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Year 1: 06. Neuro Exam 2 > Lecture 3: Blood Supply, Hemorrhage, and Herniation > Flashcards

Lecture 3: Blood Supply, Hemorrhage, and Herniation Flashcards

1
Q

Where does blood supply to the anterior cerebrum come from?

A

Internal Carotid Artery

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2
Q

Where does blood supply to the posterior cerebrum come from?

A

Vertebral Artery

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3
Q

What are the four parts of the Internal Carotid Artery?

A
  • Cervical Part
  • Petrous Part
  • Cavernous Part
  • Cerebral Part
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4
Q

Label the parts of the Internal Carotid Artery

A
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5
Q

What are the three parts of the Vertebral Artery?

A
  • Cervical Part: passes through cervical transverse foramina
  • Atlantic Part: passes throgh foramen magnum
  • Intracrainal Part
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6
Q

Label the sections of the Vertebral Artery

A
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7
Q

What is vertebral basilar insufficiency?

What causes it?

A

Reduced blood flow from Vertebral Artery

  • Extreme hyperextension of head
  • Extreme head rotation (Bowhunter Syndrome)
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8
Q

What is subclavian steal syndrome?

A

Subclavian artery steals blood from vertebral artery

  • Occlusion of subclavian artery causes retrograde flow of blood from vertebral artery
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9
Q

What arteries make up the Circle of Willis?

A
  • Anterior Cerebral Artery
  • Internal Carotid Artery.
  • Posterior Cerebral Artery
  • Anterior communicating Artery
  • Posterior Communicating Artery

Middle Cerebral Artery is not part of it!

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10
Q

Label the Circle of Willis

A
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11
Q

Where does lenticulostriate arteries come from?

What do they supply

A

Middle Cerebral Artery

Posterior limb of internal capsule + basal ganglia

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12
Q

Where do anterior choroidal arteries come from?

What do they supply?

A

Distal part of Internal Cartoid Artery

Supplies forebrain and midbrain:

  • Choroid plexus of the lateral ventricle and third ventricle
  • Optic chiasm and optic tract
  • Internal capsule
  • Lateral geniculate body
  • Globus pallidus
  • Tail of the caudate nucleus
  • Hippocampus
  • Amygdala
  • Substantia Nigra
  • Red Nucleus
  • Crus Cerebri
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13
Q

Where do labyrinthine arteries come from?

What do they supply?

A

Basilar Artery or AICA

Inner ear

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14
Q

What arteries from the Circle of Willis can compress CN II?

A
  • Internal Carotid Artery
  • Anterior Cerebral Artery
  • Anterior Communicating Arteries
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15
Q

What arteries from the Circle of Willis can compress CN III?

A
  • Posterior Communicating Artery
  • Posterior Cerebral Artery
  • Superior Cerebellar Artery

First pupil will be affected then motor functions

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16
Q

What symptoms can CN III compression cause?

A

First pupil (dilated) will be affected then motor functions

Parasympathetic functions affected first!

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17
Q

What arteries from the Circle of Willis can compress CN V?

A

Abberant branches of Superior Cerebellar Artery

Can Cause Trigeminal Neuralgia

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18
Q

What arteries from the Circle of Willis can compress CN VI?

A
  • Labyrinthine Artery
  • Anterior Inferior Cerebellar Artery
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19
Q

What arteries from the Circle of Willis can compress CN VII?

A

Abberant branches from the Anterior Inferior Cerebellar Arteries

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20
Q

What is the clinical significance of border zones?

A

Watershed areas that are susceptible to damage in times of sudden systemic hypotension or hypoperfusion

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21
Q

An anterior watershed infarct can result in what?

A

Motor and sensory defects, especially in lower limbs

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22
Q

A posterior watershed infarct can result in what?

A

Visual disturbance and language issues

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23
Q

What arteries is the Anterior watershed area located between?

A

Anterior Cerebral Artery

Middle Cerebral Artery

24
Q

What arteries is the posterior watershed area located between?

A

Middle Cerebral Artery

Posterior Cerebral Artery

25
Q

What does the Anterior Cerebral Artery supply?

A

Most of the medial and superior surface of frontal and parietal lobes

Deals with midline structures (e.g. legs)

26
Q

What does the Middle Cerebral Artery supply?

A

Most of the lateral surface of frontal and parietal lobes and superior part of temporal lobe

Deals with lateral structures (e.g. arms)

27
Q

What does the Posterior Cerebral Artery supply?

A

Occipital Lobe and Inferior Temporal Lobe

28
Q

What are the segments of the Anterior Cerebral Artery?

A
  • A1: Precommunicating Segment
    • ICA to Anterior Communicating Artery
  • A2: Infracallosal Segment
    • Anterior Communicating Artery to rostram and genu of corpus callosum
  • A3: Precallosal Segment
    • Genu to caudal part of corpus callosum
  • A4: Supracallosal
    • Superior to corpus callosum
  • A5: Postcallosal
    • Caudal to Corpus Callosum
29
Q

Label this diagram of the Anterior Cerebral Artery

30
Q

What are the segments of the Middle Cerebral Artery?

A
  • M1: Sphenoidal/Horizontal Segment
    • ICA to bifurcation at insula
  • M2: Insular Segment
    • Bifurcation at insula to circular sulcus of insula
  • M3: Opercular Segment
    • Circular sulcus or insula to external surface of lateral fissure
  • M4: Cortical Segment
    • On Cortex
31
Q

Label this diagram.

32
Q

What are the segments of the Posterior Cerebral Artery?

A
  • P1: Basilar Birtucation to Posterior Communicating Artery
  • P2: Posterior Communicating Artery to midbrain
  • P3: Quadrigeminal Segment
    • Within quadrigeminal cistern
  • P4: Cortical Segment
33
Q

Label this diagram

34
Q

What does the Superior Cerebellar Artery supply?

A

Superior half of the cerebellum

Parts of the midbrain

35
Q

What does the Anterior Inferior Cerebellar Artery supply?

A
  • Cerebellum
  • Flocculus
  • Middle cerebellar peduncle
  • Inferolateral portion of the pons
  • Cochlear nuclei
36
Q

What does the Posterior Inferior Cerebellar Artery supply?

A

Lateral Medulla

  • Nuclei
    • Dorsal Motor Nucleus of Vagus
    • Medial Vestibular Nucleus
    • Inferior Vestibular Nucleus
    • Accessory Cuneate Nucleus
    • Solitary Nuclues
    • Spinal Trigeminal Nucleus
    • Nucleus Ambiguous
  • Tracts
    • Solitary Tract
    • Spinal Trigeminal Tract
    • Rubrospinal Tract
    • Anterolateral System
37
Q

What brainstem structures does the Anterior Spinal Artery supply?

A

Medulla

  • Hypoglossal Nucleus
  • Medial Lemniscus (sensory tract)
  • Pyramid (motor tract)

Done by sulcal arteries

38
Q

What does the Posterior Spinal Artery supply?

A

Lower Medulla

  • Gracile fasciculi and nuclei
  • Cuneate fasciculi and nuclei
39
Q

What does the Paramedian Branches of Basilar Artery supply?

A

Medial Pons

  • Abducens Nucleus and Nerve
  • Medial Longitudinal Fasciculus
  • Medial Lemniscus
  • Corticospinal Fibers
40
Q

What does the Long Circumferential Branches of Basilar Artery supply?

A

Lateral Pons

  • Mesencephalic Nucleus and Tract
  • Spinal Trigeminal Nucleus and Tract
  • Facial Motor Nucleus
  • Anterolateral System
41
Q

What supplies the superior and inferior colliculi?

A

Superior Colliculus: Quadrigeminal (from PCA) and Posterior Medial Choroidal Arteries (from PCA)

Inferior Colliculus: Quadrigeminal and Superior Cerebellar Arteries

42
Q

What supplies the lateral and medial geniculate bodies?

A

Thalamogeniculate Artery

From Posterior Cerebral Artery

43
Q

What supplies the spinal cord?

A

Posterior and Anterior Spinal Arteries

44
Q

What are some important structures found in the subarachnoid space?

A
  • CSF
  • Circle of Willis
  • Veins
45
Q

What causes an epidural hematoma?

What does it look like on an x-ray?

A
  • Ruptured Middle Meningeal Artery: can be caused if hit at the pterion
  • Lens shaped hematoma on side of brain
46
Q

Pt presents after MVC, states he hit the left side of his head and had momentary unconsciousness before waking up. After 6 hours in the ED, pt starts feeling nauseous and sleepy. What should you be concerned for?

A

Epidural or subdural hematoma

47
Q

What causes a subdural hematoma?
What does it look like on an x-ray?

A
  • Bleeding of bridging veins most commonly seen in babies and the elderly
  • Crescent shaped hematoma on side of brain
48
Q

What causes a subarachnoid hemorrhage?
What does it look like on an x-ray?

A
  • Ruptured aneurysm from cerebral arteries mostly in post-menopausal women and people with hypertension
  • Spider like webs in middle of brain
49
Q

What is the source of bleeding for an intracerebral/subpial hemorrhage?

A

Middle Cerebral Artery

50
Q

What artery may be compressed in a Subfalcine herniation?

What symptoms can manifest?

A
  • Anterior Cerebral Artery can be compressed
  • Opposite lower extremity motor and sensory loss
51
Q

What is this?

A

Subfalcine Herniation

52
Q

What structures are compressed in a transtentorial herniation?

A

Upper brainstem

CN III

Maybe Basilar Posterior Cerebral Arteries

53
Q

Patient presenting with contralateral hemiplesia and ipsilateral CN III palsy most likely has a hernia where?

A

Uncus (and portions of parahippocampal gyrus)

54
Q

What structures are compressed in uncal herniations?

A

CN III

Cerebral peduncles

55
Q

What is Kernohan’s Phenomenon?

A

Uncal herniation that shifts the midbrain

Damage to CN III and cerebral peduncle on the other side so that all deficits are now on same side

56
Q

What structures can be compressed in a tonsillar herniation?

A

Medulla: respiratory center

Upper cervical Spinal Cord

Year 1: 06. Neuro Exam 2 (28 decks)

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