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NE Exam 2 > Blood Supply, Hemorrhage, & Herniation > Flashcards

Blood Supply, Hemorrhage, & Herniation Flashcards

1
Q

What artery provides anterior blood circulation to the brain?

A

Internal Carotid

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2
Q

What are the parts of the Internal Carotid A.?

A

Cervical Part
Petrous Part
Cavernous Part
Cerebral Part

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3
Q

This part of the Internal Carotid A. stretches from the bifurcation to the Carotid Canal and is anterior to the transverse process of the upper 3 vertebrae.

A

Cervical Part

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4
Q

This part of the Internal Carotid A. stretches from the Carotid Canal in the petrous part of the temporal. It goes upward and medially above the Foramen Lacerum.

A

Petrous Part

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5
Q

This part of the Internal Carotid A. is in the cavernous sinus and is S-shaped. It is surrounded by the sympathetic plexus and CNs III, IV, VI, and V1.

A

Cavernous Part

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6
Q

This part of the Internal Carotid A. comes after the Cavernous Part.

A

Cerebral Part

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7
Q

What artery provides posterior blood circulation to the brain?

A

Vertebral A.

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8
Q

The Vertebral A. comes off the Subclavian A. and has three parts, which are…

A

Cervical Part
Atlantic Part
Intracranial Part

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9
Q

This part of the Vertebral A. is within the transverse foramina of the first 6 cervical vertebrae.

A

Cervical Part

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10
Q

This part of the Vertebral A. perforates the dura and arachnoid. It lays on C1 horizontally, making an acute bend, and passes through the Foramen Magnum

A

Atlantic Part

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11
Q

This part of the Vertebral A. is in the cranium and unites with the other side at the caudal border of the pons to form the Basilar A.

A

Intracranial Part

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12
Q

Vertebral Basilar Insufficiency occurs when there is reduced blood flow from the Vertebral A. getting to the brain. What are the 2 ways this can occur?

A

1) Via severe hyperextension of the head, making the Occipital bone and C1 come together and compress the Atlantic Part of the Vertebral A.
2) Bow Hunter’s – Extreme head rotation which causes narrowing and torsion of the Vertebral A.

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13
Q

This syndrome occurs when the Subclavian As. take blood from the Vertebral As. because there is occlusion of the Subclavian A. proximal to the Vertebral A.

A

Subclavian Steal Syndrome

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14
Q

Which cranial nerve is near the ICA and Anterior Communicating A.?

A

CN II

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15
Q

Which cranial nerve is near the Posterior Cerebral A., Superior Cerebellar A., and Posterior Communicating A.?

A

CN III

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16
Q

Which cranial nerve is near the Labyrinthine A. and the AICA (Anterior Inferior Cerebellar A.)?

A

CN VI

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17
Q

These arteries supply the Spinal Cord and and the Medulla.

A

Anterior and Posterior Spinal As.

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18
Q

What arteries make up the Circle of Willis?

A 
Anterior Communicating A.
Anterior Cerebral A. (A1) 
ICA
Posterior Communicating A.
Posterior Cerebral A. (P1)
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19
Q

This artery supplies most of the medial and superior surface of the frontal and parietal lobes.

A

Anterior Cerebral A. (ACA)

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20
Q

This artery supplies the lateral surface of the frontal and parietal lobes and the superior part of the temporal lobe.

A

Middle Cerebral A. (MCA)

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21
Q

This artery supplies the occipital lobe and the inferior temporal lobe.

A

Posterior Cerebral A. (PCA)

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22
Q

These areas are very susceptible to damage under conditions of sudden systemic hypotension or hypoperfusion. They have no anastomosis, so if damaged then blood can’t get to the area.

A

Border zones = zones between the areas supplied by ACA, MCA, and PCA

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23
Q

If this border zone is damaged it results in motor and sensory deficits, as well as language and behavioral issues.

A

ACA/MCA

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24
Q

If this border zone is damaged it results in visual and language deficits.

A

MCA/PCA

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25
Q

What are the segments of the Anterior Cerebral A. (ACA)?

A 
A1 (Precommunicating segment) 
A2 (Infracallosal segment) 
A3 (Precallosal segment) 
A4 (Supracallosal) 
A5 (Postcallosal)
26
Q

What are the segments of the Middle Cerebral A. (MCA)?

A

M1 (Sphenoidal or Horizontal segment)
M2 (Insular segment)
M3 (Opercular segment)
M4 (Cortical segment)

27
Q

This segment of the MCA goes from the ICA to the bifurcation at the Insula.

A

M1 (Sphenoidal or Horizontal segment)

28
Q

This segment of the MCA goes from the bifurcation at the Insula to the circular sulcus of the Insula (right angle turn).

A

M2 (Insular segment)

29
Q

This segment of the MCA goes from the circular sulcus of the Insula to the external surface of the Lateral Fissure.

A

M3 (Opercular Segment)

30
Q

This segment of the MCA is on the cortex.

A

M4 (Cortical segment)

31
Q

What are the segments of the Posterior Cerebral A. (PCA)?

A

P1
P2
P3 (Quadrigeminal segment)
P4 (Cortical segment)

32
Q

This segment of the PCA goes from the Basilar A. bifurcation to the Posterior Communicating A.

A

P1

33
Q

This segment of the PCA goes from the Posterior Communicating A. to around the midbrain.

A

P2

34
Q

This segment of the PCA is within the quadrigeminal cistern.

A

P3 (Quadrigeminal segment)

35
Q

This segment of the PCA is after P3.

A

P4 (Cortical segment)

36
Q

This artery supplies the medial aspect of the Medulla.

A

Anterior Spinal A.

***Specifically Sulcal branches

37
Q

This artery supplies the lateral aspect of the Medulla.

A

Posterior Inferior Cerebellar A. (PICA)

38
Q

This artery supplies the dorsal aspect of the Medulla.

A

Posterior Spinal A.

39
Q

These branches of the Basilar A. supply the Pons.

A

Paramedian Branches (medial)

Long Circumferential Branches – along with AICA (posterolateral)

Short Circumferential Branches (anterolateral)

Long Circumferential Branches – along with Superior Cerebellar A. (posterior)

40
Q

This is what supplies blood to the medial Midbrain.

A

P1 segment

41
Q

What arteries supply the Internal Capsule?

A

Anterior Choroidal A.

Lenticulostriate As. (branch off MCA)

42
Q

What arteries supply the spinal cord?

A

Posterior Spinal A.

Anterior Spinal A. (Sulcal branches)

43
Q

This supplies the dorsal and ventral horns of the spinal cord.

A

Sulcal As. (from Anterior Spinal A.)

44
Q

This supplies the posterior columns of the spinal cord.

A

Posterior Spinal A.

45
Q

This meningeal space is a potential space between the cranium and periosteal dura.

A

Epidural (extradural)

46
Q

This meningeal space is a potential space between the dura and arachnoid.

A

Subdural (dura-arachnoid interface)

47
Q

This meningeal space is a real space between the arachnoid and pia. It contains CSF, arteries (Circle of Willis), and veins.

A

Subarachnoid

48
Q

This is a common finding in a severe head injury and is more common in the rupture of an aneurysm. The source of bleeding is an arterial bleed from a cerebral artery in the Circle of Willis. It presents as massive bleeding into the CSF compartment due to the arterial source with headaches and deteriorating level of consciousness.

A

Subarachnoid Hemorrhage

49
Q

This is bleeding within the brain substance (stroke). It results as a complication in 2-3 percent of all head injuries and the source is usually the MCA. It presents as hypertension or degenerative arterial disease (commonly seen at autopsy).

A

Intracerebral (Subpial) Hemorrhage

***Hemorrhagic stroke

50
Q

How can herniation syndromes be caused?

A 
Hemorrhage
Mass/tumor
Trauma
Abscess
Infection
Metabolic conditions

***These all can cause increased intracranial pressure, which leads to herniation!

51
Q

This compartment related to herniation is above the tentorium and divided into right and left by the falx cerebri.

A

Supratentorial compartment

52
Q

This compartment related to herniation is below the tentorium cerebelli.

A

Infratentorial compartment

53
Q

This compartment related to herniation is a continuation of the supra and infratentorial compartment.

A

Tentorial notch

54
Q

This type of herniation is within the supratentorial compartment and displaces brain tissue under the falx cerebri and may compress the ACA (affecting the frontal and parietal lobe). It may evolve into transtentorial herniation.

A

Subfalcine Herniation (also called Cingulate Herniation, Falcine Herniation, or Falx Herniation)

55
Q

This type of herniation occurs when the brain is displaced downward toward the tentorial notch. It compromises the upper brainstem, CN III and possibly even lower structures. It may compress the Basilar A. and Posterior Cerebral As.

A

Transtentorial Herniation

56
Q

Transtentorial Herniations can result in ________ and _______ rigidity.

A

Decorticate

Decerebrate

57
Q

An Uncal Herniation occurs when the uncus and frequently portions of the parahippocampal gyrus are extruded over the edge of the tentorium cerebelli and through the tentorial notch. It impinges on the…

A

Midbrain

58
Q

What are the two variations of an Uncal Herniation?

A

1) Herniation that damages the midbrain on the side of the herniation. Results in CN III and Cerebral Peduncle damage, causing ipsilateral deficits of CN III and hemiparesis on contralateral side. This is Weber Syndrome.
2) Herniation that shifts the midbrain from one side toward the other, damaging the root of CN III on the side of the herniation and causing damage to the Cerebral Peduncle on the opposite side. Results in ipsilateral CN III deficits and ipsilateral hemiparesis.

59
Q

Tonsillar Herniation occurs when the cerebellar tonsils are pushed through the foramen magnum. It causes compression of the Medulla and upper cervical Spinal Cord. Why is this bad?

A

Cardiac and respiratory centers are in the Medulla

60
Q

This occurs when there is bleeding between the dura and arachnoid (potential space). Occurs from the head striking a fixed object, and the source of bleeding is venous (Bridging Vs.). It is a slower accumulation of blood due to pressure and is often self-limiting. Can be resolved surgically.

A

Subdural Hematoma

61
Q

Besides striking your head on a fixed object, what’s another way you could get a Subdural Hematoma?

A

Lumbar puncture

62
Q

This occurs when there is bleeding into the epidural space. Most commonly from being hit in the Pterion (temporal region) causing the Middle Meningeal A. to rupture. There is momentary unconsciousness followed by a lucid interval period of hours to 1-2 days then unconsciousness again. Treatment can be surgical.

A

Epidural Hematoma

NE Exam 2 (24 decks)

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