Exam 2 week 6 ppt 7 & 8 Blood Supply and Vascular disorders of brainstem structures Flashcards

1
Q

name the arteries in the picture of an overall veiw the the vascular supply to the brainstem

A
  1. Anterior spinal artery
  2. Posterior spinal artery
  3. Vertebral Artery
  4. Posterior inferior cerebellar artery
  5. Basilar artery
  6. Anterior inferior cerebellar artery
  7. Circumferential artery
  8. Superior cerebellar artery
  9. Posterior cerebral artery
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2
Q

Explain the vertebrobasilar system: purpose and path

A

The brainstem is supplied with blood via the Vertebrobasilar system.
•Vertebrobasilar system

  • –Vertebral arteries arise from subclavian arteries
  • –Rise thru transverse foramina of cervical vertebrae to enter skull thru foramen magnum
  • –Run along ventral brainstem to form single basilar artery at caudal pons

The brainstem is supplied with blood via the Vertebrobasilar system. Vertebral arteries arise from subclavian arteries and Rise thru transverse foramina of cervical vertebrae to enter skull thru foramen magnum. The vertebral arteries then run along ventral medulla to form single basilar artery at caudal pons

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3
Q

Anterior and posterior spinal arteries

arise from what?

anterior spinal arteriy supplies what?

anterior spinal artery exits the cranium where and why?

A

Branches from the vertebral arteries

The anterior spinal artery supplies the medial medulla

The anterior spinal artery exits out through the foramen magnum to supply blood to the spinal cord

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4
Q

Posterioir inferior cerebellar arteries

abbreviation

where it arises

what does it supply?

A

PICAs

Paired branches off the vertebral artery

supplies blood to

  • the cerebellum
  • lateral medulla
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5
Q

Another name for Lateral Medullary Syndrome

A

Wallenberg’s Syndrome

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6
Q

Describe Lateral Medullary Syndrome

cause

structures damaged

A
  • •Caused by occlusion of PICA or vertebral artery near PICA
  • •Structures damaged include
    • –Spinothalamic tract & Spinal nucleus & tract of V
    • –CN VIII, IX, X & XI nuclei
    • –Sympathetic descending tracts
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7
Q

Lateral Medullary Syndrome

Symptoms of damage to spino-thalamic tract & nucleus & tract of V

A
  • Impaired pain and temperature sensibility over ipsilateral face and contralateral body

Symptoms of Lateral Medullary Syndrome (Wallenberg’s Syndrome) as the result of damage to the spino-thalamic tract & nucleus & tract of V are Impaired pain and temperature sensibility over ipsilateral face and contralateral body. Remember the spinothalamic tract has decussated but the trigeminal afferents have not

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8
Q

Lateral Medullary Syndrome

Symptoms of damage to vestibular nuclei

A

Symptoms of Lateral Medullary Syndrome (Wallenberg’s Syndrome) as the result of damage to the vestibular nuclei include

  • §Nystagmus – involuntary movement of eyes
  • §Diplopia – double vision
  • §Vertigo – dizziness
  • §Ipsiversive lateral pulsion (gait deviation of turning to the same side of the lesion)
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9
Q

Lateral Medullary Syndrome

Symptoms of damage to nuclei of CN IX & X (4)

A

Symptoms of Lateral Medullary Syndrome (Wallenberg’s Syndrome) as the result of damage to nuclei of CN IX & X include:

  1. Dysarthria
  2. dysphonia
  3. Diminished gag reflex
  4. Hiccups
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10
Q

Lateral Medullary Syndrome

Symptoms of damage to sympathetic tracts (3)

A

Symptoms of Lateral Medullary Syndrome (Wallenberg’s Syndrome) as the result of damage to sympathetic tracts incude:

  • Horner’s syndrome which is
    • Miosis (constricted pupil)
    • Ptosis
    • Anhydrosis (no sweating)
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11
Q

what is Horner’s syndrome? (with 3 symptoms)

A

damage to sympathetic tracts

Symptoms include:

  • Miosis (constricted pupil)
  • Ptosis
  • Anhydrosis (no sweating)
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12
Q

Alternate name for Medial Medullary Syndrome

A

•alternating hypoglossal hemiplegia

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13
Q

Medial Medullary Syndrome:

Causes

Structures damaged (3)

A
  • •Caused by occlusion of anterior spinal artery
  • •Structures damaged
    • –Medial lemniscus
    • –medullary pyramid
    • –Nucleus for CN XII

Medial Medullary syndrome (Also called alternating hypoglossal hemiplegia) occurs when there is occlusion of anterior spinal artery (illustrated as B in this picture)

Structures damaged include:

Medial lemniscus

medullary pyramid

Nucleus for CN XII

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14
Q

Medial Medullary Syndrome

Symptoms of damage to Medial lemniscus

A

–contralateral loss of discriminative touch and kinesthesia

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15
Q

Medial Medullary Syndrome

Symptoms of damage to pyramids

A

–contralateral spastic hemiparesis

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16
Q

Medial Medullary Syndrome

Symptoms of damage to CN XII Nucleus

A

Symptoms of Medial Medullary Syndrome as the result of damage to the CN XII Nucleus is atrophy of ipsilateral tongue and tongue deviation to the side of occulsion when protruded

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17
Q

List four branches of the basilar artery

A
  1. –Anterior inferior cerebellar arteries (AICAs)
  2. –Superior cerebellar arteries (SCAs)
  3. –Paramedian (pontine)branches
  4. –Posterior cerebral arteries (PCAs)
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18
Q

AICAs

A

Anterior inferior cerebellar arteries

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19
Q

SCAs

A

Superior cerebellar arteries

20
Q

PCAs

A

Posterior cerebral arteries

21
Q

The Pons is nourished by branches of the ________ artery

A

The Pons nourished by branches of the basilar artery

22
Q

Syndromes which result in damage to artery branches that nourish the pons include: (4)

(infarcts of the pons)

A
  1. –Medial (paramedian) inferior pontine syndrome
  2. –Lateral superior pontine syndrome
  3. –Complete basilar syndrome
  4. –Locked-in syndrome
23
Q

another name for Medial inferior pontine syndrome

A

•paramedian inferior pontine syndrome

24
Q

Medial Inferior Pontine Syndrome:

cause

damages what? (5)

A

(an infarct of the Pons)

Caused by Occulsion of paramedian (pontine) artery branches of basilar artery

  1. –Damages CN VI nerve fibers –
    • results in ipsilateral medial eye deviation due to paralysis of the lateral rectus
  2. –Corticospinal & corticobulbar tracts –
    • spastic paralysis of contralateral face & body
  3. –Medial lemniscus –
    • contralateral loss of discriminative touch and kinesthesia
  4. –Paramedian pontine reticular formation –
    • ipsilateral horizontal gaze palsy
  5. –Pontine nuclei & pontocerebellar fibers –
    • limb & gait ataxia
25
Q

Medial Inferior Pontine Syndrome:

Symptoms of damage to CN VI nerve fibers

A

results in ipsilateral medial eye deviation due to paralysis of the lateral rectus

26
Q

Medial Inferior Pontine Syndrome:

Symptoms of damage to Corticospinal & corticobulbar tracts

A

spastic paralysis of contralateral face & body

27
Q

Medial Inferior Pontine Syndrome:

Symptoms of damage to Medial lemniscus

A

contralateral loss of discriminative touch and kinesthesia

28
Q

Medial Inferior Pontine Syndrome:

Symptoms of damage to Paramedian pontine reticular formation

A

ipsilateral horizontal gaze palsy

29
Q

Medial Inferior Pontine Syndrome:

Symptoms of damage to Pontine nuclei & pontocerebellar fibers

A

limb & gait ataxia

30
Q

Lateral Superior Pontine Syndrome

cause

what it damages (4)

A

(infarct of the pons)
–Caused by superior cerebellar artery occlusion

  1. –Damage to Superior cerebellar peduncle –
    • resulting in ipsilateral limb & gait ataxia & intention tremor
  2. –Spinothalamic & trigeminothalamic tracts –
    • contralateral face & body loss of pain & temperature
  3. –Medial lemniscus –
    • contralateral loss of discriminative touch and kinesthesia
  4. –Sympathetic tracts –
    • ipsilateral Horner’s syndrome
31
Q

Lateral Superior Pontine Syndrome:

Symptoms of damage to Superior cerebellar peduncle

A

resulting in ipsilateral limb & gait ataxia & intention tremor

32
Q

Lateral Superior Pontine Syndrome:

Symptoms of damage to the Spinothalamic & trigeminothalamic tracts

A

contralateral face & body loss of pain & temperature

33
Q

Lateral Superior Pontine Syndrome:

Symptoms of damage to the Medial lemniscus

A

contralateral loss of discriminative touch and kinesthesia

34
Q

Lateral Superior Pontine Syndrome:

Symptoms of damage to the Sympathetic tracts

A

ipsilateral Horner’s syndrome:

  • Miosis (constricted pupil),
  • Ptosis and
  • Anhydrosis
35
Q

Complete basilar syndrome

cause

produces

s/s

A

(infarct of the pons)

  • caused by lack of lack of blood flow through both paramedian & circumferential (cerebellar) arteries
  • produces Complete transection of pons
  • –Signs & symptoms
    • Coma & paralysis
    • Pinpoint, unequal pupils
36
Q

Locked In Syndrome

cause

structurea damaged

s/s

A

(Infart of the Pons)

  • –May follow occlusion of the basilar artery but infarct confined to the ventral pons
    • –spares ascending somatosensory pathways and ascending reticular activating system (ARAS)
  • •Structures damaged include
    • bilateral corticobulbar and
      • corticospinal tracts
  • signs & symptoms
    • •Fully conscious, but locked-in with near total paralysis
    • •Inexpressible – only vertical eye movements remain

Locked-In Syndrome May follow occlusion of the basilar artery but infarct confined to the ventral pons and spares ascending somatosensory pathways (medial lemniscus & anterolateral systems) and ascending reticular activating system (ARAS). Locked in syndrome produces damaged bilateral corticobulbar and corticospinal tracts. But with intact ARAS the person is fully conscious, but locked-in with near total paralysis. Only inexpressive vertical eye movements remain. Imagine the horror of being able to perceive everything, be cognitively alert but be totally paralyzed and unable to communicate with the outside.

37
Q

Alternate name for Weber’s Syndrome

A

Superior alternating hemiplegia

38
Q

Weber’s Syndrome

cause

structure damaged

A

(infarct of the midbrain)

  • –Caused by infarction of paramedian PCA branches in midbrain
  • –Results in damage to:
    • Cerebral peduncle (contains corticospinal & corticobulbar tracts)
    • Oculomotor nerve (CN III)

Weber’s Syndrome (shown as A in this illustration) and also called superior alternating hemiplegia is Caused by infarction of paramedian PCA branches in midbrain. This condition results in damage to: cerebral peduncle containing the Corticospinal & corticobulbar tracts and the Oculomotor nerve

39
Q

Weber’s Syndrome:

Symptoms of damage to CN III

A
    • oculomotor ophthalmoplegia, fixed dilated pupil & ptosis
40
Q

Weber’s Syndrome:

Symptoms of damage to the Cerebral peduncle

A

spastic hemiparesis of contralateral body and contralateral lower half of face, tongue & palate

41
Q

Benedikt’s Syndrome

cause

structures damaged (3)

A

(infarct of the midbrain)

  • •Caused by occlusion of tegmental branch of the PCA
  • •Structures damaged
    • –Nucleus for CN III,
    • red nucleus &
    • cerebellothalamic tract

Benedikt’s Syndrome (B in this illustration) is Caused by occlusion of tegmental branch of the posterior cerebral artery. This results to

Damage in the Nucleus for CN III, red nucleus & cerebellothalamic tract

42
Q

Benedikt’s Syndrome:

Symptoms of damage to CN III nucleus & nerve

A

Ipsilateral oculomotor palsy –

  • oculomotor ophthalmoplegia,
  • fixed dilated pupil &
  • ptosis
43
Q

Benedikt’s Syndrome:

Symptoms of damage to the cerebellothalamic tract

A

Contralateral ataxia of the extremities –

44
Q

Two other symptoms associated with midbrain infarction

A
  1. –Hemiballism
    • §Damage to basal nuclei (ganglia) connections
    • §Involuntary, forceful flinging of contralateral limb
  2. –Apathetic akinetic mutism
    • §Damage to periaqueductal gray
    • §Drowsy, relatively immobile state with arousal only with strong stimuli

There are Other symptoms associated with midbrain infarction

Hemiballism which is Involuntary, forceful flinging of contralateral limb due to Damage to basal nuclei (ganglia) connections

Apathetic akinetic mutism which is a state of consciousness characterized by Drowsy, relatively immobile state with arousal only with strong stimuli due to Damage to periaqueductal gray

45
Q

–Hemiballism:

what is it?

cause

s/s

A
  • a symptom associated with midbrain infarction
  • Damage to basal nuclei (ganglia) connections
  • Involuntary, forceful flinging of contralateral limb

Hemiballism which is Involuntary, forceful flinging of contralateral limb due to Damage to basal nuclei (ganglia) connections

46
Q

Apathetic akinetic mutism:

what is it

causes

s/s

A
  • symptom associated with midbrain infarction
  • Damage to periaqueductal gray
  • Drowsy, relatively immobile state with arousal only with strong stimuli

Apathetic akinetic mutism which is a state of consciousness characterized by Drowsy, relatively immobile state with arousal only with strong stimuli due to Damage to periaqueductal gray