Brain blood vessels and intracerebral bleeds

Question 1

what are the largest arteries that supply the entirety of the brain?

Answer 1

internal carotid

Vertebral arteries

Question 2

the internal carotid enters the brain at either side of what structure?

Answer 2

on either side of the optical chiasma

Question 3

What are the branches of the internal carotid artery?

Answer 3

• Opthalmic - through the optic canal to the eye
• anterior choroidal artery - to choroid plexus, optic chiasma/tract, lateral geniculate body and retrolentiform nucleus
• posterior communicating artery
• anterior cerebral
• middle cerebral

Question 4

what are considered the terminal branches of the internal carotid artery?

Answer 4

the Anterior cerebral

The middle cerebral

Question 5

where does the internal carotid system finish and the posterior system starts?

Answer 5

when the posterior communicating artery meets the posterior cerebral artery

Question 6

where do the verteral arteries arise from?

Answer 6

from the subclavian artery

Question 7

How do the vertebral arteries pass up the neck?

Answer 7

they go through the foramina transversarium (except the 7th cervical vertebrae)

Question 8

how do the vertebral arteries enter the skull?

Answer 8

through the foramen magnum - then they pass on either side of the medulla

Question 9

what are the branches of the vertebral arteries?

Answer 9

anterior spinal arteries

posterior spinal arteries

PICA

Question 10

where does the basilar artery form?

Answer 10

forms at the pontomedullary junction by union of the two arteries

Question 11

what are the branches of the basilar artery?

Answer 11

AICA

labyrinthine (to inner ear)

pontine

superior cerebellar

posterior cerebral arteries = terminal branches

Question 12

the basilar system is conected to the internal carotid system by what?

Answer 12

by the posterior communicating artery

Question 13

describe the regions of the brain suppied by the anterior cerebral artery, the middle cerebral artery and the posterior cerebral artery

Answer 13

lateral cerebral hemisphere = middle cerebral

“mohawk”/longitudinal fissure = anterior cerebral

Occipital lobe = posterior cerebral artery

Question 14

the middle region of the brain where the two faces of the hemispheres meet is majorly supplied by what artery?

Answer 14

by the anterior cerebral artery

Question 15

the perineum is supplied by what cerebral artery?

Answer 15

by the anterior cerebral artery

Question 16

which cerebral artery is the largest?

Answer 16

the middle cerebral artery

Question 17

where would you experience motor loss if there is an embolis in the middle cerebrall artery?

Answer 17

you would experience contralateral motor and sensory loss (except lower limb and perineum)

Question 18

what cerebral artery supplies vision?

Answer 18

the posterior cerebral artery

• • or - macular sparing from long branch of middle cerebral artery

Question 19

the posterior communicating artery is a remnant of what?

Answer 19

it is a remnant of the posterior cerebral artery coming from the internal carotid artery

Question 20

Describe the regions of the internal capsule

Answer 20

• anterior limb = frontopontine fibers
• genu= corticobulbar fibers
• posterior limb = corticospinal fibers and sensory fibers to the ascending tracts
• retrolentiform = visual fibers

Question 21

Describe the different regions of the striate arteries?

Answer 21

• anterior choroidal = from internal carotid, lowest part from posterior limb and retrolentiform fibers
• medial sriates= from anterior cerebral- supply anterior limb and genu
• lateral striates = come from middle cerebral artery- branches to all parts of internal capsule -

Question 22

Describe the implication of a stroke to the anterior cerebral, middle cerebral, posterior cerebral or vetebrobasilar arteries

Answer 22

anterior cerebral = contralateral hemiplegia and anaesthesia

middle cerebral = contralateral hemiplegia and anaesthesia +- aphashia if in dominant side

posterior cerebral = contralateral hemianopia

vertebrobasilar - focal brainstem syndrome

Question 23

where is the commonest source of cerebral haemorrhage?

Answer 23

the lateral striate branches of the middle cerebral artery

Question 24

what would be the clinical presentation of a haemorrhage of the lateral striate branches of the middle cerebral artery?

Answer 24

sudden severe headache followed by unconsciousness- complete flaccid hemiplaegia, absent reflexes, babinski’s sign

Question 25

what is PICA syndrome?

Answer 25

If cerebellum is involved – they will have disarthia (difficulty forming words)- they will have nystagnis(eyes pop back to middle), diminished tone

Lateral side of medulla = descending sympathetics– if they are involved, then the person will have Horner’s syndrome they also have a defect in trigeminal tract, the 10th cranial nerve can be invovlved too = pharyngeal/laryngeal paralysis, also have impaired spinothalamic tract

Question 26

what is medial medullary syndrome?

Answer 26

•Signs and Symptoms

Contralateral hemiparesis – b/c it’s before decussation of the lower medulla

• Contralateral impaired sensations of position and movement, tactile discrimination – why? B/c of the dorsal columns
• Ipsilateral paralysis of tongue – b/c this is where the 10thnerve comes off

If on both sides, then paralyzation of entire body = locked in syndrome