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Neuroscience > CNS Blood Supply > Flashcards

CNS Blood Supply Flashcards

1
Q

What blood vessels of the brain are part of the anterior blood supply?

A
  • middle cerebral artery
  • anterior cerebral artery

off of the ICA

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2
Q

What blood vessels of the brain are part of the posterior blood supply?

A

posterior cerebral artery

off of vertebral-basilar artery

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3
Q

What structures of the brain get blood supply from the middle cerebral artery?

A

lateral areas of brain
- broca’s area
- wernicke’s area
- primary motor and somatosensory cortex

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4
Q

What structures of the brain get blood supply from the anterior cerebral artery?

A

supplementary motor area
leg of somatosensory and motor

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5
Q

What structures of the brain get blood supply from the posterior cerebral artery?

A

medial-lower supply
- temporal lobe
- occipital lobe (calcarine fissure)
- medial temporal memory system
- visual system

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6
Q

What is the role of the anterior spinal artery?

A

supply blood to the anterior 2/3 of spinal cord

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7
Q

What is the role of the 2 posterior spinal arteries?

A

supply blood to the posterior 1/3 of spinal cord

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8
Q

What does ischemia mean?

A

to keep back blood

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9
Q

What is cerebrovascular disease?

A

any disease that affects the blood vessels of the brain

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10
Q

What is ischemic stroke?

A

stroke resulting from insufficient blood flow that causes tissue death

80% of all strokes

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11
Q

What is hemorrhagic stroke?

A

rupture of blood vessel causing bleeding effect

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12
Q

What is FAST when it comes to stroke?

A
  • the faster someone gets medical attention better the outcome

Face
Arm
Speech
Time needed to act

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13
Q

What are the risk factors to ischemic stroke?

A
  • age
  • cardiac disease
  • hypertension
  • blood lipids
  • diabetes mellitus
  • smoking
  • obesity
  • excessive alcohol consumption
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14
Q

How does a stroke work?

A
  • lack of oxygen due to obstruction preventing blood supply distally
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15
Q

What is ischemic necrosis?

A

neuronal death caused by lack of blood flow

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16
Q

What is an infarct?

A

area of death brain tissue

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17
Q

What is a thrombus?

A

blood clot attached to the wall of an artery

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18
Q

What is a embolus?

A

fragment of thrombus that has become loose and traveled to another area

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19
Q

What is a factor unique to the cerebral arterial supply that helps mitigate stroke?

A
  • anastomoses help redirect blood if there is an occlusion, stopping a stroke
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20
Q

What is important when it comes to the speed of an occlusion?

A

if a an occlusion forms slowly, it allows for more time for circulation to redirect

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21
Q

What artery connects the ICA and ECA in the skull?

A

opthalmic artery

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22
Q

How can thrombosis cause vascular problems?

A
  • decrease blood flow
  • fragment off and become embolus
  • hemorrhaging center of thrombus creating high pressure, hard for blood to pass
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23
Q

What is cerebral embolism the result of?

A

most often cardiovascular disease

75% of cardiac emboli become lodged in the brain

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24
Q

What is a transient ischemic attack?

A

a “mini stroke” that lasts 2-15 min, rarely 30 min, resolves on its own

strong predictor or stroke

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25
Q

What are the symptoms of ischemic attack?

A
  • numbness, tingling, weakness in face, arm, or leg one side of the body
  • difficulty walking
  • difficulty talking or understanding what others say
  • confusion
  • difficulty with vision in one/both eyes
  • dizziness
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26
Q

How does the anatomy of arteries impact the effect of stroke?

A

ACA, MCA, PCA have a stem that if occlusion lies there, affects will happen in areas supplied by penetrating and cortical branches

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27
Q

What is important to remember about the location of occlusion?

A

the more proximal the location of occlusion, more widespread and severe the deficits

28
Q

What artery in the brain is most common to suffer and ischemic stroke?

A

Middle cerebral artery

29
Q

Why does infarction of the cortical branches of a vessel cause contralateral sensory loss and weakness of the UMN?

A

b/c it primarily supplies primary motor and somatosensory parts

30
Q

What are the effects of dominant and on-dominant hemispheres suffering ischemic stroke of the MCA?

A

dominant (left): aphasia
non-dominant (right): problems wit prosody and unilateral visuospatial deficits

31
Q

What is prosody?

A

ability to interpret the meaning behind tone of voice (produce or understand)

32
Q

How does occlusion of the ACA affect the brain?

A

may cause no symptoms due to collateral circulation

33
Q

What does ischemic stroke of the ACA affect the most?

A

UMN weakness and sensory deficits of contralateral lower extremity and bowel and bladder dysfunction

34
Q

How does a bilateral ACA infarction occur?

A
  • anomaly in circle of willis
  • sensory motor syndrome involving both LEs due to no collateral circulation (causing occlusion of both ACAs
35
Q

What does unilateral occlusion of the PCA cause?

A

contralateral hemianopsia

36
Q

What is bilateral PCA infarction?

A
  • when single embolic or thrombotic occlusion of upper basilar artery
37
Q

What is the result of bilateral PCA infarction?

A

bilateral homonymous hemianopsia (cortical blindness)

38
Q

What happens when the inferomedial temporal lobes are infarcted?

A

severe memory problems

if also affecting occipital lobe, can’t interpret visual info and memorize who someone is

39
Q

How much of the internal carotid artery must be occluded to produce a carotid-border zone syndrome?

A

70%

40
Q

What is important about carotid-border zone syndrome?

A

max ischema occurs in watershed areas there is not enough pressure in ICA to get to distal cortical branches

41
Q

What causes Lacunar syndrome?

A

occlusion of small, deep, penetrating vessels

42
Q

What are the symptoms of lacunar syndrome?

A

sensory and/or motor deficits occur without cognitive deficits

face, leg, arm are typically affected equally

43
Q

When do 1/3 of thrombotic strokes occur?

A

during sleep

44
Q

What is important about the timing of catching a stroke?

A

decision if ischemic or hemorrhagic must be made within 2-4.5 hours

45
Q

How are ischemic strokes treated?

A

anticoagulation, while hemorrhagic cannot

46
Q

How does prognosis look if someone survives a stroke?

A

favors long term improvement

related to edema 3-4 days after

47
Q

What is the prognosis of ischemic stroke syndromes?

A

severe to least severe
- large strokes
- presence of edema or hemorrhage
- stroke in many territories
- single territory MCA > ACA > PCA

48
Q

What is a hemorrhagic stroke?

A

Avery rupture and blood flows into intracranial structures, brain tissue, ventricles, subarachnoid space

49
Q

What are the types of hemorrhagic stroke?

A
  • primary hemorrhagic stroke
  • rupture of aneurysms
  • arteriovenous malformations
50
Q

What are the risk factors of a hemorrhagic stroke?

A

hypertension
anticoagulation
inherited coagulation deficits (hemophilia)

51
Q

How does hemorrhagic stroke work?

A

escaped blood fills intracranial space, increasing pressure and obstructing structures

a once broken vessel is likely to break again

52
Q

When do hemorrhagic strokes occur?

A

mostly in wakefulness and activity

as time increases, symptoms worsen

usually without headache

53
Q

What is the mortality rate of primary intracerebral hemorrhage?

A

30-35%

if they survive they can have considerable recovery

54
Q

What is primary intracerebral hemorrhage?

A

occurs when brain penetrating artery is damaged or ruptures

higher incidence with those with hypertension

can displace and compress adjacent brain tissue

can result in coma or death

55
Q

What is a ruptured intracranial aneurysm?

A
  • second most common cause of hemorrhagic stroke
  • small, localized ballooning of vessel wall
56
Q

Where do most aneurysms occur?

A

90-95% in circle of willis

57
Q

When do aneurysm ruptures occur?

A

waking hours with sudden and severe headache, neck pain, and stiffness, altered consciousness and neurological deficits

58
Q

are unruptured aneurysms asymptomatic?

A

yes

59
Q

What is an arteriovenous malformation?

A

tangle of dilated blood vessels that form abnormal communications between arteries and veins

60
Q

Where do arteriovenous malformations occur?

A

brain, brainstem, spinal cord

61
Q

Can arteriovenous malformations be dangerous?

A
  • often asymptomatic, produce symptoms in 30+ year olds
  • when large can be life threatening
62
Q

What does UMN injury lead to?

A

lack of descending control, lead to:
- spasticity
- clonus
- hyper reflexia
- hypertonia
- primitive reflexes
- synergies
- weakness

63
Q

What is the course of MCA stroke on the left side?

A
  • flaccid hemiparesis, no reflex
  • after a couple months you could have stiff extremities on the right, high reflex activity
  • drooping eyelid and lips on the right side
64
Q

What are the characteristics of Broca’s aphasia?

A

broken choppy speech

intelligence still intact

65
Q

What are the characteristics of fluent aphasia (wernicke’s)?

A

smooth speech that lacks intelligence and coherence

Neuroscience (15 decks)

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