Blood Supply to the Brain (Yr 2 Lecture) Flashcards
Describe the nature of anterior communicating and posterior communicating arteries under normal conditions [1]
Under normal situations anterior communicating and posterior communicating CLOSED
Normal arterial supply in brain
Most intracerebral strokes effect which artery in the brain? [1]
Which artery coming off this artery are commonly effected? [1]
MCA - causes lenticulostriate arteries to have common strokes
What are watershed areas in the brain? [1]
Watershed areas: where ACA & MCA anastomose
Label A-G
Superficial venous drainage
Which veins drain from cerebral cortex into the venus sinuses? [1]
Describe their path x
Superficial cerebral veins
* Cross the subarachnoid space & pierce the dura
(confirm !)
Which two fluids drain into the venous sinuses? [2]
Blood from superficial cerebral veins
CSF - from arachnoid granulations
State the veins from blue & red arrow [2]
Red arrow = vein of Trolard (superior anastomotic vein)
Blue arrow = vein of Labbe (inferior anastomotic vein)
What are the two types of strokes [2] & their causes [2]
Ischaemic (thrombotic; embolic): 80%
Haemorrhagic stroke (trauma; spontaneous): 20%
Label the blood supply impacted by these hemorrhagic stroke
A = cortical branches of ACA, MCA or PCA
B = ascending lenticulostriate arteries of MCA
C = thalamogeniculate of PCA
D = paramedian branches of basilar artery
E = branches of AICA, SCA and PICA
Name the leading causes of hemorrhagic stroke [5]
Major causes of hemorrhagic stroke
* Hypertension
* Aneurysm
* Elderly
* Head injury (trauma)
* Alcoholics
* Arteriovenous malformation
Label type of stroke in this diagram
What are the two leading causes of non-traumatic hemorrhagic stroke? [2]
HTN
Aneursym
Describe MCA stroke if occurs on the:
- Left
- Right
MCA Left stroke
* Global aphasia
* Sensorimotor loss on contralateral face, upper limb and trunk
Right MCA Stroke:
* Neglect syndrome
Which artery is effected here? [1]
Lenticulostriate
Describe the effect of ACA stroke [4]
- Contralateral sensorimotor loss below waist
- Urinary incontinence
- Personality defects (start off as apathetic: replaced by impulsivity)
- Split-brain syndrome
Split brain syndrome
Describe how a patient with split brain syndrome would percieve & verbalise an object in their right visual field & their right hand
Describe how a patient with split brain syndrome would percieve & verbalise an object in their left visual field & their left hand
Human anatomy; the right hemisphere receives visual input from the left visual field and controls the left hand
right visual field the patient responds correctly verbally and with his/her right hand.
Left visual field the patient verbally states that he/she saw nothing, and identifies the object accurately with the left hand only
Describe the effects of PCA stroke [3]
- Contralateral homonymous hemianopsia (a field loss deficit in the same halves of the visual field of each eye,)
- Reading and writing deficits
- Impaired memory
Why is split brain syndrome caused by ACA stroke [1]
Corpus callosum supplied by ACA and connects L&R
Define TIA [1]
What is TIA a warning sign for? [2]
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retina ischemia, without acute infarction
Warning sign for heart attack of stroke
Why do TIAs commonly present with temporary blindness? [1]
Opthalmic artery
What are the 3 types of extra-axial bleed? [3]
Subdural hematoma (SDH)
Epidural (extradural) hematoma
Subarachnoid hematoma
Which type of intra-axial bleed causes the most mortality? [1]
Which type of veins are commonly ruptered to cause this? [1]
Subdural hematoma - due to bridging veins rupturing
Which arteries are commonly affected during extradural (epidural) hematoma? [2]
Middle meningeal Artery(temperoparital area, pterion)
Ant. Ethmoidal A. (frontal)
Which cranial nerve is commonly effected by extradural (epidural) hematoma [1]
What happens to visual field? [1]
What happens to feelings of extremities? [1]
CN III damaged
Loss of visual field opposite to lesion (compress of PCA)
Weakness of extremities on opposite side of lesion (crossed pyramid pathways)
What are the 3 types of subdural hemtoma? [3]
Acute
subacute
chronic
Describe the onset of SDH [1]
Explain why [1]
SDH can occur days to weeksafter trauma.
Slower onset as venous bleed
Describe the symptoms of SDH [5]
Irritability
Seizures
Headache
Numbness
Disorientation
Describe the onset of SAH [1]
Describe pain experienced in SAH [1]
Rapid onset: thunderclap headache
Whats the main cause of subarachnoid hem.? [1]
Cerebral aneurysms that burst
What are the two types of cerebral aneurysm? [2]
Saccular (berry is a sub-type)
Fusiform
What is causing this? [1]
Cerebral arteriovenous malformation
Describe common symptoms of cerebral AVM [2]
The most frequently observed problems related to an AVM areheadaches andseizures
(although at least 15% of sufferers have no symptoms)
Tx for cerebreal AVM? [3]
embolization, radiosurgery (if less than 3cm in diameter and in good location, lag period of 1-3 years to obliterated AVM), surgical resection.
Which artery supplies the midbrain & thalamus? [1]
PCA
A patient develops acute left hemiplegia involving the face more than the arm and leg. The suck and grasp reflexes and speech are preserved. Which cerebral vessel is involved?
A. Anterior cerebral artery
B. Vertebrobasilar artery
C. Middle cerebral artery
D. Posterior cerebral artery
A patient develops acute left hemiplegia involving the face more than the arm and leg. The suck and grasp reflexes and speech are preserved. Which cerebral vessel is involved?
A. Anterior cerebral artery
B. Vertebrobasilar artery
C. Middle cerebral artery
D. Posterior cerebral artery
Which neurologic deficit is associated with infarct of the anterior cerebral artery?
A. Upper extremities motor function and temperature sensation
B. Posture
C. Lower extremities motor function
D. Cervical level sensation
Which neurologic deficit is associated with infarct of the anterior cerebral artery?
A. Upper extremities motor function and temperature sensation
B. Posture
C. Lower extremities motor function
D. Cervical level sensation
Which neurologic deficit is associated with infarct of the anterior cerebral artery?
A. Upper extremities motor function and temperature sensation
B. Posture
C. Lower extremities motor function
D. Cervical level sensation
Which neurologic deficit is associated with infarct of the anterior cerebral artery?
A. Upper extremities motor function and temperature sensation
B. Posture
C. Lower extremities motor function
D. Cervical level sensation
What type of stroke would most commonly cause a person to draw like this? [1]
Name this syndrome [1]
Right MCA Stroke (or non-dominant hemisphere stroke)
Neglect syndrome
A 66-year-old male with a past medical history of right middle cerebral artery stroke presents for evaluation. During one of his sessions, he was asked to draw a clock and write the time at 15 minutes after 3. The clock has a flat left side, and the numbers 1 through 8 are correct in order but crowded onto to right side of the clock. The patient was able to draw the hands correctly. When asked to copy an object, he was able to do the right side appropriately but was missing the left side of the drawing. Which of the following is the likely diagnosis?
A. Hemianopsia
B. Hemineglect
C. Visual constructional abilities
D. Hemiparesis
A 66-year-old male with a past medical history of right middle cerebral artery stroke presents for evaluation. During one of his sessions, he was asked to draw a clock and write the time at 15 minutes after 3. The clock has a flat left side, and the numbers 1 through 8 are correct in order but crowded onto to right side of the clock. The patient was able to draw the hands correctly. When asked to copy an object, he was able to do the right side appropriately but was missing the left side of the drawing. Which of the following is the likely diagnosis?
A. Hemianopsia
B. Hemineglect
C. Visual constructional abilities
D. Hemiparesis
What syndrome is this patient suffering from? [1]
Which artery is this person most likely to have suffered a stroke in? [1]
Split-brain syndrome
ACA syndrome - because supplies corpus callosum
A bleed coming from A would cause which type of hematoma? [1]
(A = middle meningeal artery)
Epidural (extradural) hematoma
Which is the most common hematoma? [1]
Subarachnoid hematoma
Which of the following is the most common?
A
B
C
D
Which of the following is the most common?
A
B
C
D
Label the types of extra-axial bleed occuring at the red; yellow & green arrows [3]
red arrow: EDH
brown arrow shows how EDH respects the suture margins
yellow arrow points at SAH
green arrow: SDH
blue arrow shows the fracture
Label the types of extra-axial bleed occuring at the red; yellow & green arrows [3]
red arrow: EDH
brown arrow shows how EDH respects the suture margins
yellow arrow points at SAH
green arrow: SDH
blue arrow shows the fracture
What are the MR signal characteristics of early subacute intracranial hemorrhage?
A. Dark of T1, Bright on T2
B. Dark on T1, Dark on T2
C. Bright on T1, Bright on T2
D. Bright on T1, Dark on T2
What are the MR signal characteristics of early subacute intracranial hemorrhage?
A. Dark of T1, Bright on T2
B. Dark on T1, Dark on T2
C. Bright on T1, Bright on T2
D. Bright on T1, Dark on T2
A patient presents to the emergency department with a severe headache and is suspected of having a subarachnoid bleed. What is the next step in the investigation?
A. Brain MRI
B. CT of the brain with contrast
C. CT of the brain without contrast
D. Lumbar puncture
A patient presents to the emergency department with a severe headache and is suspected of having a subarachnoid bleed. What is the next step in the investigation?
A. Brain MRI
B. CT of the brain with contrast
C. CT of the brain without contrast
D. Lumbar puncture
Which artery would a stroke occur in to cause this eye sight deficit?
Anterior Cerebral Artery
Middle Cerebral Artery
Posterior Cerebral Artery
Internal Carotid Artery
Which artery would a stroke occur in to cause this eye sight deficit?
Anterior Cerebral Artery
Middle Cerebral Artery
Posterior Cerebral Artery
Internal Carotid Artery
Homonymous Hemianopia after Posterior Cerebral Artery Territory Infarction (Mosaic, VF, MRI)
A patient has a recent stroke and presents to you because they have are having problems with urinary incontinence. Where was their stroke most likely to have occured?
Anterior Cerebral Artery
Middle Cerebral Artery
Posterior Cerebral Artery
Internal Carotid Artery
A patient has a recent stroke and presents to you because they have are having problems with urinary incontinence. Where was their stroke most likely to have occured?
Anterior Cerebral Artery
Middle Cerebral Artery
Posterior Cerebral Artery
Internal Carotid Artery
State where this stroke has occured
Right MCA
Which artery has caused this stroke?
Right Anterior Cerebral Artery
Left Anterior Cerebral Artery
Right Middle Cerebral Artery
Right Posterior Cerebral Artery
Left Posterior Cerebral Artery
Which artery has caused this stroke?
Right Anterior Cerebral Artery
Left Anterior Cerebral Artery
Right Middle Cerebral Artery
Right Posterior Cerebral Artery
Left Posterior Cerebral Artery
Label the arteries A-E
A: SCA
B: BA
C: PCA
D: AICA
E: VA
What type of hematoma is present ? [1]
Subarachnoid hematoma
Which of the following is the most common cause of subarachnoid haemorrhage?
arteriovenous malformation
berry aneurysm
cerebral amyloid angiopathy
dural arteriovenous fistula
trauma
Which of the following is the most common cause of subarachnoid haemorrhage?
arteriovenous malformation
berry aneurysm
cerebral amyloid angiopathy
dural arteriovenous fistula
trauma
What is Xanthochromia?
Which type of hematoma does it occur in? [1]
Xanthochromia is the presence of bilirubin in the cerebrospinal fluid and is sometimes the only sign of an acute subarachnoid hemorrhage.
Which type of hematoma can present with blood in lumbar puncture? [1]
Subarachnoid hematoma
Lumbar puncture - Evidence of blood in 3% of people with normal CT
Label A-C
A: ICH
B: SDH
C: SAH
Which the following is SAH and which is ICH?
L: SAH
R: ICH
