Chapter 3 : Blood Supply of The Central System (4)

Question 1

1. A 50-year-old hypertensive woman complains of numbness and weakness in her left leg and foot. Occlusion of which of the following vessels may account for this complaint? (A) Anterior choroidal artery (B) Anterior cerebral artery (C) Interior carotid artery (D) Middle cerebral artery (E) Posterior artery

Answer 1

1–B. The anterior cerebral artery perfuses the paracentral lobule, which represents the motor and sensory strips of the leg and foot areas.

Question 2

2. A 15-year-old boy is hit on the temple with a baseball and becomes unconscious. After about 10 minutes, he regains consciousness, but he soon becomes lethargic, and over the next 2 hours, he becomes stuporous. His pupils are unequal. Intracranial hemorrhage is suspected. Which of the following vessels is most likely to be the source of the hemorrhage? (A) Anterior cerebral artery (B) Anterior communicating artery (C) Basilar artery (D) Middle cerebral artery (E) Middle meningeal artery

Answer 2

2–E. Laceration of the middle meningeal artery gives rise to an epidural hematoma. Classic signs of an epidural hematoma are skull trauma, usually with fracture, and sequential progression from unconsciousness to lucidity to progressive coma to death due to transtentorial herniation with ipsilateral third palsy.

Question 3

3. Which artery supplies the caudate and putamen and anterior limb of the internal capsule via the medial striate artery of Heubner? (A) Middle cerebral (B) Anterior communicating (C) Anterior cerebral (D) Anterior choroidal (E) Posterior communicating

Answer 3

3–C. The anterior cerebral artery supplies part of the caudate nucleus and putamen and anterior limb of the internal capsule via the medial striate artery of Heubner (see Figure 3-2).

Question 4

4. Which artery supplies the cochlea? (A) Pontine (B) Labyrinthine (C) Superior cerebellar (D) Posterior cerebral (E) Anterior inferior cerebellar

Answer 4

4–B. The labyrinthine artery supplies the cochlea and the vestibular apparatus. In 15% of the population, it arises from the basilar artery; in the other 85% of the population, it arises from the anterior inferior cerebellar artery.

Question 5

5. Which sinus drains the superior surface of the cerebellum? (A) Straight (B) Inferior sagittal (C) Inferior petrosal (D) Sigmoid (E) Sphenoparietal

Answer 5

5–A. The straight sinus drains the superior surface of the cerebellum. It is formed by the great cerebral vein and the inferior sagittal sinus.

Question 6

6. A 40-year-old female graduate student had an excruciating headache. When she looked in the mirror, she noticed that her eyelid was drooping; when she lifted the eyelid, she saw that her eyeball was looking down and out and her pupil was huge. She complained of both blurred and double vision. An MRA scan showed an aneurysm of the circle of Willis. Which artery gives rise to the offending aneurysm? (A) Heubner’s (B) anterior communicating (C) posterior communicating (D) Charcot-Bouchard’s (E) anterior choroidal

Answer 6

6–C. The posterior communicating artery may give rise to a berry aneurysm, which compresses the third cranial nerve and results incomplete third nerve palsy (see Figure 3-14). Heubner’s artery is a branch of the anterior cerebral artery. A communicating artery may harbor berry aneurysms that impinge on the optic chiasm, causing a bitemporal lower quadrantanopia. Charcot-Bouchard microaneurysms are found in the territory of the lateral striate arteries and are the most common cause of nontraumatic intraparenchymal hemorrhage. Rupture occurs most frequently in the basal ganglia. The anterior choroidal artery is a branch of the internal carotid artery and irrigates the globus pallidus and posterior limb of the internal capsule.

Question 7

Questions 7 to 11 The response options for items 7 to 11 are the same. Select one answer for each item in the set.

(A) Posterior cerebral artery

(B) Superior cerebellar artery

(C) Anterior inferior cerebellar artery

(D) Posterior inferior cerebellar artery

(E) Anterior spinal artery Match each of the following descriptions with the most appropriate artery.

7. Usually gives rise to the artery that supplies the inner ear

Answer 7

7–C. The anterior inferior cerebellar artery usually gives rise to the labyrinthine artery, which supplies the structures of the inner ear (i.e., the cochlea and vestibular apparatus).

Question 8

Questions 7 to 11 The response options for items 7 to 11 are the same. Select one answer for each item in the set.

(A) Posterior cerebral artery

(B) Superior cerebellar artery

(C) Anterior inferior cerebellar artery

(D) Posterior inferior cerebellar artery

(E) Anterior spinal artery Match each of the following descriptions with the most appropriate artery.

8. Supplies the facial nucleus and the spinal trigeminal nucleus and tract

Answer 8

8–C. The facial nucleus and the spinal trigeminal nucleus and tract are supplied by the anterior inferior cerebellar artery.

Question 9

Questions 7 to 11 The response options for items 7 to 11 are the same. Select one answer for each item in the set.

(A) Posterior cerebral artery

(B) Superior cerebellar artery

(C) Anterior inferior cerebellar artery

(D) Posterior inferior cerebellar artery

(E) Anterior spinal artery Match each of the following descriptions with the most appropriate artery.

9. Is the terminal branch of the basilar artery

Answer 9

9–A. The posterior cerebral artery is the terminal branch of the basilar artery.

Question 10

Questions 7 to 11 The response options for items 7 to 11 are the same. Select one answer for each item in the set.

(A) Posterior cerebral artery

(B) Superior cerebellar artery

(C) Anterior inferior cerebellar artery

(D) Posterior inferior cerebellar artery

(E) Anterior spinal artery Match each of the following descriptions with the most appropriate artery.

10. Supplies the deep cerebellar nuclei

Answer 10

10–B. The superior cerebellar artery supplies the superior surface of the cerebellum and the cerebellarnuclei (dentate nucleus).

Question 11

Questions 7 to 11 The response options for items 7 to 11 are the same. Select one answer for each item in the set.

(A) Posterior cerebral artery

(B) Superior cerebellar artery

(C) Anterior inferior cerebellar artery

(D) Posterior inferior cerebellar artery

(E) Anterior spinal artery Match each of the following descriptions with the most appropriate artery.

11. Supplies the nucleus ambiguus

Answer 11

11–D. The posterior inferior cerebellar artery supplies the dorsolateral medullary field, including the nucleus ambiguus.

Question 12

Questions 12 to 16
Match the statements in items 12 to 16 with the appropriate lettered artery shown in the figure.

12. An aneurysm of this artery may cause a third nerve palsy
    

Answer 12

12–E. An aneurysm of the posterior communicating artery may cause a third nerve palsy.

Question 13

Questions 12 to 16
Match the statements in items 12 to 16 with the appropriate lettered artery shown in the figure.

13. Irrigates the posterior limb of the internal capsule

Answer 13

13–D. The anterior choroidal artery irrigates the posterior limb of the internal capsule.

Question 14

Questions 12 to 16
Match the statements in items 12 to 16 with the appropriate lettered artery shown in the figure.

14. Occlusion of this artery results in a fluent receptive aphasia

Answer 14

14–C. Occlusion of the proximal stem of the left middle cerebral artery results in Wernicke aphasia,a fluent receptive aphasia.