension or degenerative arterial disease

39
Q

Herniation syndromes:

A

-displacement of brain tissue

Caused by hemorrhage, tumor, trauma etc.

40
Q

herniation syndromes:
Supratentorial compartment:
Infratentorial compartment:
Tentorial notch:

A
  • above the tentorium cerebelli and divided into right and left by falx cerebri
  • below the tentorium cerebelli
  • continuation of the supra and infratentorial compartment
41
Q

Subfalcine/cingulate/falcine/falx herniation

A

Involves the supratentorial compartment
Displacement of brain tissue under the falx cerebri
Can compress the ACA (lower limb sensory and motor deficits)
Can evolve into transentorial herniation

42
Q

Transentorial/central herniation:

A

Brain displaced downward toward the tentorial notch
Compromises the upper brainstem, CN III (along with parasympathetics) and lower structures (may compress basilar and posterior cerebral arteries)
Decorticate and decerebrate rigidity

43
Q

Uncal herniation:

A

Uncus and portions of the parahippocampal gyrus are extruded over edge of tentorium cerebelli. Also damage CN III (ipsilateral) and motor deficits (contralateral).
Mid-brain impingement (cerebral peduncle).

44
Q

Tonsillar herniation

A

Cerebellar tonsils herniate through foramen magnum

Compression of medulla and upper cervical spinal cord (has cardiac and respiratory centers)

45
Q

Abducens N. relationships

A

Between labyrinthine and AICA

46
Q

Uncal herniation consequences:

A

Cerebral peduncle impingement. Results in oculomotor palsy in side of lesion and motor deficits on opposite side
Kernohan phenomenon. Shifts the midbrain and impinges the peduncle. Same side motor and oculomotor deficits.

(OMS1) Neuro exam 2 (24 decks)

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