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NE2 > Blood Supply, Hemorrhage, Herniation > Flashcards

Blood Supply, Hemorrhage, Herniation Flashcards

1
Q

What kind of circulation does the ICA do?

A

Anterior

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2
Q

Cervical part ICA

A

Bifurcation to carotid canal, anterior to transverse processes of upper 3 vertebrae

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3
Q

Petrous part ICA

A

Carotid canal in petrous part of temporal b. Upward and medially above foramen lacerum.

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4
Q

Cavernous part ICA

A

Within the cav sin. Surrounded by sympathetic plexus, CN III, IV, VI, and V1.

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5
Q

What kind of circulation does vertebral A do

A

Posterior circulation

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6
Q

Cervical part Vertebral A

A

Through transverse foramina of C1-6

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7
Q

Atlantic part vertebral a

A

Perforates the dura and arachnoid. Passes thru foramen magnum. Acute angle is clinically important.

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8
Q

Intracranial part vertebral a

A

Within the cranium. Unites at the caudal border of the pons, making the basilar a.

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9
Q

Describe vertebral basilar insufficenecy

A

Inadequate blood flow through the posterior circulation of the brain, supplied by the 2 vertebral arteries that merge to form the basilar artery.

Due to severe hyperextension of the head (acute angle; compresses VA between C1 and occipital) or severe rotation (causes torsion w/ resulting narrowing; Bow Hunters)

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10
Q

Describe subclavian steal syndrome

A

Blood flows away from the brain due to an occlusion that’s proximal to the vertebral A off the subclavian.

As blood flows up the RCC then into the R sublavian as normal, it reaches an occlusion proximal to vertebral. This causes the blood to “come down” from the vertebral A to supply the upper limb.

This leads to decreased blood flow in the brain because vertebral blood is stolen by the subclavian!

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11
Q

If there is a deficit of CN II, which arteries could be at fault?

A

ICA
Anterior cerebral A
Anterior communicating A

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12
Q

If there is a deficit of CN III, which arteries could be at fault?

A

Posterior communicating A (more liekely P1)
Posterior cerebral A
Superior cerebellar A
Quadrigeminal A

“Oculomotor sandwich”

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13
Q

If there is a deficit of CN V, which arteries could be at fault?

A

Pontine As
Superior cerebellar A
Basilar A

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14
Q

If there is a deficit of CN VI, which arteries could be at fault?

A

Anterior inferior cerebellar A
Vertebral A
Basilar A

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15
Q

If there is a deficit of CN VII, which arteries could be at fault?

A

Anterior inferior cerebellar A

Labyrinthine A

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16
Q

Which artery runs in between CN XI and CN X

A

Posterior inferior cerebellar A

Note, CN XI runs inferiorally and passes through posterior spinal A

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17
Q

CN XII is “cornered” by which 2 arteries?

A

Posterior inferior cerebellar A and vertebral A

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18
Q

Which arteries are NOT part of the CoW?

A

MCA
Anterior choroidal A
Ophthalmic A

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19
Q

Where is CoW located?

A

In the subarachnoid space w/ CSF and veins

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20
Q

Which arteries branch off the Basilar A?

A

Anterior inferior cerebellar A (AICA)
Pontine A
Superior cerebellar A
Basilar A terminates into the posterior cerebral A. (P1 and P2, P1 is more medial)

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21
Q

What arteries does the posterior communicating A connect?

A

posterior communicating arteries are arteries at the base of the brain that form part of the circle of Willis.
Each posterior communicating artery connects the three cerebral arteries (posterior, middle, and anterior) of the same side.

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22
Q

What is a “border zone” and what are they susceptible to

A

Areas between arteries. Susceptible to damage under sudden systemic hypotension of hypoperfusion b/c there are no anastomotic connections.

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23
Q

ACA supply

A

Medial and superior surface of frontal and parietal lobes

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24
Q

MCA supply

A

Lateral surface of frontal and parietal. Superior temporal.

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25
Q

PCA supply

A

Occipital and inferior temporal.

26
Q

Issues involved with ACA/MCA border zone

A

Motor, sensory, language, behavior

27
Q

Issues involved with MCA/PCA border zone

A

Visual and language

28
Q

Arteries in the CoW

A

CAIC PB

Ant. comm. A, Ant. cerebral A, ICA, Post. comm. A, Post. cerebral A, Basilar A

29
Q

Arteries supplying the brain stem

A

SPA VP

Superior cerebrellar A, pontine A, Anterior inferior cerebellar A, Vertebral A, Posterior inferior cerebellar A

30
Q

Arteries supplying pons and midbrain

A

SPA B

superior cerebellar A, pontine A, AICA, Basilar A

31
Q

Arteries supplying the medulla

A

posterior inferior cerebellar A, vertebral A, AICA

32
Q

A1

A

Precommunicating segment

ICA to anterior communicating A

33
Q

A2

A

Infracallosal segment

Anterior communicating A to where rostrum and genu of corpus callosum meet

34
Q

A3

A

Precallosal segment

Goes around genu and ends when vessels turn caudal

35
Q

A4

A

Supracallosal

Above corpus callosum

36
Q

A5

A

Postcallosal

Caudal (behind) corpus callosum

37
Q

M1

A

Sphenoidal or horizontal segment

ICA to bifurcation @ insula

38
Q

M2

A

Insular segment

Bifurcation at insula to circular sulcus of insula (right angle turn)

39
Q

M3

A

Opercular segment

Circular sulcus of insula to external surface of lateral fissure

40
Q

M4

A

Cortical segment

On the cortex

41
Q

Where do M3 and M4 come out from

A

Lateral sulcus for M4 to get onto cortex.

42
Q

P1

A

Basilar bifurcation to posterior communicating A

43
Q

P2

A

Posterior communicating A to around the midbrain

44
Q

P3

A

Quadrigeminal segment within the quadrigeminal cistern

45
Q

P4

A

Cortical segment

46
Q

Nervous tissue supplied by Anterior spinal A

A

Hypoglossal nucleus, medial lemniscus (sensory tract), and pyramid (motor tract)

47
Q

Nervous tissue supplied by posterior inferior cerebeallar A

A

DIMA SSRN

Dorsal motor nucleus of vagus (autonomics)
Medial vestibular nucleus
Inferior vestibular nucleus
Accessory cuneate nucleus
Solitary tract and nucleus
Spinal trigeminal tract and nucleus
Rubrospinal tract (motor tract)
Nucleus ambiguous
48
Q

Nervous tissue supplied by basilar A branches

A

C MAMA

Abducens nucleus
Median longitudinal fasciculus
Absucens nerve
Medial lemniscus
Corticospinal fibers
49
Q

What does P1 segment of PCA supply

A

MORS

Oculomotor nucleus
Medial longitudinal fasciculus
Red nucleus
Substantia nigra

50
Q

What artery supplies the dorsal columns of the spinal cord

A

Posterior spinal A

51
Q

what artery supplies almost all of the dorsal and ventral horn

A

Sulcal A

52
Q

Describe epidural hematoma (where, bleeding source, sx)

A

Potential space between skull and dura, lens shaped
Middle cranial fossa
Due to temporal or pterion fx
MIDDLE MENINGEAL A
Unconsciousness, lucidity, acute sx, coma

53
Q

Describe subdural hematoma (where, bleeding source, sx)

A

Potential space between sura and arachnoid, crescent-shaped
Head strikes a fixed object
VENOUS- BRIDGING AND CORTICAL VS. OPEN INTO SUP. SAG. SIN.
Slower onset, self limiting

54
Q

Describe subarachnoid hematoma (where, bleeding source, sx)

A

Beneath arachnoid
RUPTURED ANEURYSM OF CEREBRAL A; CoW
Massive bleeding into CSF; worst HA; vary LOC

55
Q

Describe intracerebral or subpial hematoma (where, bleeding source, sx)

A

Bleeding into brain substance
MIDDLE CEREBRAL A
HTN or degenerative arterial disease; stab wound

56
Q

Describe supratentorial, infratentorial, and tentorial notch

A

Supra: above tentorium; falx cerebri divides
Infra: below horizontal tentorium cerebelli
Notch: continuation of the supra and infratentorial compartment

57
Q

Causes of herniation syndromes (6)

A

Hemorrhage, Mass, Trauma, Abscess, Infection, Metabolic condition. Can all increase ICP.

58
Q

Subfalcine herniation

A

Displace tissue beneath falx cerebri.
ACA compression leads to compromised frontal and parietal lobes
Could become transtentorial herniation
Enlarged lateral ventricle

59
Q

Transtentorial herniation

A

Brain displaced downward toward tentorial notch
Compromises upper brain stem, CN III,.
May compress Basilar A and posterior cerebral A
Decorticate and decerebrate rigidity
Blood in posterior horn

Wont be able to constrict pupils if CN III is affected bc parasympathetics run here

60
Q

Uncal herniation

A

Uncus and parahippocampal gyrus extrude over tentorium cerebelli and thru tentorial notch

Impinge on midbrain and damage cerebral peduncle

Kernoham phenomenon shifts the midbrain

61
Q

Tonsillar herniation

A

Cerebellar tonsils go thru foramen magnum

Compress medulla and upper cervical spinal cord (compromise cardiac and respiratory centers)

NE2 (12 decks)

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