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Neuro Anatomy > Cerebral Hemispheres And Vascular Supply > Flashcards

Cerebral Hemispheres And Vascular Supply Flashcards

1
Q

% of problems in cranial cavity that are vascular

A

50

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2
Q

Loss of consciousness occurs when

A

The brain is deprived of oxygen for ~10 seconds, after ~3 minutes brain damage will result
After 10 minutes, brain death

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3
Q

No dominant hemisphere

A

(Right), association cortex (parietal lobe > frontal lobe) attention to contralateral

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4
Q

Circle of Willis

A

Anterior - internal carotid arteries
Posterior- vertebrobasilar
Circle of Willis
-and and posterior circulation joined by this circle
-provides opportunity for collateral blood flow
-major cerebral vessels arise from Circle of Willis

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5
Q

Main arteries supplying cerebral hemispheres

Anterior circulation-terminal branches of ICAs

A

Anterior cerebral arteries - jointed by anterior communicating artery
Middle cerebral arteries

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6
Q

Main arteries supplying cerebral hemisphere

Posterior circulation

A

Vertebral arteries-converge to form basilar
Posterior cerebral arteries - arise from top of basilar

Posterior communicating arteries - join ICAs and PCAs. Joins anterior circulation to posterior circulation

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7
Q

Three main cerebral arteries

A

ACA, MCA, PCA

Gives off numerous branches that travel over surface of brain and into sulci-supply superficial cortex and underlying white after

Gives off small branches that arise from initial segments of cerebral arteries at base of brain to supply deeper structures- BG, thalamus, internal capsule

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8
Q

Anterior cerebral artery

A

Supplies most of the anterior medial surface of the cortex from the frontal to anterior parietal lobes

Anterior portion of caudate nucleus
Putamen
Internal capsule

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9
Q

Middle cerebral artery

A

Most of lateral cortex
Enters Sylvian fissue to bifurcate into superior and inferior divisions

Most of caudate nucleus, putamen, globes pallidus, genu of internal capsule

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10
Q

Superior division of middle cerebral artery

A

Cortex about sylvian fissure (lateral frontal lobe and most of insula)

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11
Q

Inferior division of middle cerebral artery

A

Supplies cortex below sylvian fissue (lateral temporal lobe and portion of parietal lobe)

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12
Q

Posterior cerebral artery

A

Inferior and medial temporal lobes
Medial occipital cortex and most of medial parietal cortex
Thalamus and hippocampus

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13
Q

Lenticulostriate artiers

A

Small penetrating vessels at base of brain
Arise from initial portions of MCA before it enters sylvian fissure

Portions of basal ganglia and internal capsule

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14
Q

Anterior choroidal artery

A

Arise from ICA
Posterior limb of internal capsule
Portion of globes pallidus, putamen, lateral thalamus

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15
Q

Ischemia events are most common in

A

MCA

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16
Q

Ischemia in MCA- three divisions

A
  1. Superior division
  2. Inferior division
  3. Deep territory
17
Q

Stem infarcts

A

Proximal MCA occlusion affecting superior, inferior and deep territory divisions

18
Q

Left MCA superior division

A
  • right face and arm weakness
  • UMN type
  • non fluent or brocas aphasia

Cortical-type sensory loss- problems with localization and/or higher order sensory functions -

19
Q

Left MCA inferior division

A
  • Fluent or wernicke’s aphasia
  • right visual field deficit
  • Right face and arm cortical type sensory loss
  • mild right sided weakness may be present (edge of motor cortex)
20
Q

Left MCA deep territory

A
  • Right pure motor hemiparesis UMN-BG and left upper posterior internal capsule (descending CTS)
  • Aphasia - axons to broca’s or wernicke’s
21
Q

Left MCA stem

A
  • Combo of deficits for MCA
  • Right hemiplegia
  • R hemiansesthesia- PSC, sensory association cortex and left upper posterior internal capsule
  • R homonymous hemianopia
  • Global aphasia - broca’s and wericke’s
  • Left gaze preference - damage to left frontal eye fields and parietal cortical areas (normally drive eye movements toward opposite side)
22
Q

Left ACA

A
  • right leg weakness UMN and cortical type sensory loss
  • Grasp reflex - presence of primitive reflexes (frontal release signs)
  • frontal lobe behavioral abnormality
  • Transcortical motor aphasia- normal comp and repetition is spared but impaired fluency (language areas in frontal lobe)
  • large infarcts cause Right hemiplegia - ACA territory could extend to UE motor cortex (rare)
23
Q

Right ACA

A
  • left leg weakness UMN and cortical type sensory loss
  • grasp reflex
  • frontal lobe behavioral abnormalities
  • Left hemineglect - right frontal lobe (r hemisphere is spatial awareness)
  • larger infarcts may cause hemiplegia
24
Q

Right MCA superior division

A
  • left face and arm weakness UMN
  • Left hemineglect (right hemisphere - spatial awareness)
  • may have some left face/arm cortical type sensory loss
25
Q

Right MCA inferior division

A
  • Profound left hemineglect (r parietal - visual cortex and right hemisphere is spatial awareness
  • left visual field and somatosensory deficits (hard to test)
  • Motor reflect w/ decreased voluntary or spontaneous initiation on left side
  • some mild left sided weakness
  • often right gaze preference
26
Q

Right MCA deep territory

A
  • left pure motor hemiparesis of UMN

- large infarcts produce cortical deficits like left hemineglect

27
Q

Right MCA stem

A
  • left hemiplegia
  • left hemianestesia
  • left homonymous hemaniopia
  • profound hemineglect
  • right gaze preference
28
Q

left PCA

A
  • right homonymous hemianopia
  • extension to selenium of corpus callosum—alexia without agraphia (reading impairment without writing impairment-prevents processing of written material due to damage of post CC and left PVC)
  • larger infarcts to thalamus and internal capsule: aphasia, right hemisensory loss, right hemiparesis
29
Q

Right PCA

A
  • left homonymous hemianopia

- large including thalamus and internal capsule: left hemisensory loss and hemiparesis

30
Q

Watershed infarcts

A

Regions b/n cerebral arteries are called watershed zones

Can occur where the cerebral vascular territories meet-where brain parenchyma is furthest from the arterial supply making it most vulnerable to reductions in perfusion

ACA-MCA zone
MCA-PCA zone

31
Q

ACA-MCA watershed infarct

A
  • sudden occasion of an ICA
  • drop in BP in pt w/ carotid stenosis

Can produce proximal arm and leg weakness (homunculus regions would include proximal limbs and trunk)

32
Q

MCA-PCA watershed infarcts

A

Problems w/ higher order visual processing

Interrupts pathway from PVC to visual association cortex

33
Q

Bilateral watershed infarcts

A

Both ACA-MCA and MCA-PCA can occur w/ severe drops in systemic BP

34
Q

Risk factors for ischemic event

A 
Hypertension
Diabetes
Hypercholesterolemia
Cigarette smoking
Positive family hx
Cardiac disease
Prior history of stroke or other vascular disease

Neuro Anatomy (22 decks)

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