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Brain and Behavior Exam 1 > Lec 7 Ventricular System and Vasculature > Flashcards

Lec 7 Ventricular System and Vasculature Flashcards

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1
Q

What are wateshed areas?

A

brain regions that get blood from very distal tips of two different cerebral arteries

  • -> protective since multiple source of blood
  • -> vulnerable since blood supply only from distal capillaries
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2
Q

What are the two main sources of blood to the brain?

A
  • internal carotid arteries

- vertebral arteries

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3
Q

What vessels supply blood to the anterior circulation system of brain? posterior?

A
  • anterior = internal carotid arteries

- posteriro = vertebral arteries

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4
Q

What is the blood supply to the brainstem?

A
  • solely the posterior/verebral system
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5
Q

Where doe the vertebral arteries branch from?

A

the subclavian arteries

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6
Q

Where do the vertebral arteries anastamose? What artery do they form?

A

anastomose at the pontomedullary junction

form single midline basilar artery

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7
Q

What are the 3 types of branches in the posterior system that supply the brainstem?

A
  • paramedian
  • short circumfrential
  • long circumfrential
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8
Q

What are the 3 major “long circumfrential” branches off of the posterior circulation?

A
  • PICA [posterior inferior cerebellar artery]
  • AICA [anterior inferior cerebellar artery]
  • SCA [superior cerebellar artery]
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9
Q

What is PICA and what does it supply?

A
  • a long circumfrential branch
  • comes off of vertebral artery
  • supplies dorsolateral medulla
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10
Q

What blood vessels supply the lateral and dorsal pons?

A
  • the AICA [anterior inferior cerebellar artery] and the SCA [superior cerebellar artery], both long circumfrential branches off of the posterior circulation
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11
Q

What blood vessels supply the cerebellum?

A
  • the AICA (anterior inferior), PICA (posterior inferior) , SCA (superior)
  • all are long circumfrential vessels off the posterior circulation
  • supply the corresponding area of the cerebellum
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12
Q

How/where does the basilar artery end?

A

bifurcates into two posterior cerebral arteries [PCA] at the junction of the pons and midbrain

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13
Q

What blood vessel supplies the midbrain?

A

the basilar artery including SCA and PCA

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14
Q

How/where does teh common carortid artery end?

A
  • bifuracates into external and internal carotids

- at level of C4 vertebra

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15
Q

How does the IC enter the skull?

A
  • goes through temporal (petrosal) bone then through cavernus sinus
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16
Q

How does the internal carotid end?

A
  • bifurcates into anterior (ACA) and middle cerebral arteries (MCA)
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17
Q

What are the 4 main parts of the internal carotid?

A
  1. cervical (extracranial): from common carotid bifurcation to point of entery into carotid canal at skull base
  2. intrapetrosal: within petrous portion of temporal bone
  3. intracavernous: through cavernous sinus
  4. cerebral: from cavernous sinus to bifurcation into ACA/MCA
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18
Q

What is the carotid siphon?

A

the intracavernous and cerebral portions of the carotid artery together

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19
Q

What 5 vessels comprise the circle of wilis?

A
  • anterior, middle, and posterior cerbral arteries [ACA MCA PCA]
  • anterior and posterior communicating arteries
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20
Q

What is responsible for blood supply to cerebral cortex and underlying white matter?

A

distal branches of the cerebral arteries

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21
Q

Where does the MCA [middle cerebral artery] begin? path? supplies?

A
  • begins from internal carotid lateral to the optic chiasm
  • passes through lateral sulcus [sylvian fissure]
  • supplies lateral cerebral cortex [areas of motor, somatosensory, auditory, taste, language, higher cognitive function]
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22
Q

What does the anterior communicating area connect?

A

the left and right anterior cerebral arteries [that come off of the IC]

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23
Q

What does the ACA supply?

A
  • inferior and medial of frontal and parietal lobes as well as subcortical anterior structures
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24
Q

What do the posterior communicating arteries connect?

A
  • the MCA to the PCA
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25
Q

What does the PCA [posterior cerebral artery] supply?

A
  • occipital lobe and inferior/medial surfaces of temporal lobe
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26
Q

What do the terminal branches of the PCA anastomose wtih?

A
  • terminal branches of ACA and MCA
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27
Q

Where do veins of the brain empty into?

A

dural sinuses

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28
Q

What are teh 3 main parts of the cerebral venous system?

A
  • superficial veins
  • deep veins
  • venous [dural ] sinuses
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29
Q

What does the superficial venus cerebral system drain? where does it go?

A
  • drains cerebral cortex and subcortical white matter into the dural sinuses
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30
Q

Are superficial veins or cortical arteries more superficial?

A

superficial veins

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31
Q

What are the 4 main sinuses that the superficial venous cerebral system drains into?

A
  • superior sagital
  • cavernous
  • petrosal
  • transverse
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32
Q

Where do superior cerebral veins collect from? empty into? [superficial]

A
  • collect from medial and convex areas of cortex

- empty into superiro sagittal sinus

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33
Q

Where do inferior cerebral veins collect from? empty into? [superficial]

A
  • collect from lateral area of cortex

- empty into middle cerebral vein

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34
Q

What is the path of middle cerebral vein? [superficial]

A
  • runst rhough lateral sulcus [sylvian fissure] to reach cavernous sinus
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35
Q

What does the vein of Trolard connect?

A
  • connects between superior and inferior cerebral veins
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36
Q

What does the vein of Labbe connect?

A
  • connects between the middle cerebral vein and transverse sinus
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37
Q

What is the great vertebral vein of galen?

A
  • deep vein that drains from the paired internal/deep cerebral veins
  • joins with the inferior sagittal sinus to form the straight sinus
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38
Q

What does the basal vein of rosenthal drain?

A
  • the basal cortical areas
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39
Q

Where is teh superior sagittal sinus located?

A
  • at the midline at the superior edge of the falx cerebri
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40
Q

Where is the inferior sagittal sinus located?

A
  • at the midline at theinferior edge of the falx cerebri
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41
Q

What is the blood supply to the spinal cord?

A
  • radicular [segmental] artiers
  • 1 anterior spinal artery
  • 2 posterior spinal arteries
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42
Q

What is the artery of adamkiewicz?

A
  • anterior radicular artery
  • larger than the rest
  • enters on left between T9 and T12 then reinfoces anterior spinal artery
  • reinforces blood supply to anterior 2/3 of lumbar and sacral spinal cord including lumbo-sacral enlargement
43
Q

What happenes of artery of adamkiewicz is occluded?

A
  • blood supply to lumbar cord is compromised
44
Q

What part of the spinal cord is most vlunerable due to occlusion of a radicular artery?

A
  • thoracic area of spinal cord

- because fewer radicular arteirs

45
Q

What is the 4th ventricle?

A

the portion of ventricular system present in medulla and pons

46
Q

What are the 3 important channels in the 4th ventricle that provide conduits between ventricular system and subarachnoid space?

A
  • foramen of magendie

- 2 foramina of luschka

47
Q

Where does the foramen of magendie go?

A
  • posterior directed channel from 4th ventricle that opens into cisterna magna
48
Q

Where doe the foramina of luschka go?

A
  • lateral extensions of 4th ventricle that open into the pontine cistern
49
Q

What is the obex of the ventricular system?

A
  • the caudalmost point of the 4th ventricle

- where it merges with the central canal of the spinal cord

50
Q

What is the cerebral aqueduct of sylvius?

A
  • narrow midline cannal that tunnels through the midbrain

- continuous with the 4th ventricle

51
Q

What is the 3rd ventricle?

A
  • the area of ventricular system in the diencephalon

- continuous with cerebral aqueduct of sylvius

52
Q

What are the largest recesses of the 3rd ventricle?

A
  • optic recesses
  • infudibular recess
  • pineal recess
  • habenular recess
53
Q

What is the inerventricular foramen of Monro?

A
  • y-shaped conduit from single 3rd ventricle to the two lateral ventricles of the 2 cerebral hemispheres
54
Q

Where the the laterral ventricles?

A

the part of the ventricular system in the 2 cerebral hemispheres

55
Q

What is the septum pellucidum?

A
  • sheet of ependyma that separates the two lateral ventricles from each other
56
Q

Where is CSF produced?

A

epithelial cells in choroid plexus in the lateral and 4th ventricle secrete CSF by selective transport [requires ATP]

small amount produced by ependymal cells

57
Q

What are the functions of the CSF?

A
  • prevent contact between neural structures and surrounding bones
  • support brain
  • transport nutrients/chem messengers/waste
  • act as signal transducer of hormones
58
Q

Where is the ependymal lining of the ventricular system freely permeable?

A

everywhere except at choroid plexus

59
Q

What drives CSF resorption?

A
  • passive process

- driven by pressure gradient between intracranial space [ICP] and venous system [CVP]

60
Q

What is the flow of CSF from choroid plexus into venous system?

A
  • choroid plexus
  • -> through lateral ventricles
  • -> foramina of monro
  • -> central 3rd ventricle
  • -> cerebral aqueduct [of sylvius]
  • -> 4th ventricle
  • -> either 2 foramen of luschka or single foramen of magendie
  • -> subarachnoid space
  • -> into venous system through arachnoid villi along the dural venous sinuses
61
Q

Passive or active transport to secrete CSF into ventricles?

A

both passive and active

62
Q

How do you evaluate CSF?

A
  • via lumbar puncture at L4-L5
63
Q

What are routine things you measure from lumbar puncture?

A
  • opening pressure
  • protein
  • glucose
  • cell count
  • culture
  • sensitivity
64
Q

What are complications of lumbar puncture?

A
  • infection
  • low pressure headache
  • herniation
65
Q

What is difference between CSF and blood plasma?

A

CSF has HIGHER: Cl, Mg, Na

66
Q

What is average volume of CSF in adult?

A

120 mL

67
Q

What 2 factors influence movement of CSF through the ventricular system + subarachnoid space?

A
  1. pressure gradient between choroid plexuses and arachnoid villi [CSF tends to move this direction]
  2. mechanical means of movement in the subarachnoid space
68
Q

What is normal color of CSF? opening pressure? protein? glucose? mononuclear cells?

A
  • clear/colorless
  • opening pressure: 50-180 mmH20
  • protein: 15-45 mg/dl
  • glucose: 50-80 mg/dl
  • 0-5 mononuclear cells
69
Q

What is normal ratio WBC to RBC in CSF?

A

1 WBC : 700 RBC

70
Q

What is normal ratio protein to RBC in CSF?

A

1 dl protein : 1000 RBC

71
Q

What is normal ratio of glucose in CSF to blood?

A

glucose in CSF is 2/3 of glucose in blood

72
Q

What three areas of the brain are exceptions to blood brain barrier?

A

portions of:

  • hypothalamus
  • pineal gland
  • choroid plexus
73
Q

What 3 structures make up the BBB?

A
  • endothelial cells lining capillary wall with tight junctions between them
  • astrocyte foot processes
  • capillary basement membrane
74
Q

What is commonicating vs non-communicating vs obstructive mean in hydrocephalus?

A
  • if CSF path is open strat to finish [CSF can travel freely from choroid plexus to arachnoid granulations] –> there is no obstruction = communicating hydrocephalus
  • if CSF can’t travel freely from start to finish –> there is obstruction = non-communicating hydrocephalus
75
Q

What are symptoms of hydrocephalus?

A
  • headaches, nausea, vomitting

- papilledema, diplopia [double vision], lethaargy, coma

76
Q

What is hydrocephalus?

A
  • abnormal accumulation of CSF in ventricles, increases size of ventricles and puts pressure on brain
77
Q

What happens in communicating hydrocephalus?

A
  • more CSF production than absorption
  • increased intracranial pressure [ICP]
  • ventricular system dilates uniformly
  • can lead to papilledema, herniation
78
Q

What can cause communicating hydrocephalus?

A
  • congenital absence of arachnoid villi
  • blood [villi partially blocked by RBC after subarachnoid hemorrhage]
  • high level of protein in CSF (>500 mg/dL)
  • papilloma [tumor] of choroid plexus
79
Q

What is treatment for communicating hydrocephalus? complications?

A
  • shunt placement [ventriculo-peritoneal]

- complications = infection, seizures, high incidence of shunt failure,

80
Q

What are signs of communicating hydrocephalus?

A
  • disproportional increase in head circumfrence compared to rest of face/body in children whose cranial sutures have not fused
  • in older children/adutls: high ICP –> nausea/vomitting, headahce, gait disturbance
81
Q

When are choroid plexus tumors common? symptoms?

A
  • rare, more common between birth and 10 yrs
  • most often occur in 4th ventricle
  • signs: increase ICP –> hydrocephalus, deficits of eye movement, headache, N?V
82
Q

What is hydrocephalus ex vacuo?

A
  • generalized atrophy of brain –> ventricles relatively larger due to loss of white matter
  • no increased ICP
  • no treatment
  • in alzheimers, HIV, pick disease
83
Q

What is normal pressure hydrocephalus (NPH)?

A
  • rare reversible cause of dementia
  • urinary incontinence, gait disturbance, rapid dementia
  • no increase in subarachnoid space volume
  • expansion of ventricles distorts fibers of corona radiata
  • usually in elderly
84
Q

What is classic triad of normal pressure hydrocephalus

A
  • wet, wobbly, wacky
    wet: urinary incontience
    wobbly: gait disturbance
    wacky: rapidly progressive dementia
85
Q

What do you see on CT/MRI with normal pressure hydrocephalus?

A

looks like communicating hydrocephalus

86
Q

What do you see in opening pressure on LP with normal pressure hydrocephalus?

A
  • normal opening pressure
87
Q

What treatment for normal pressure hydrocephalus?

A
  • remove some CSF by VP shunting procedure
88
Q

What is most likely symptom of NPH to improve with shunting? least likely?

A

most likely = incontinence

least likely = dementia

89
Q

What is non-communicating hydrocephalus?

A
  • CSF flow obstructed at some point along CSF circulation within the ventricular system
  • ex. stenosis of aqueduct of sylvius
  • can be gradual symptom onset [if from mass] or rapid [if from acute obstruction]
90
Q

What are some possible causes of non-communicating hydrocephalus

A
  • aqueductal stenosis
  • tumors
  • cysts
  • infection
  • hemorrhage/hematoma
  • congenital malformation
91
Q

What is an ependymoma?

A
  • tumor of ependyma that lines ventricles
92
Q

Where are most epenymomas found? In who?

A
  • most commonly in 4th ventricle, posterior fossa
  • in children younger than 5 years
  • can lead to hydrocephalus
  • poor prognosis
93
Q

What are signs of ependymom in supratentorial region?

A
  • hydrocephalus, seizure
94
Q

What are signs of ependymoma in infratentorial region?

A
  • N/V
  • headache
  • hydrocephalus
95
Q

What are histologic characteristics of ependymomas?

A
  • true rosettes [clustered tumors composed of polygonal or columnar cells facing a lumen]
  • perivascular rosettes [clusters of tumor cells in a small blood vessel
  • rod-shaped blepharoplasts [basal ciliary bodies] found near nucleus
96
Q

What causes congenital hydrocephalus?

A
  • genetic
  • intrauterine infection
  • secondary to immaturity/birth trauma
97
Q

What causes aqueductal stenosis?

A
  • tumor in midbrain that compresses brain and occludes cerebral aqueduct
  • cellular debris following intraventricular hemorrhage, by infections, by ependymal proliferation due to viral infection of CNS [mumps]
98
Q

What is a major sequela of aqueductal blocaked?

A
  • enlargement of 3rd and both lateral ventricles [triventricular hydrocephalus]
99
Q

What is effect of colloid cyst obstructing one of the interventricular foramen?

A
  • enlargement of lateral venticle on that side
100
Q

What is treatmetn for acute hydrocephalus?

A
  • whether communicating or not –> urgent placement of external ventricular drain [EVD] that drains CSF
101
Q

What is psuedotumor cerebri?

A
  • idiopathic intracranial hypertension

- seen in obese women of child-bearing age and people with chornic renal failure

102
Q

What are some causes of pseudotumor cerebri?

A
  • vitamin A toxicity
  • endocrinopathies
  • tetracycline [TCN]
103
Q

What happens in pseudotumor cerebri?

A
  • increase in ICP (>25 cm H2O)
  • little evidence of pressure increase on CT or MRI
  • have headache and visual defects up to blindness
104
Q

What is treatment for psuedotumor cerebri?

A
  • weight loss
  • meidcation
  • if needed lumboperitoneal shunting

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