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Neuro I Exam 2 - Pathways > Lecture 1: Blood Supply and Ventricular System > Flashcards

Lecture 1: Blood Supply and Ventricular System Flashcards

1
Q

CSF is similar to blood ultrafiltrate and contains higher/lower cocentrations of which molecules?

A

Higher concentrations:

  • Sodium
  • Chloride
  • Magnesium

Lower concentrations:

  • Potassium
  • Calcium
  • Glucose
  • Protein
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2
Q

What produces the CSF and primarily in which ventricles?

A
  • Choroid plexus
  • Primarily in lateral ventricles and 4th ventricle
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3
Q

What are the 4 ventricles and where are they found?

A
  • 2x lateral ventricles –> in each cerebral hemisphere
  • 3rd ventricle —> between thalami
  • 4th ventricle –> between cerebellum and pons
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4
Q

What is the general flow of CSF starting in the lateral ventricles all the way to the superior sagittal sinus?

A
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5
Q

Hydrocephalus is an increase in cerebral mass/size due to presence of excessvie CSF where?

A

Ventricular system, subarachnoid space, or both!

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6
Q

External hydrocephalus is also know as what; there is an excessive accumulation of CSF where; what are the size of the ventricles like?

A
  • Communicating hydrocephalus
  • Excessive CSF in the subarachnoid space
  • Normal ventricle size
  • Compression of CNS
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7
Q

What are the 2 types of external hydrocephalus; commonly caused by?

A
  1. Supratentorial external hydrocephalus = above the tentorium cerebelli
    - Most commonly associated w/ senile atrophy of the cortex (i.e., Alzheimer’s disease)
  2. Infratentorial external hydrocephalus = below the tentorium cerebelli
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8
Q

What type of hydrocephalus is shown here?

A

Supratentorial external hydrocephalus

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9
Q

Internal hydrocephalus is also known as what; what is occuring?

A
  • Noncommunicating hydrocephalus
  • CSF produced in the ventricular system does NOT drain into the subarachnoid space
  • Results in dilation of the ventricles proximal to the obstruction
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10
Q

3rd ventricle choroid plexus ependyoma causes an obstruction of?

A
  • Interventricular foramen
  • CSF backs up into lateral ventricles
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11
Q

Midbrain astrocytoma is causes an obstruction of?

A
  • Cerebral aqueduct
  • CSF backsup into the 3rd and lateral ventricles
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12
Q

Arnold-Chiari malformation or Dandy-Walker Cyst causes an obstruction of?

A
  • Median and Lateral aperatures
  • CSF backs up into 4th, 3rd, and lateral ventricles
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13
Q

With communicating hydrocephalus CSF can move where, but not move where, which results in a combination of which 2 hydrocephalus?

A
  • CSF can move through the ventricular system into the infratentorial subarachnoid space
  • CSF cannot circulate over the cerebrum to be resorbed at the arachnoid villi near the superior sagittal sinus

Results in:

  • Hypertrophy of ventricles (internal hydrocephalus)
  • Accumulation of CSF in the infratentorial space (infratentorial external hydrocephalus)
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14
Q

Communicating hydrocephalus is caused by an obstruction of; what causes this obstruction?

A
  • Obstruction of narrow space between the tentorial notch and midbrain
  • Adhesions of fibrosis in subarachnoid space from —>
  • Previous inflammation - infantile meningitis
  • Cerebral edema
  • Uncal herniation
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15
Q

What are the clinical signs of hydrocephalus in infants/young children versus adults?

A
  • Increased intracranial pressure is partially/completely compensated via enlargement of cranial sutures (children)
  • In adults, sutures are fused —> prevent head enlargement, but there is still increased intracranial pressure
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16
Q

Why is Papilledema one of the clinical signs of hydrocephalus/increased intracranial pressure?

A
  • Optic sheath surrounds the optic nerve and inside the sheath is the subarachnoid space
  • If CSF increases within subarachnoid space, there will be increased pressure on the optic nerve and can lead to the optic disc bulging out
  • One of the key signs of hydrocephalus
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17
Q

What are 3 of the clinical signs of hydrocephalus?

A
  1. Papilledema
  2. Internal strabismus/abducens (CN VI) palsy
  3. Mental retardation
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18
Q

Where is the internal venous plexus of Batson located, where does it receive drainage from and where does it empty?

A
  • Receives drainage from veins in the spinal cord
  • Located in the EPIDURAL space
  • Empties into the intervertebral veins and then segmental veins
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19
Q

The internal cerebral vein is located where, receives drainage from what and empties into which vein?

A
  • Runs next to the parahippocampal gyrus
  • Receives thalamostriate and anterior septal veins
  • Drains into the Great Vein of Galen
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20
Q

Which veins drain into the Great Vein of Galen and where does this vein drain?

A
  • Receives the Internal Cerebral VeinandBasal Vein of Rosenthal
  • Drains into the Straight Sinus
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21
Q

What is the significance of an occlusion to the Great Vein of Galen? What structures may be compressed in a Great Vein Varix?

A
  • Occlusion is usually fatal, as it drains the deep cerebrum
  • Great vein varix –> may compress the pineal body and posterior commissure
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22
Q

Where does the superior sagittal sinus drain versus the straight sagittal sinus?

A
  • Superior sagittal sinus usually drains into the right transverse sinus

- Straight sinus usually drains into the left transverse sinus

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23
Q

Thrombosis of superior sagittal sinus or right transverse sinus leads to?

A

Cortical ischemia and/or necrosis

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24
Q

Thrombosis of straight sagittal sinus or left transverse sinus usually results in?

A
  • Ischemia and/or necrosis of deep cerebrum
  • Usually fatal
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25
Q

What 3 locations is the blood brain barrier absent?

A

1) Pineal body
2) Area Postrema
3) Median eminence of the hypothalamus

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26
Q

The ICA and vertebral arteries pierce which layer and then run into which space before giving off cerebral arteries?

A
  • Pierce the dura
  • Run in subarachnoid space
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27
Q

Cerebral arteries run in the subarachnoid space before giving off branches that penetrate where; what are these branches surrounded by?

A
  • Branches penetrate into brain parenchyma
  • Surrounded by Virchow-Robin space (perivascular space) and Pia mater
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28
Q

What are the 4 branches off the ICA which supply the anterior circulation?

A

1) Opthalmic artery
2) Anterior Choroidal artery
3) Anterior Cerebral artery
4) Middle Cerebral artery

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29
Q

Which artery is frequently a cause of vacular insufficiency to globus pallidus and hippocampus in elderly?

A

Anterior Choroidal artery

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30
Q

What 5 areas are supplied by the anterior choroidal artery; why is this artery clinically significant?

A
  1. The choroid plexus of the lateral ventricle
  2. Internal capsule
  3. Basal ganglia
  4. Thalamus
  5. Rostral midbrain

*Prone to thrombosis due to long course in subarachnoid space

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31
Q

Which nerves does the anterior cerebral artery run next to?

A

Olfactory and optic nerves

32
Q

Which areas are supplied by the Anterior Cerebral artery?

A
  • Anterior 2/3 of the medial side and supero-lateral portion of the hemisphere
  • Paracentral lobule region
33
Q

Occlusion of the Anterior Cerebral artery will affect which region of the brain and cause what downstream problems?

A
  • Will affect blood supply to the paracentral lobule region (motor and sensory to LE)
  • Contralateral paresis and/or parasthesia of the leg and foot
34
Q

What branches does the Anterior Cerebral artery give off; including thre 2 cortical branches?

A
  • Recurrent Artery of Heubner
  • Anterior Communicating artery

Cortical branches:

1 ) Anterior Pericallosal artery

2) Callosomarginal artery

35
Q

Where do the medial and lateral striate/thalamostriate arteries arise from and what do they supply?

A
  • Middle Cerebral artery
  • Supply Internal CapsuleandCorpus Striatum + Thalamus
36
Q

What does the Central/Rolandic artery off the MCA supply?

A

Primary motor and somesthetic cortices

37
Q

What do the frontal branches off the MCA supply?

A
  • Premotor and Prefrontal Cortices
  • Broca’s speech area in dominant hemisphere (usually left)
38
Q

What do the parietal branches off the MCA supply?

A

Association cortex

39
Q

What do the temporal branches off the MCA supply?

A

Primary auditory cortex

40
Q

What does the angular artery off the MCA supply?

A
  • Supramarginal and angular regions
  • Wernicke’s area in dominant hemisphere (left usually)
41
Q

What occurs with occlusion of the Central artery off of the MCA?

A

Contralateral spastic paralysis and/or paresthesia of the head and upper 1/2 of the body

42
Q

What occurs with occlusion of the frontal branches off of the MCA?

A
  • Broca’s Aphasia = expressive language disorder
  • Can hear and comprehend, however cannot respond appropriately
  • Frustrating problem in initiation of speech motor patterns
43
Q

What occurs with occlusion of the parietal branches off the MCA?

A

Variety of interpretive disorders including body neglect, agnosia, and apraxia

44
Q

What occur with occlusion of the temporal branches off the MCA?

A

Difficulty localizing sounds

45
Q

What occurs with occlusion of the angular artery off the MCA?

A
  • Wernicke’s Aphasia = Receptive language disorder
  • Fluent in speech, however lacks content or meaning in spoken and written comprehension
  • Circumlocute w/ inappropriate word choices and new word creation
46
Q

Where does the Anterior Spinal artery arise from and what does it supply?

A
  • From the Vertebral artery
  • Supplies most of the central gray matter and anteromedial portion of white matter
47
Q

Where do the Posterior Spinal arteries arise from and what do they supply?

A
  • Branch off the vertebral or PICA
  • Supply dorsal roots and about 75% of posterior columns
  • Along with radicular arteries they supply peripheral margins of the cord
48
Q

Spinal cord trauma may interrupt blood flow to spinal cord especially if supplied by 2 arterial supplies, most frequently occurs adjacent to enlargements at which vertebral levels?

A
  • C2-3
  • T1-4
  • L1
49
Q

What is the major supply to the inferior 2/3 of the spinal cord, where does this artery arise from and what artery does it contribute to?

A
  • Great Anterior Artery or Adamkiewicz
  • Arises from: left inferior intercostal or superior lumbar arteries
50
Q

What may compromise the Great Anterior Artery of Adamkiewicz and what does this cause?

A
  • Secondary to thoracolumbar fracture or surgical repair of AAA
  • Results in ischemic necrosis of the spinal cord (partial or complete transection)
51
Q

What causes Central Cord Syndrome?

A
  • Disruption of blood flow to the Anterior Spinal artery
  • Thrombosis or hyperextension injury of the neck
  • Ischemia of the central region of the spinal cord
52
Q

Which deficits or other clinical outcomes may result from Central Cord Syndrome; which extremities most affected?

A
  • Central necrosis and cavitation of the spinal cord
  • Sensory and motor deficits to upper extremities > LE’s

- Distal musculature > proximal musculature

53
Q

What 3 areas does the PICA supply?

A
  1. Posterior inferior portion of cerebellum
  2. Posterolateral aspect of the medulla
  3. Choroid plexus of the 4th ventricle
54
Q

What does occlusion of the PICA lead to?

A

Lateral medullary syndrome/Wallenburg syndrome

55
Q

Where is the AICA located and what CN’s and other structure is it next to?

A
  • Located in the Pontobulbar sulcus
  • Next to CN VI, VII, and VIII and the Flocculus of the Cerebrum
56
Q

What 3 things does the AICA supply?

A

1) Anteror inferior portion of Cerebellum
2) Superior and Middle Cerebellar peduncles
3) Part of brainstem

57
Q

The superior cerebellar artery is located posterior to which CN?

A

CN III

58
Q

The superior cerebellar artery supplies what 3 regions?

A
  1. Superior lateral portion of cerebellum
  2. Deep cerebellar nuclei
  3. Part of pons and midbrain
59
Q

The labyrinthine artery is a branch off of and is the main artery to?

A
  • Branch of Basilar artery or off AICA
  • Main artery to the internal ear
60
Q

What is Labyrinthinitis and what does it cause?

A
  • Atherosclerosis or inflammation of the Labyrinthine Artery resulting in irritation of the vestibulo-cochlear apparatus
  • Disrupts equilibrium and/or hearing
61
Q

What do the Pontine branches off the Basilar artery supply and what type of pattern do these branches distribute in?

A
  • Medial and lateral aspects of the pons
  • Distribute to regions of the brainstem in a “pie wedge” pattern
62
Q

What is supplied by the Penetrating branches, Temporal branches, Parieto-occipital artery, Calcarine artery, and Posterior Pericallosal artery all coming from the Posterior Cerebral artery?

A

Penetrating branches: internal capsule, thalamus, choroid plexus of the lateral ventricle, and upper midbrain

Temporal branches: inferior temporal cortex

Parieto-occipital artery: visual association corex

Calcarine artery: primary visual cortex

Posterior pericallosal artery: anastomoses w/ anterior pericallosal artery of the anterior cerebral artery

63
Q

What may causes PCA occlusion and what does it result in?

A
  • Thrombosis or compression due to uncal herniation
  • Causes: ischemic necrosis of the primary visual cortex

- Contralateral homonymous hemianopsia w/ macular sparing

64
Q

What causes a falx herniation and what occurs; what are the clinical symptoms?

A
  • Unilateral space-occupying lesion present –> Cingulate Gyrus can herniate
  • Pushes beneath the free edge of Falx Cerebri
  • Headache, contralateral leg weakness, may not present clinical deficits
65
Q

What causes an Uncal herniation (tentorial); what happens?

A
  • Unilateral space-occupying lesion is present —> Uncus can herniate
  • Pushes through tentorial notch (opening in tentorium cerebelli)
66
Q

What are the early clinical signs of Uncal herniation; what about when there is midbrain involvement?

A

- Early sign: unilateral dilating pupil (CN III compression) = oculomotor nerve palsy = closed eyelid, deviation of eye down/out and pupil dilation

- Midbrain involvement: contralateral hemiparesis and respiratory compromise

- Kernohan’s notch

67
Q

An uncal herniation causes pressure on the ipsilateral brainstem leading to; if the increases pressure pushes the brainstem into tentorium cerebelli what is observed?

A
  • Pressure on ipsilateral brainstem = contralateral limb weakness
  • Referred to as Kernohan’s Notch or a False Localizing Sign
  • Brainstem pushed into tentorium cerebelli = ipsilateral limb weakness (to space-occupying lesions)
68
Q

What occurs in a Tonsilar herniation and why are they so serious?

A
  • Cerebellar tonsils herniate through foramen magnum
  • Compress medulla and lead to respiratory arrest = fatal
69
Q

A patient comes in after a traumatic incident and is initially unconcious but then has a rapid recovery. After a few hours pass neurologic symptoms begin, what do you suspect?

A
  • Epidural Hematoma
  • Rupture of the Middle Meningeal A.
70
Q

A rupture of the middle meningeal artery is a high pressure bleed and what space does this bleeding expand and what does this hematoma press on; what is the treatment for epidural hematoma?

A
  • Expands the epidural space, pushes the dura mater from the bone creating a blood filled space
  • Hematoma presses upon cerebral hemisphere; uncal herniation compression of midbrain
  • Progressive decrease in level of conciousness
  • Treatment = evacuation of hematoma
71
Q

What pathology is shown here?

A
  • Epidural hematoma
  • Has a “lens” look to it
72
Q

What is a Subdural Hematoma and why do they become more likely to occur in older patients?

A
  • Head trauma causes veins to rupture as they cross the subdural space
  • Veins vulnerable to sheer forces between movement of the brain versus dura; veins become stretched as we age and are more susceptible to rupture
  • Ruptured vein —> blood slowly accumulates in subdural space
73
Q

What is seen clinically with Subdural Hematoma’s and how are they differentiated from Epidural Hematoma’s?

A
  • Same symptoms as epidural hematomas, however more insidious
  • Delayed due to slower pooling of blood
  • Can have more acute onset
  • Lethargy, seizures, or headaches
74
Q

What pathology is this?

A
  • Subdural hematoma
75
Q

All major blood vessels suppying the CNS run in the subarachnoid space with surrounding CSF; what is seen clinically with a Subarachnoid Hemorrhage?

A
  • Rupture = presence of RBC’s in the CSF
  • To sample the CSF –> Lumbar Puncture at L4-L5

Neuro I Exam 2 - Pathways (18 decks)

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