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Hannah Neuro > blood supply, hemorrhage, herniation > Flashcards

blood supply, hemorrhage, herniation Flashcards

1
Q

what are the parts of the ICA

A
  1. cervical
  2. petrous
  3. cavernous
  4. cerebral

cerebral branches off into ophthalmic A, anterior cerebral, middle cerebral, and posterior communicating branch

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2
Q

what are the parts of the vertebral A.

A
  1. cervical (C1-C6)
  2. atlantic (pierces dura and arachnoid matter and atlantooccipital membrane to enter foramen magnum)
  3. intracranial (foramen magnum–> basilar A. at lower pons)
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3
Q

what parts of the circle of willis create the anastomotic connections

A
  1. anterior cerebral A.
  2. anterior communicating
  3. posterior cerebral A.
  4. posterior communicating

*coming from vertebral and ICA

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4
Q

what nerves are compressed from the blood supply to the brain (cerebrum and cerebellum)

A

CN 2 - 7 *except 4

2- ICA and ACA 
3- SCA and PCA 
5- aberrant branches of SCA
6-AICA and IAA
7- aberrant branches of AICA
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5
Q

what is the blood supply to the cortex

A

ACA- superior and medial frontal and pariteal lobes
MCA- lateral frontal and parietal lobes and superior temporal lobe
PCA- inferior temporal lobe and occipital lobe

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6
Q

what are the border zones of the cortical blood supply? (watershed infarct spots)

A

-areas between arteries in which are at high risk for damage due to sudden hypotension or hypoperfusion

  1. anterior (between ACA and MCA) = motor and sensory deficits to LE
  2. posterior (between MCA and PCA) = vision and language deficits
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7
Q

what are the 5 parts of the Anterior cerebral A.

A

A1
A2 (infracollosal - from communicating branch to where rostral part meets genu)
A3 (precollosal- around bend of genu)
A4 (supracollosal- above the body of corpus callosum)
A5 (postcollosal) terminal branches going to cortex that DO NOT anastomose with other branches

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8
Q

what are the 2 arteries off the ACA that make up most of A3 and A4

A 
pericallosal A (above corpus callosum) 
callasomarginal A. (above cingulate gyrus)
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9
Q

what are the 4 parts of the MCA

A

M1-. horizontal (gives of lenticulostriate A. s)
M2.- insular
M3 - opercular
M4 (cortical) on cortex

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10
Q

what are the 4 parts of the PCA

A

P1 - basically bifurcation to posterior communicating
P2 - posterior communicating - around midbrain
P3 - in quadrigeminal cistern
P4 - on cortex

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11
Q

what is the blood supply to the medulla

A

*vertebral A. and basilar A.

  1. anterior spinal A. [ medial supply including the hypoglossal nucleus, medial lamniscus, pyramids]
  2. posterior spinal A. [ lower medulla, superior portion including the fasiculus gracilis and cunteuas ]
  3. AICA - [upper medulla - dorsal and ventral cochlear nuclei]
  4. PICA - [ upper medulla laterally]
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12
Q

what A. is responsible for medial medullary syndrome

A

anterior spinal A.

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13
Q

what A. is responsible for lateral medullary syndrome ( wallenburgs syndrome)

A

PICA

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14
Q

what is the blood supply to the pons

A

Basilar A. and AICA

  1. paramedian branches from basilar A. (pontine A.s) supply medial aspect
  2. long circumferential branches from basilar and AICA supply lateral aspect
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15
Q

what is the blood supply to the midbrain

A
  • PCA, SCA, and basilar A.
    1. anteromedial paramedian branches of basilar bifurcation and PCA (P1) - medial midbrain
    2. quadrigeminal A. and SCA - inferior colliculus
    3. quadrigeminal A. and posterior medial choroidal branches - superior colliculus
  • quadrigeminal A. comes from PCA
  • posterior choroidal A. comes from P2 segment of PCA
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16
Q

what A. is responsible for medial pontine syndrome

A

paramedian branches from the basilar A. (pontine A.s)

17
Q

what A. is responsible for the lateral pontine syndrome

A

long circumferential branches from basilar and AICA

18
Q

_____ infarcts result in contralateral homonymous hemianopia and contralateral hemisensory loss. There may be some disturbance of higher function, such as altered memory or speech or cortical blindness.

A

Posterior cerebral artery

19
Q

Occlusion of the _____ produces lesions of both posterior cerebral arteries and high brain stem lesions that may lead to ‘a locked in’ state – where the upper brain stem lesion prevents the conscious brain having any control over bulbar function or the limbs, though some control of eye movements can remain.

A

basilar artery

20
Q

what are the terminal branches of the basilar A.

A

2 posterior cerebral A. s

21
Q

what causes Webers syndrome (midbrain syndrome) which is ipsilateral CN III palsy with contralateral hemiplegia or hemiparesis

A

PCA due to anteromedial branches from the P1 segment of PCA supplying medial midbrain

22
Q

what is the blood supply to the forebrain

A

**MCA; ICA; PCA

  1. thalamogeniculate branches of the PCA
    [thalamus; medial and lateral geniculate bodies]
  2. anterior choroidal A. (from M1 of MCA or ICA)
    [ optic tract; hippocampal formation; parts of internal capsule]
  3. lenticulostriate A.s (from MCA)
    [part of internal capsule]
23
Q

what artery supplies most the diencephalon

A

PCA (branches such as the thalamogenticulate A.)

24
Q

what is the blood supply to the spinal cord

A
  1. paired posterior spinal A.s (from PICA)
    - posterior 1/3 of spinal cord
    - fasiculus gracilis and cuneuatus [ white matter on dorsal side]
    - legs of the cortical spinal tract
  2. single anterior spinal A. (from vertebral A. )
    - anterior 2/3 of spinal cord
    - gives off sulcal A.s that supply the dorsal and ventral horns of gray matter
  3. arterial vasocorona supplies peripheral lateral aspect
    * reinforced by segmental (radicular arteries which come from different sources down the spinal cord)
25
Q

what is the side effect of sulcal A. occlusion ? where does this artery originate ?

A

*from the anterior spinal A.
one sided medullary or spinal cord affect depending on level.
*one sided bc of stair step pattern

26
Q

what supplies the legs of the cortical spinal tract ? arms?

A

legs = the Posterior spinal A.

arms=

27
Q

what artery connects the anterior and posterior spinal artery allowing an anastamotic connection to supply all around the cord

A

arterial vasocorona
(AVC)
helps supply outer ring of the spinal cord all the way around

28
Q

what are the potential spaces of the meninges? and what is the true space and what does it contain?

A

potential

  1. epidural (between periosteum and periosteal dura)
  2. subdural (between meningeal dura and arachnoid)

true

  1. subarachnoid (between arachnoid and pia)
    - contains CSF, circle of willis arteries, and veins
29
Q

what is the major trauma site for an epidural hematoma? blood supply of bleed? common symptoms ? and CT presentation? tx?

A
  • trauma to pterion of skull
  • blood supplied by MMA
  • momentary unconsciousness, long period of lucidness, followed by more unconsciousness
  • if not caught = possible death
  • smooth lens shaped hematoma on CT
  • tx: surgery
30
Q

what does the MMA supply

A

mostly calvaria (bone) not dura

31
Q

what is the blood supply for a subdural hematoma? clinical presentation ? tx? CT presentation?

A
  • venous blood supply (usually cerebral veins opening into superior sagital sinus)
  • slow blood accumulation bc of venous pressure, often self-limiting
  • symptoms depend on trauma site
  • tx: surgery
  • CT: crescent / jagged hematoma
32
Q

causes of subarachnoid hemorrhage ? source of bleeding? clinical presentation? survival rate?

A
  • severe head trauma or more likely aneurysm rupture
  • blood supply: cerebral A.s (circle of willis aneurysm rupture usually; ACA and PCA)
  • immediate “worst headache of life”
  • massive bleeding into CSF space, headache, deteriorating consciousness
  • 50% die

*WEAK BLOOD VESSEL RUPTURE ON SURFACE OF BRAIN = HEMORRAGIC STROKE

33
Q

T/F

there are 2 types of strokes. an ischemic stroke and hemorrhagic stroke

A

true

34
Q

cause of intracranial (subpial) hemorrhage ? blood source? what increases your risk of this event occurring?

A
  • hemorrhagic stroke inside the brain tissue
  • casues: knife wound, bullet, stroke
  • blood source: usually middle cerebral A. (MCA)
  • risk increased by HTN and degenerative arterial disease
35
Q

what is the cause of herniation syndromes in the brain ? what are the 3 compartments they can occur in ?

A

-caused by increased intracranial pressure (hemorrhage, tumor, infection, etc)

  • supratentorial compartment (above tentorium cerebelli and separated in R and L by falx cerebri)
  • infratentorial compartment (below the TC)
  • tentorial notch (continuation/space between the supra and infratentorial compartment ?
36
Q

what is a subfalcine herniation ? where is the location of the causative lesion? what is the effect of the brain? what structures does it damage? CT presentation ?

A

*aka falcine/ falx/ cingulate herniation

  • supratentorial compartment
  • pushes cingulate gyrus under falx cerebri into opposite supratentorial compartment
  • may compress the ACA affecting the frontal and parietal lobes [ LE motor/sensory of homunculus]
  • may evolve into transtentorial herniation if not treated
  • CT: bowed falx cerebri with white spots of bleeding seen
37
Q

what is a transtenorial herniation? what structures does it compromise? possible side effects?

A

*aka central herniation

  • supratenorial compartment
  • hernation of the brain downward towards the tectorial notch pass tentorial cerebelli
  • compromises the midbrain and CN3
  • can compress the basilar A. and PCA’s leading to vision deficits from occipital lobe dysfunction
  • decorticate rigidity
  • decerebrate rigidity

**BADDDD

38
Q

what is an uncle herniation ? what does it effect? what are the 2 types

A
  • supratentorial compartment
  • uncus (and usually parahippocampal gyrus; from temporal lobe of forebrain) pushed over edge of tentorium cerebelli and towards the center towards the tentorial notch
  • impinges the midbrain
  1. over tentorial cerebelli and notch and compression of ipsilateral midbrain structure causeing damage to cerebral peduncle with motor tracts and CN 3
    * leads to CONTRALATERAL hemiplesia (paralysis) , and ipsilateral CN 3 deficits (eye movement problems)
  2. kernohan syndrome
    - herniation pushes midbrain to side and damages ipsilateral CN3 and contralateral cerebral peduncles
    * leads to ipsilateral CN 3 deficits and IPSILATERAL hemiplesia
39
Q

what is a tonsillar herniation ? what does it cause?

A

*infratentorial compartment

  • movement of cerebellar tonsils through foramen magnum
  • causes medulla and upper spinal cord compression
  • can lead to heart and respiratory issues there sudden herniation can = sudden death

Hannah Neuro (20 decks)

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