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Neuroscience-Spinal Nerve Roots > Cerebral Hemispheres & Vascular Supply > Flashcards

Cerebral Hemispheres & Vascular Supply Flashcards

1
Q

Main Functional Areas of Cerebral Cortex

A
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2
Q

Circle of Willis

A
  • Arterial supply to the cerebral hemispheres.
  • An anastomotic ring giving collateral circulation.
  • Anterior circulation.
  • From brachial cephalic trunk or aorta > internal carotid aa.
  • Posterior circulation.

From subclavian aa. > transverse foramen / vertebral aa. > basilar arter

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3
Q

Anterior & Posterior Circulation

A
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4
Q

Anterior & Posterior Circulation

A
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5
Q

Main Arteries of the Circle of Willis

A
  • Anterior cerebral artery (ACA).
  • Anterior communicating aa. (AComms) link the ACAs.
  • Middle cerebral artery (MCA).
  • Posterior cerebral artery (PCA).
  • Arise from the top of the basilar a.
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6
Q

Main Arteries of the Circle of Willis

A
  • The anterior & posterior circulations are linked via the posterior communicating aa. (PComms).
  • PComms connect internal carotids to PCA.
  • Brainstem branches & cerebellar aa. arise from basilar a.
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7
Q

Figure 10.3 Circle of Willis and Its Main Branches

A
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8
Q

Internal Carotid Artery

A
  • Named segments.
  • Cervical segments.
  • Petrous segment.
  • Cavernous segment (carotid siphon).
  • Passes anterior clinoid process to pierce dura & bed posterior to subarachnoid space as intracranial segment.
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9
Q

Circle of Willis and Its Main Branches

A
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10
Q

Circle of Willis and Its Main Branches

A
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11
Q

Main Branches of Intracranial Segment of Internal Carotid Artery

A
  • OPAAM
  • Ophthalmic a. - enters optic foramen with optic n.
  • Posterior communicating a.
  • .Anterior choroidal a.
  • Anterior cerebral a.
  • Middle cerebral a.
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12
Q

Territories of 3 Main Cerebral Aa.
Superficial Cerebral Structures

A
  • ACA (anterior cerebral artery) travels in interhemispheric fissure and back over corpus callosum.
  • Supplies most of cortex on anterior medial surface from frontal > parietal lobes & medial sensorimotor cortex.
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13
Q

Anterior Cerebral Artery

A
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14
Q

Arteries of the Brain

A
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15
Q

Territories of 3 Main Cerebral Aa.
Superficial Cerebral Structures

A

•MCA turns laterally & enters Sylvian fissure.

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16
Q

Territories of 3 Main Cerebral Aa.
Superficial Cerebral Structures

A
  • MCA turns laterally & enters Sylvian fissure ad then bifurcates into
  • Superior division
  • Inferior division
  • (varies, sometimes into 3 or 4).

The branches form a loop as they pass over the insula and back out Sylvian fissure.

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17
Q

Middle Cerebral Artery -MCA

A
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18
Q

Arteries of the Brain

A
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19
Q

Territories of 3 Main Cerebral Aa.
Superficial Cerebral Structures

A
  • PCA curves back with branches over:
  • Inferior & middle temporal lobe
  • Occipital cortex.
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20
Q

Arteries of the Brain

A
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21
Q

Arteries of the Brain

A
22
Q

Territories of 3 Main Cerebral Aa.
Superficial Cerebral Structures

A
  • MCA turns laterally & enters Sylvian fissure ad then bifurcates into
  • Superior division
  • Inferior division
  • (varies, sometimes into 3 or 4).
  • The branches form a loop as they pass over the insula and back out Sylvian fissure.
23
Q

Territories of 3 Main Cerebral Aa.
Deep Cerebral Structures

A
  • **MOST IMPORTANT penetrating vessels at the base of brain = lenticulostriate aa.
  • Arise from MCA.
  • Penetrate anterior perforated substance.
  • Supply large part of basal nuclei (ganglia) & internal capsule.
  • Prone to narrowing in HTN > infarct > rupture

> hemorrhage.

24
Q

Figure 10.7 Lenticulostriate Arteries

A
25
Q

Territories of 3 Main Cerebral Aa.
Deep Cerebral Structures

A
  • Anterior choroidal a. arises from internal carotid aa.
  • Globus palladus, putamen, thalamus, (lateral geniculate nucleus?), posterior limb internal capsule (corticospinal & corticobulbar tracts).
  • Infarct of lenticulostriate or anterior choroidal aa. territories often=contralateral hemiparesis.
26
Q

Figure 10.8 Blood Supply to Deep Cerebral Structures (Part 1)

A
27
Q

Figure 10.8 Blood Supply to Deep Cerebral Structures (Part 2)

A
28
Q

Territories of 3 Main Cerebral Aa.
Deep Cerebral Structures

A
  • Branches of ACA.
  • Recurrent a. of Heubner.
  • Supplies head of caudate nucleus, anterior putamen, globus palladus & internal capsule.
  • Thalamoperforator aa.
  • Thalamus & maybe post. limb int. capsule.
29
Q

Figure 10.9 Summary of Superficial and Deep Blood Supply to the Cerebral Hemispheres (Part 1)

A
30
Q

Figure 10.9 Summary of Superficial and Deep Blood Supply to the Cerebral Hemispheres (Part 2)

A
31
Q

Clinical Syndromes

A
  • MCA infarct & ischemia is common - and more common than ACA & PCA.
  • MCA in 3 regions:
  • Superior division.
  • Inferior division.
  • Deep territory.
  • Aphasia, hemineglect, hemianopia, face-arm or face-arm-leg sensorimotor loss.

-Gaze toward side of lesion acutely

32
Q

Major Clinical Syndromes of the MCA

A
33
Q

Major Clinical Syndromes of the MCA

A
34
Q

Clinical Syndromes

A
  • ACA
  • UMN lesion weakness & cortical type sensory loss affecting contralateral leg more than face or arm.
  • Large ACA stroke can give contralateral hemiplegia.
35
Q

Major Clinical Syndromes of the MCA, ACA, PCA

A
36
Q

Clinical Syndromes

A

•PCA

. Contralateral homonymous hemianopia.

•Small penetrating branch can infarct thalamus, posterior limb of internal capsule with sensory loss, contralateral hemiparesis or a thalamic aphasia (so can mimic MCA).

37
Q

Watershed Infarcts

A
  • When blood supply to 2 adjacent arteries are compromised, region between 2 vessels are susceptible to ischemia/infarct.
  • Watershed zone.
  • Bilateral watershed infarcts in both ACA-MCA & MCA-PCA watershed zones can occur with severe drop in systemic BP.
  • Occlusion of internal carotid a. or drop in BP in patient with carotid stenosis can cause ACA-MCA watershed infarct.
38
Q

Watershed Infarcts

A
  • Proximal arm & leg weakness (“man in a barrel syndrome”).
  • In dominant hemisphere – transcortical aphasia syndromes.
  • MCA-PCA infarct can cause higher order visual processing.
39
Q

Figure 10.10 Watershed Zones for the Major Cerebral Arteries

A
40
Q

Transient Neurological Episodes

A
  • Common, motor, somatosensory, visual, auditory, olfactory, kinesthetic, emotional, or cognitive.
  • Most common causes:
  • Transient ischemic attack (TIA).
  • Migraine.
  • Seizure.
  • Cardiac arrhythmia.
  • Hypoglycemia.
41
Q

TIA

A
  • Neurological deficit lasting less than 24 hours.
  • Most typical less than 10 minutes.
  • More than 10 minutes; some permanent cell death.
  • More than 1 hour usually small infarct; sometimes complete functional recovery within 24 hours.
  • Caused by temporary brain ischemia.
  • ** Warning sign.
  • Neurological emergency.
42
Q

TIA

A
  • 15% will have a stroke within 3 month with persistent deficits.
  • ½ of these occur within 48 hours.
  • Urgent referral, admittance, & evaluation for treatment.
43
Q
  • 15% will have a stroke within 3 month with persistent deficits.
  • ½ of these occur within 48 hours.
  • Urgent referral, admittance, & evaluation for treatment.
A
  • Without other focal features…
  • Most commonly by cardiogenic syncope.
  • Vasovagal transient episodes of hypotension.
  • Arrhythmias.
  • Other non-neurogenic causes.
  • Neurologic causes:
  • Seizures.
44
Q

Ischemic Stroke

A
  • 3rd leading cause of death in U.S.A.
  • Major cause of permanent disability.
  • Acute diagnostic & therapeutic management essential, treated like severity of cardiac emergencies.
  • Ischemic strokes can lead to hemorrhagic conversion.
  • Inadequate blood supply causing tissure death.
  • Embolic infarct.
  • Thrombotic infarct.
45
Q

Common Stroke Risk Factors

A
46
Q

Carotid Auscultations

A
47
Q

Circle of Willis

A
  • Complete the following learning module on the Circle of Willis.
  • http://www.neuroanatomy.ca/flex_labs/Circle_Willis/story_html5.html
48
Q

Ischemic Stroke

(Use Blumenfeld pp 405 - 409.)

A
  • For the following, define & discuss the mechanisms of pathology:
  • Embolic infarcts & cause.
  • Thrombolic causes and mechanism.
  • Large vessel infarct.
  • Small vessel / lacunar infarct.
  • Cortical vs. subcortical.
  • Hemispheric vs. brainstem lesions.
  • Stroke risk factors.
  • Treatment & diagnostic workup.
49
Q

Stenosis & Dissection, Thrombosis

(Use Blumenfeld pp 410 – 411, 413.)

A
  • For the following, define & discuss the mechanisms of pathology:
  • Carotid stenosis.
  • Dissection of the carotid & vertebral aa.
  • Sagittal sinus thrombosis.
50
Q
A

Neuroscience-Spinal Nerve Roots (4 decks)

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