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Neuro Exam 1 > CNS Blood Supply > Flashcards

CNS Blood Supply Flashcards

1
Q

vessels involved in the circle of willis

A

-ICA
-ACA
-Acom
-Pcom
-PCA
-basilar artery

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2
Q

carotid syphon

A

tortuous portion of the ICA with high risk for calcification and aneurysm

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3
Q

terminal branches of the internal carotid artery (ICA)

A

1) anterior cerebral arteries (ACA)
2) middle cerebral arteries (MCA)

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4
Q

intermediate branches of the internal carotid artery (ICA)

A

1) ophthalmic artery
2) posterior communicating artery (Pcom)
3) anterior choroidal artery

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5
Q

ACA branches & their perfusion

A

1) superficial branches to:
-paracentral lobule, where hip, lower limb, and genital area are represented
-frontal lobe cognitive area
-cingulate gyrus and corpus callosum

2) perforating branches to:
-deep cerebral nuclei
-internal capsule

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6
Q

A1-A4 of the anterior cerebral artery (ACA)

A

*A1 is pre-communicating (before the anterior communicating artery)
*A2, A3, and A4 are post-communicating

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7
Q

signs of an ACA stroke

A

*weakness of contralateral LEG
*sensory loss of contralateral LEG
*urinary incontinence
*altered mental status or judgement
*behavioral and emotional disorders

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8
Q

A1 vs A2 occlusion of ACA

A

*in A1 occlusion, there is distal ACA circulation via Acom
*in A2 occlusion, there is NO distal perfusion of tissue

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9
Q

segments of the MCA

A

1) M1 = deep/horizontal
2) M2 = lateral (sylvian) fissure
3) M3/M4 = cortical (superior and inferior divisions)

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10
Q

MCA perfusion and branches

A

1) superficial branches to:
-lateral surfaces of frontal, parietal, and temporal lobes
-cortex in sylvian sulcus, including insula
-portion of occipital lobe

2) deep perforating branches

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11
Q

important functional areas supplied by the MCA

A

*primary and secondary motor
*primary and secondary somatosensory
*parietal association cortex
*Wernicke’s area and Broca’s area
*primary and secondary auditory

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12
Q

signs of an MCA stroke

A

*contralateral weakness of UPPER LIMB AND FACE
*expressive (non-fluent) aphasia (Broca’s)
*contralateral sensory loss of UPPER LIMB AND FACE
*receptive (fluent) aphasia (Wernicke’s)
*gaze preference to ipsilateral side
*neglect: non-dominant hemisphere
*possible partial visual deficits due to white matter involvement

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13
Q

lenticulostriate arteries

A

arteries that supply regions of the BASAL NUCLEI

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14
Q

medial lenticulostriate arteries supply?

A

supply the globus pallidus, the medial portion of the putamen, and the anterior internal capsule

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15
Q

medial lenticulostriate artery - alternative name

A

Recurrent Artery of Heubner

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16
Q

medial lenticulostriate arteries arise from?

A

arise from the A1 segment of the ACA (anterior cerebral artery)

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17
Q

lateral lenticulostriate arteries arise from?

A

arise from the proximal MCA (usually M1)

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18
Q

lateral lenticulostriate arteries supply?

A

supply the lateral portion of the putamen and the posterior internal capsule

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19
Q

stroke in the lenticulostriate arteries would present with what signs?

A

movement issues
(NOT issues with speech, spatial processing, or other cognitive deficits)

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20
Q

the posterior communicating artery supplies blood to?

A

supplies blood to thalamus, optic chiasm, and regions of the hypothalamus

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21
Q

what cranial nerve does the posterior communicating artery travel adjacent to?

A

Pcom travels adjacent to the oculomotor nerve (CN III)

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22
Q

what is a classic Pcom stroke sign?

A

third nerve palsy (ptosis, down and out pupil, and mydriasis on the ipsilateral side)

23
Q

what do the vertebral arteries arise from

A

subclavian arteries

24
Q

what are the branches of the vertebral arteries

A

1) anterior spinal artery
2) PICA and AICA
3) basilar

25
Q

where do the 2 vertebral arteries join to form the basilar artery

A

at the junction between the pons and medulla

26
Q

what are the branches of the basilar artery

A

1) superior cerebellar arteries (SCA)
2) basilar divides into 2 posterior cerebral arteries (PCA)

27
Q

posterior cerebral artery (PCA) - perfusion and branches

A

**occipital cortex visual areas
*inferior temporal lobe
*splenium of corpus callosum
*hippocampus
*portions of midbrain

28
Q

PCA divisions

A

*P1 is pre-communicating (before posterior communicating artery)
*P2, P3, and P4 are post-communicating

29
Q

P1 vs. P2 occlusions

A

*with P1 occlusions, there is distal PCA circulation via Pcom
*with P2 occlusions, there is NO distal perfusion of cortex

30
Q

clinical signs of a PCA stroke

A

*homonymous hemianopsia
*in-utero strokes are most commonly strokes in the PCA (fetal PCAs)

31
Q

watershed zones

A

regions of the brain that receive dual blood supply branches of 2 major arteries

32
Q

superior cerebellar artery (SCA) supplies?

A

cerebellar hemispheres and parts of the midbrain

33
Q

clinical signs of SCA stroke

A

trigeminal neuralgia (severe pain in the jaw) due to compression of the trigeminal nerve

34
Q

anterior inferior cerebellar artery (AICA) supplies?

A

ventral surface of cerebellum and the lateral pons

35
Q

clinical signs of AICA stroke

A

*loss of pain and temperature to face (ipsilateral)
loss of pain and temp to limbs (contralateral)
**LOSS OF HEARING, VERTIGO, and NYSTAGMUS

36
Q

posterior inferior cerebellar artery (PICA) supplies?

A

LATERAL MEDULLA, as well as vermal region and inferior lateral surface of the cerebellar hemisphere

37
Q

clinical signs of PICA stroke

A

*dysphagia, hoarseness, tongue deviation, loss of gag reflex
*ipsilateral Horner’s syndrome (ptosis, miosis, hemianhidrosis)
*cerebellar ataxia

38
Q

lateral medullary (Wallenburg’s) syndrome

A

PICA STROKE
presents as:
*dysphagia, hoarseness, tongue deviation, loss of gag reflex
*ipsilateral Horner’s syndrome

39
Q

midbrain blood supply

A

*PCA primarily (some from SCA)

40
Q

most common midbrain syndrome

A

Weber Syndrome

41
Q

Weber Syndrome

A

*occlusion of PCA
*ipsilateral oculomotor palsy
*contralateral weakness/hemiplegia of body and face

42
Q

pontine blood supply

A

*basilar artery (paramedian, short, and long branches)
*SCA contributes to rostral pons

43
Q

example of a pontine syndrome

A

Locked In Syndrome

44
Q

Locked In Syndrome

A

*complete occlusion of basilar artery
*pt can move their eyes but nothing else

45
Q

medullary blood supply

A

MEDIAL = anterior spinal artery
LATERAL = PICA

46
Q

syndrome associated with occlusion to MEDIAL medullary blood supply

A

Medial Medullary Syndrome of Dejerine
*caused by occlusion of anterior spinal artery

47
Q

all blood is drained from the brain by what vein

A

INTERNAL JUGULAR vein

48
Q

bridging veins

A

*veins that drain underlying neural tissue, penetrate the dura mater, and empty into the dural sinuses

note - subdural hematomas classically result from tearing of the bridging veins

49
Q

acute, subdural hematomas most commonly develop after rupture of ?

A

rupture of a bridging vein

50
Q

superior sagittal sinus

A

*largest venous sinus
*CSF return to venous drainage through bridging veins (arachnoid granulations)

51
Q

issues associated with the superior sagittal sinus

A

1) occlusion = increased intracranial pressure (potentially fatal)
2) shearing = subdural hematoma
3) superior sagittal sinus thrombosis (SSST) = stroke related to hypercoagulability

52
Q

cavernous sinus

A

*venous sinus that drains the eyes and superficial cortex
*ICA and CNs III, IV, V1, V2, and VI pass through

53
Q

cavernous sinus thrombosis

A

*thrombosis secondary to bacterial infection in the face
*can cause headache, proptosis, and ipsilateral CN deficits

Neuro Exam 1 (22 decks)

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