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Neuroscience Block 4 > CNS Blood Supply > Flashcards

CNS Blood Supply Flashcards

1
Q

The brain drains blood through venous dural channels into the general venous circulation via what major vein?

A

internal jugular vein

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2
Q

Describe the rate of the utilization of glucose in the brain. What structures use the most glucose. (Don’t be specific. What structures generally)? What relationship does this utilization have to blood flow?

A

the more active a brain structure, the higher its rate of glucose utilization

Also the higher its rate of local CBF

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3
Q

What fuel source does the brain use when in starvation/glucose deprivation?

A

ketone bodies

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4
Q

What ketone bodies are formed in the liver from catabolism of fatty acid (specifically)?

A

acetoacetate, & D-beta hydroxybutyrate

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5
Q

How is regional blood flow determined in brain & correlated with functional activity? (what tools)

A

Through use of Blood oxygen-level depletion (BOLD)or Perfusion fMRI.

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6
Q

How is energy metabolism determined in brain and correlated with functional activity? (technology used)

A

Through use of Fluorodeoxyglucose (FDG) radionucleotide in PET scan

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7
Q

What are the 2 major arterial systems supplying the brain?

A
  1. Internal Carotid Arteries (ICA)

2. Vertebral Arteries (VA)

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8
Q

What part of the brain (in general) does the internal carotid artery supply?

A

anterior 2/3 of brain

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9
Q

What part of the brain (in general) do the vertebral arteries supply?

A

Posterior 1/3 of brain
Brainstem
Cerebellum
Spinal cord

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10
Q

What type of stimuli has the least effect on the CBF? What sites does it have more of an impact on the brain.

A

humoral stimuli

choroid plexus
circumventricular organs
areas that lack BBB

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11
Q

What is the role of ANS stimuli in cerebral vessels?

A

role of autonomic innervations of cerebral vessels in cerebral blood flow is unclear.

Sympathetic overactivity may attenuate cerebral blood flow in acute hypertension

Parasympathetic stimulation has been observed to increase blood flow

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12
Q

Changes in tissue concentration of adenosine, lactate, and tissue PO2 ,PCO2 ,and pH may contribute to what changes in the brain?

A

changes in blood flow

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13
Q

What signaling molecule produced by neurons may play a role in increasing cerebral blood flow during metabolic activity?

A

NO (Nitric Oxide)

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14
Q

Hypercapnia and hypoxia are doing what to the circulation?

A

they are potent vasodilators

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15
Q

How do hypercapnia (excess CO2) and hypoxia (less oxygen) affect cerebral circulation?

A

These conditions produce vasodilation in the case of hypercapnia and hypoxia

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16
Q

Autoregulatory changes in cerebral vascular resistance functions to do what?

A

maintain constant cerebral blood flow over a wide range of pressure changes

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17
Q

What are the mechanisms by which cerebral vascular autoregulation is controlled?

A

metabolic factors, neural stimuli and activation of potassium channels

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18
Q

Endothelial Derived Relaxing Factor (NO) and endothelial potassium activation channels act as potent vasoconstrictors or potent vasodilators?

A

potent vasodilators of cerebral vasculature

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19
Q

What are the endothelial derived contracting factors that we discussed and what is their purpose in relation to CBF?

A

endothelin (an isopeptide)

vasoconstriction

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20
Q

How does acute and chronic hypertension affect the brain?

A

damages the endothelium which in turn impairs dilator responses

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21
Q

How does hypercholesterolemia and atheriosclerosis affect CBF?

A

impair cerebral vascular-dependent relaxation through mechanisms still not fully known.

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22
Q

How does a subarachnoid hemorrhage affect CBF?

A

causes reactive vasospasms

Leads to a reduction in cerebral blood flow after SAH

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23
Q

What vertebral lvl does the internal carotid artery arise from?

A

C3

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24
Q

The internal carotid artery enters the base of the skull through what canal?

A

the carotid canal

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25
Q

What do the branches of the carotid artery include?

A
  1. Ophthalmic artery
  2. Anterior choroidal artery
  3. Posterior communicating artery
  4. Middle cerebral artery
  5. Anterior cerebral artery
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26
Q

What artery gives rise to the central artery of retina?

A

CAR arises from the opthalmic artery

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27
Q

What happens if the opthalmic artery is occluded?

A

CAR occlusion = blindness

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28
Q

What areas does the anterior choroidal artery supply?

A

optic tract

some choroid plexus

part of the cerebral peduncle

posterior limb of internal capsule

thalamus

hippocampus

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29
Q

What happens if the anterior choroidal artery is occluded?

A

Asymptomatic

Symptomatic

Internal capsule

Contralateral hemiplegia and sensory abnormalities

Optic tract and lateral geniculate body
Contralateral homonymous hemianopsia

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30
Q

What does the posterior communicating artery supply?

A

hypothalamus
pituitary stalk
medial thalamus

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31
Q

What happens if the posterior communicating artery is occluded?

A

Infarct in tuberal and posterior hypothalamus

Infarct in medial thalamic nuclei

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32
Q

What are the common artery/site involved with aneurysm of the circle of Willis?

Which one is the most common? What is caused when there is an aneurysm of this artery? (regarding the last question)

A

PcomA and AcomA

AcomA
3rd nerve palsy

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33
Q

What sulcus does the middle cerebral artery lie?

A

lateral sulcus

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34
Q

What does the middle cerebral artery supply?

A

insula

much of lateral surface of cerebral cortex incl. Broca’s & Wernicke’s areas in the dominant hemisphere

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35
Q

What artery that supplies the striatum, does the middle cerebral artery give off?

A

lenticulostriate artery

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36
Q

What happens if middle cerebral artery is occluded?

A

Contralateral sensorimotor deficits most noticeable in the lower part of face and in arm

Hemianopsia of contralateral visual fields of both eyes (due to lesions of geniculocalcarine tract)

Language deficits if the left hemisphere is involved

Striatal deficits due to lesion of anterior limb of internal capsule

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37
Q

What does the anterior cerebral artery supply?

A

orbital surface of frontal lobe, incl. olfactory bulb and tract

medial surface of frontal & parietal cortex

mediodorsal surface of frontal and parietal cortex

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38
Q

What is the name of the artery that arises from the anterior cerebral artery and supplies the head of the caudate nucleus and nucleus accumbens?

A

artery of Heubner

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39
Q

What happens if anterior cerebral artery is occluded?

A

Anosmia

Contralateral motor and somatosensory deficits restricted to the lower limb

Transcortical apraxia (due to lesion of anterior two-thirds of corpus callosum)

Emotional lability and lack of social interaction

Akinetic mutism

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40
Q

Which artery links the two anterior cerebral arteries?

A

anterior communicating artery

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41
Q

Aneurysm of AcomA can have what clinical correlates?

A

Visual-field defects (ipsilateral superior temporal visual field cut)

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42
Q

What section of the whole brain in general does the ICA supply? Relate this to the vertebral arteries and their area of blood supply.

A

ICA: anterior 2/3 of brain
VA: posterior 1/3 of brain (brainstem, cerebellum, spinal cord)

43
Q

What foramen does the vertebral artery run through in the vertebrae?

A

Foramen transversorium

C6-C1 vertebrae

44
Q

Where does the ASA terminate?

A

caudal equinal and sacral arteries

45
Q

The ASA receives collaterals from where?

A

Intercostal Arteries

Anterior Segmental Arteries including:
Artery of Adamkiewicz

46
Q

Medial medullary syndrome is caused by occlusion of what artery?

A

the ASA

47
Q

What nuclei/tracts/nerves/etc are affected in medial medullary syndrome?

A

Corticospinal Tract
Medial Lemniscus
Hypoglossal Nucleus/Nerve (CN XII)

48
Q

What happens if anterior spinal artery is occluded in medulla?

A

Contralateral hemiplegia of arm and leg

Contralateral loss of position and vibratory sense and discriminative touch

Deviation of tongue to ipsilateral side when protruded; muscle atrophy and fasciculations

49
Q

What artery is implicated in dissecting aneurysm of the abdominal aorta?

A

Artery of Adakiewicz

50
Q

How is sudden anterior spinal artery syndrome appear?

A

During abdominal surgery the abdominal aorta may be compromised.

When this happens it may affect artery of Adamkiewicz leading to sudden anterior spinal artery syndrome which affects lower half of body including bladder and bowel loss.

51
Q

What other syndrome is sudden anterior spinal artery syndrome similar to?

A

conus medullaris syndrome or transverse myelitis

52
Q

PICA supplies what part of the brain?

A

inferior surface of the cerebellar hemisphere

53
Q

PICA gives rise to what artery that runs down the vertebra?

A

posterior spinal artery

54
Q

Another name for lateral medullary syndrome.

A

Wallenberg’s Syndrome

55
Q

Lateral medullary syndrome is caused by occlusion of what arteries?

A

caused by occlusion of PICA/VA

56
Q

What structures does lateral medullary syndrome affect?

A

Inferior cerebellar peduncle

Spinothalamic tract

Spinal tract and nucleus

Nucleus Ambiguus

Nucleus Solitarius

Descending sympathetic fibers

57
Q

What happens if PICA is occluded?

A

Nausea, diplopia, tendency to fall to ipsilateral side

Ataxia to ipsilateral side

Contralateral loss of pain and temperature of body

Ipsilateral loss of pain and temperature of face

Dysphagia, soft palate paralysis, hoarseness, diminished gag reflex

Ipsilateral Horner syndrome

58
Q

u

A

g

59
Q

Another name for lateral inferior/caudal pontine syndrome?

A

AICA syndrome

60
Q

What structures does AICA occlusion affect?

A
  1. Middle and inferior cerebellar peduncle
  2. Vestibular nuclei and nerve
  3. Cochlear nuclei and nerve
  4. Facial nuclei and nerve
  5. Spinothalamic tract
  6. Spinal nucleus and tract
  7. Trigeminal nucleus and tract
  8. Descending hypothalamo sympathetic
61
Q

What happens if AICA is occluded?

A
  1. Ipsilateral ataxia
  2. Vertigo, nystagmus, nausea, vomiting
  3. unilateral central nerve deafness
  4. ipsilateral facial nerve paralysis, loss of taste from the anterior two-thirds of the tongue, loss of the corneal and stapedial reflexes
  5. contralateral loss of pain and temperature sensation from the trunk and extremities
  6. ipsilateral loss of pain and temperature sensation from face
  7. ipsilateral Horner syndrome (ptosis, miosis, hemianhidrosis, vasodilation, and apparent enophthalmos)
62
Q

The (labyrinthine) artery supplies what organ?

A

supplies inner ear

63
Q

What are the clinical manifestations of an occluded labyrinthine artery

A

Deafness in the corresponding ear

Vestibular dysfunction
Vertigo with a tendency to fall towards the side of the lesion

64
Q

Lateral superior pontine syndrome is also called what?

A

Superior Cerebellar Artery Syndrome

65
Q

What structures do superior cerebellar artery syndrome affect?

A
  1. Superior and middle cerebellar peduncle
  2. Lateral cerebellum (Dentate nucleus)
  3. Spinothalamic & Trigemino-thalamic tracts
  4. Medial lemniscus (lateral division [gracilis])
  5. Descending hypothalamo-sympathetic spinal tract
  6. Lateral lemniscus
66
Q

What happens if the superior cerebellar artery is occluded?

A
  1. Ipsilateral ataxia
  2. neocerebellar deficits/signs (dystaxia, dysmetria, and intention tremor)
  3. contralateral loss of pain and temperature sensation from the trunk, limbs, and face
  4. Contralateral loss of conscious proprioception, discriminative tactile sensation, and vibration from the trunk and lower extremity
  5. Ipsilateral Horner’s syndrome
  6. Auditory deficits
67
Q

Posterior cerebral artery gives rise to what arteries which supply the choroid plexus of the 3rd and lateral ventricles?

A

posterior choroidal arteries

68
Q

What are the syndromes we discussed involving the posterior cerebral artery?

A

Weber’s Syndrome
Benedikt’s syndrome
Parinaud syndrome

69
Q

Describe what Weber’s syndrome is caused by?

A

Unilateral damage to the ventral region of the midbrain caused by occlusion of the P1 part of posterior cerebral artery/basilar arteries

70
Q

What are the structures affected in Weber’s syndrome?

A

Oculomotor nerve
Cerebral peduncle (medial part)
Substantia nigra

71
Q

What are the clinical deficits observed when one has Weber’s syndrome?

A

Ipsilateral oculomotor paresis (loss of adduction and vertical gaze; pupillary dilation)

Contralateral hemiparesis

Contralateral parkinsonism

72
Q

Would Weber’s syndrome be considered a classical syndrome of superior alternating hemiparesis?

A

yes

73
Q

Benedikt’s Syndrome is caused by what?

A

Damage to the ventral & tegmental regions of the midbrain caused by occlusion of the P1 part of posterior cerebral/basilar arteries

74
Q

What are the structures affected in Benedikt’s Syndrome?

A

Oculomotor nerve

Cerebral peduncle (medial part)

Substantia nigra

Ventral tegmentum structures including the red nucleus, decussation of SCP, and medial lemniscus

75
Q

Clinical deficits involved in Benedikt’s Syndrome.

A

Ipsilateral oculomotor paresis
Contralateral hemiparesis
Parkinsonism
Contralateral ataxia, tremor & involuntary movements.

76
Q

What are the causes of Parinaud Syndrome?

A

compression of dorsal midbrain: pineal tumor (younger patients)

stroke (older patients)

Affecting vessel: P3 part of PCA

77
Q

What are the structures affected in Parinaud syndrome?

A

Pretectal area

Oculomotor & trochlear nuclei

78
Q

Clinical deficits observed in Parinaud Syndrome.

A

Paralysis of upward gaze, fixed pupil

Oculomotor & trochlear palsy

Central nystagmus

Disorders of saccades

79
Q

Paramedian pontine branches supply what part of the brainstem?

A

supply the medial portion of lower & upper pons

80
Q

Medial pontine syndrome can take place because of occlusion of which arteries?

A

paramedian pontine arteries

81
Q

Occlusion of the paramedian pontine arteries affects what? (nuclei/structures)

A

corticospinal tract
medial lemniscus
abducens nucleus & pontine gaze center
facial nucleus

82
Q

What happens if PPA (paramedian pontine arteries) are occluded?

A

Contralateral hemiplegia of arm and leg

Contralateral loss or decrease of:
position and vibratory sense
discriminative touch (arm and leg)

Ipsilateral lateral rectus muscle paralysis

Conjugate gaze paralysis toward side of lesion

83
Q

Describe what locked-in syndrome is caused by? What area of the brainstem involved? (also what is the vessel involved)

A

Lesion in the caudal pontine tegmentum

Vessel involved: basilar artery (paramedian branches)

84
Q

What are the signs and symptoms of Locked-in- Syndrome?

A

Conscious and aware individual
Bilateral lateral gaze paralysis
Bilateral spastic paresis

The patient is fully aware, able to hear and understand everything in the environment

Can only communicate with eye movements (can only blink)

85
Q

What arteries form Circle of Willis?

A

Anterior cerebral, internal carotid & posterior cerebral arteries of both sides are connected (by posterior and anterior com arteries) creating a structure called the “Circle of Willis”

important anastomoses in brain

86
Q

What 3 forms in which vascular disruption can occur?

A
  1. Stroke
  2. Transient Ischemic Attack
  3. Aneurysms
87
Q

What is a watershed zone and the importance.

A

Area between two vessels occluded and regions in between becoming susceptible.

88
Q

What is a symptom of ACA-MCA watershed infarct?

A

weakness in proximal limb, trunk. Distal limbs are spared

89
Q

Where is the CSF barrier located?

A

Anatomically located in outer most layer of epithelial cells covering choroid plexus in ventricles of brain

90
Q

Purpose of blood CSF barrier?

A

Functionally prevents passage of large molecules from blood into CSF

Advantage: prevents introduction of unwanted blood borne foreign substances into CSF

91
Q

Disadvantage of the blood CSF barrier?

A

Prevents beneficial delivery of drugs into CSF and therefore ECF of CNS

92
Q

Where is the blood brain barrier found?

A

Anatomically located at interface between capillary wall and brain tissue

93
Q

Advantage of BBB?

A

prevents introduction of unwanted blood borne foreign substances into brain tissue

94
Q

Disadvantage of BBB?

A

Prevents beneficial delivery of drugs into CNS

95
Q

Superficial cortical veins drain brain surface and empty into what veins?

A

superior sagittal sinus

96
Q

Deep cortical veins drain deep cortical structures and ultimately drain into what veins?

A

straight sinus

97
Q

All sinuses from the brain superficial and deep veins drain into what major vein?

A

internal jugular vein

98
Q

Superior group of superficial cortical veins empties blood where?

A

empties into superior and inferior sagittal sinuses

99
Q

Inferior group of the superficial cortical veins drains blood where?

A

empties into transverse and cavernous sinuses

100
Q

The superior anastomotic vein connects what two veins? What is this vein called?

A

(vein of Trolard)

connects superficial middle cerebral vein
with superior sagittal sinus

101
Q

The inferior anastomotic vein of the superficial cortical vein connects what two veins? What is it’s other name?

A

(vein of Labbe)

connects superficial middle cerebral vein
with transverse sinus

102
Q

The internal cerebral vein of the deep cortical veins is formed by what veins?

A

Septal vein

Thalamostriate (terminal) vein

Venous angle

103
Q

The great vein of Galen receives blood from what veins?

A

Internal cerebral veins

Basal vein of Rosenthal

104
Q

The Great vein of Galen (GVG) drains into what veins?

A

Straight sinus & eventually systemic venous circulation

Neuroscience Block 4 (6 decks)

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