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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
What do the branches of the carotid artery include?
1. Ophthalmic artery 2. Anterior choroidal artery 3. Posterior communicating artery 4. Middle cerebral artery 5. Anterior cerebral artery
26
What artery gives rise to the central artery of retina?
CAR arises from the opthalmic artery
27
What happens if the opthalmic artery is occluded?
CAR occlusion = blindness
28
What areas does the anterior choroidal artery supply?
optic tract some choroid plexus part of the cerebral peduncle posterior limb of internal capsule thalamus hippocampus
29
What happens if the anterior choroidal artery is occluded?
Asymptomatic Symptomatic Internal capsule Contralateral hemiplegia and sensory abnormalities Optic tract and lateral geniculate body Contralateral homonymous hemianopsia
30
What does the posterior communicating artery supply?
hypothalamus pituitary stalk medial thalamus
31
What happens if the posterior communicating artery is occluded?
Infarct in tuberal and posterior hypothalamus Infarct in medial thalamic nuclei
32
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)
PcomA and AcomA AcomA 3rd nerve palsy
33
What sulcus does the middle cerebral artery lie?
lateral sulcus
34
What does the middle cerebral artery supply?
insula much of lateral surface of cerebral cortex incl. Broca’s & Wernicke’s areas in the dominant hemisphere
35
What artery that supplies the striatum, does the middle cerebral artery give off?
lenticulostriate artery
36
What happens if middle cerebral artery is occluded?
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
37
What does the anterior cerebral artery supply?
orbital surface of frontal lobe, incl. olfactory bulb and tract medial surface of frontal & parietal cortex mediodorsal surface of frontal and parietal cortex
38
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?
artery of Heubner
39
What happens if anterior cerebral artery is occluded?
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
40
Which artery links the two anterior cerebral arteries?
anterior communicating artery
41
Aneurysm of AcomA can have what clinical correlates?
Visual-field defects (ipsilateral superior temporal visual field cut)
42
What section of the whole brain in general does the ICA supply? Relate this to the vertebral arteries and their area of blood supply.
ICA: anterior 2/3 of brain VA: posterior 1/3 of brain (brainstem, cerebellum, spinal cord)
43
What foramen does the vertebral artery run through in the vertebrae?
Foramen transversorium C6-C1 vertebrae
44
Where does the ASA terminate?
caudal equinal and sacral arteries
45
The ASA receives collaterals from where?
Intercostal Arteries Anterior Segmental Arteries including: Artery of Adamkiewicz
46
Medial medullary syndrome is caused by occlusion of what artery?
the ASA
47
What nuclei/tracts/nerves/etc are affected in medial medullary syndrome?
Corticospinal Tract Medial Lemniscus Hypoglossal Nucleus/Nerve (CN XII)
48
What happens if anterior spinal artery is occluded in medulla?
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
What artery is implicated in dissecting aneurysm of the abdominal aorta?
Artery of Adakiewicz
50
How is sudden anterior spinal artery syndrome appear?
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
What other syndrome is sudden anterior spinal artery syndrome similar to?
conus medullaris syndrome or transverse myelitis
52
PICA supplies what part of the brain?
inferior surface of the cerebellar hemisphere
53
PICA gives rise to what artery that runs down the vertebra?
posterior spinal artery
54
Another name for lateral medullary syndrome.
Wallenberg's Syndrome
55
Lateral medullary syndrome is caused by occlusion of what arteries?
caused by occlusion of PICA/VA
56
What structures does lateral medullary syndrome affect?
Inferior cerebellar peduncle Spinothalamic tract Spinal tract and nucleus Nucleus Ambiguus Nucleus Solitarius Descending sympathetic fibers
57
What happens if PICA is occluded?
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
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59
Another name for lateral inferior/caudal pontine syndrome?
AICA syndrome
60
What structures does AICA occlusion affect?
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
What happens if AICA is occluded?
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
The (labyrinthine) artery supplies what organ?
supplies inner ear
63
What are the clinical manifestations of an occluded labyrinthine artery
Deafness in the corresponding ear Vestibular dysfunction Vertigo with a tendency to fall towards the side of the lesion
64
Lateral superior pontine syndrome is also called what?
Superior Cerebellar Artery Syndrome
65
What structures do superior cerebellar artery syndrome affect?
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
What happens if the superior cerebellar artery is occluded?
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
Posterior cerebral artery gives rise to what arteries which supply the choroid plexus of the 3rd and lateral ventricles?
posterior choroidal arteries
68
What are the syndromes we discussed involving the posterior cerebral artery?
Weber’s Syndrome Benedikt’s syndrome Parinaud syndrome
69
Describe what Weber's syndrome is caused by?
Unilateral damage to the ventral region of the midbrain caused by occlusion of the P1 part of posterior cerebral artery/basilar arteries
70
What are the structures affected in Weber's syndrome?
Oculomotor nerve Cerebral peduncle (medial part) Substantia nigra
71
What are the clinical deficits observed when one has Weber's syndrome?
Ipsilateral oculomotor paresis (loss of adduction and vertical gaze; pupillary dilation) Contralateral hemiparesis Contralateral parkinsonism
72
Would Weber's syndrome be considered a classical syndrome of superior alternating hemiparesis?
yes
73
Benedikt's Syndrome is caused by what?
Damage to the ventral & tegmental regions of the midbrain caused by occlusion of the P1 part of posterior cerebral/basilar arteries
74
What are the structures affected in Benedikt's Syndrome?
Oculomotor nerve Cerebral peduncle (medial part) Substantia nigra Ventral tegmentum structures including the red nucleus, decussation of SCP, and medial lemniscus
75
Clinical deficits involved in Benedikt's Syndrome.
Ipsilateral oculomotor paresis Contralateral hemiparesis Parkinsonism Contralateral ataxia, tremor & involuntary movements.
76
What are the causes of Parinaud Syndrome?
compression of dorsal midbrain: pineal tumor (younger patients) stroke (older patients) Affecting vessel: P3 part of PCA
77
What are the structures affected in Parinaud syndrome?
Pretectal area | Oculomotor & trochlear nuclei
78
Clinical deficits observed in Parinaud Syndrome.
Paralysis of upward gaze, fixed pupil Oculomotor & trochlear palsy Central nystagmus Disorders of saccades
79
Paramedian pontine branches supply what part of the brainstem?
supply the medial portion of lower & upper pons
80
Medial pontine syndrome can take place because of occlusion of which arteries?
paramedian pontine arteries
81
Occlusion of the paramedian pontine arteries affects what? (nuclei/structures)
corticospinal tract medial lemniscus abducens nucleus & pontine gaze center facial nucleus
82
What happens if PPA (paramedian pontine arteries) are occluded?
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
Describe what locked-in syndrome is caused by? What area of the brainstem involved? (also what is the vessel involved)
Lesion in the caudal pontine tegmentum | Vessel involved: basilar artery (paramedian branches)
84
What are the signs and symptoms of Locked-in- Syndrome?
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
What arteries form Circle of Willis?
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
What 3 forms in which vascular disruption can occur?
1. Stroke 2. Transient Ischemic Attack 3. Aneurysms
87
What is a watershed zone and the importance.
Area between two vessels occluded and regions in between becoming susceptible.
88
What is a symptom of ACA-MCA watershed infarct?
weakness in proximal limb, trunk. Distal limbs are spared
89
Where is the CSF barrier located?
Anatomically located in outer most layer of epithelial cells covering choroid plexus in ventricles of brain
90
Purpose of blood CSF barrier?
Functionally prevents passage of large molecules from blood into CSF Advantage: prevents introduction of unwanted blood borne foreign substances into CSF
91
Disadvantage of the blood CSF barrier?
Prevents beneficial delivery of drugs into CSF and therefore ECF of CNS
92
Where is the blood brain barrier found?
Anatomically located at interface between capillary wall and brain tissue
93
Advantage of BBB?
prevents introduction of unwanted blood borne foreign substances into brain tissue
94
Disadvantage of BBB?
Prevents beneficial delivery of drugs into CNS
95
Superficial cortical veins drain brain surface and empty into what veins?
superior sagittal sinus
96
Deep cortical veins drain deep cortical structures and ultimately drain into what veins?
straight sinus
97
All sinuses from the brain superficial and deep veins drain into what major vein?
internal jugular vein
98
Superior group of superficial cortical veins empties blood where?
empties into superior and inferior sagittal sinuses
99
Inferior group of the superficial cortical veins drains blood where?
empties into transverse and cavernous sinuses
100
The superior anastomotic vein connects what two veins? What is this vein called?
(vein of Trolard) connects superficial middle cerebral vein with superior sagittal sinus
101
The inferior anastomotic vein of the superficial cortical vein connects what two veins? What is it's other name?
(vein of Labbe) connects superficial middle cerebral vein with transverse sinus
102
The internal cerebral vein of the deep cortical veins is formed by what veins?
Septal vein Thalamostriate (terminal) vein Venous angle
103
The great vein of Galen receives blood from what veins?
Internal cerebral veins | Basal vein of Rosenthal
104
The Great vein of Galen (GVG) drains into what veins?
Straight sinus & eventually systemic venous circulation

Neuroscience Block 4 (6 decks)

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