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Neurology > Neuro Arterial Supply > Flashcards

Neuro Arterial Supply Flashcards

1
Q

What are the Watershed zones of the Cebral arteries?

A

Between Anterior/middle cerebral arteries & Posterior/middle cerebral arteries

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2
Q

What is the consequence of severe hypotension in the Watershed zones?

A

Upper leg/upper arm weakness, defects in higher-order visual processing

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3
Q

What is Cerebral perfusion primarily driven by?

A

PCO2

(PO2 in severe hypoxia)

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4
Q

What is Therapeutic hyperventilation (dec PCO2) used for?

A

Helps dec ICP in cases of acute cerebral edema (stroke, trauma) via dec cerebral perfusion

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5
Q

What are the effects of a stroke in the MCA area of the Motor cortex?

A

Contralateral paralysis of the upper limb & face

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6
Q

What are the effects of a stroke in the MCA area of the Sensory cortex?

A

Contralateral loss of sensation in upper limb & face

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7
Q

What are the effects of a stroke in the MCA area of the Temporal lobe (Wernicke’s area) or Frontal lobe (Broca’s area)?

A

Aphasia if in dominant (us. left) hemisphere

Hemineglect if lesion in nondominant (us. right) side

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8
Q

What are the effects of a stroke in the ACA area of the Motor cortex?

A

Contralateral paralysis in the lower limb

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9
Q

What are the effects of a stroke in the ACA area of a Sensory cortex?

A

Contralateral loss of sensation in the lower limb

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10
Q

What are the effects of a stroke in the Lateral striate artery area of the Striatum or internal capsule?

A

Contralateral hemiparesis/hemiplegia

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11
Q

What are the effects of a stroke in the ASA area of the Lateral corticospinal tract?

A

Contralateral hemiparesis of lower limbs

Stroke commonly bilateral

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12
Q

What is Medial medullary synd?

A

Caused by infarct of paramedian branches of ASA & vertebral arteries

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13
Q

What are the effects of a stroke in the ASA area of Medial Leminsucs?

A

Dec contralateral proprioception

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14
Q

What are the effects of a stroke in the ASA area of the Caudal medulla (hypoglossal n.)?

A

Ipsilateral hypoglossal dysfunction

(tongue deviates ipsilaterally)

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15
Q

What are the structures of the lateral medulla?

A
  • Vesibular nuclei
  • Lateral Spinothalamic tract
  • Spinal trigemeinal nucleus
  • Nucleus ambiguus
  • Sympathetic fibers
  • Inferior cerebellar peduncle
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16
Q

What are the effects of a stroke in the PICA area of the Lateral medulla?

A
  • Dysphagia*
  • Hoarseness*
  • Vomiting
  • Vertigo
  • Nystagumus
  • Dec pain & temp sensation to limbs/face
  • Dec gag reflex
  • Ipsilateral Horner’s synd
  • Ataxia
  • Dysmetria
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17
Q

What synd can stroke to the PICA area of the Lateral medulla cause?

A

Lateral medullary (Wallenburg’s) synd

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18
Q

What are the effects of a stroke to the AICA area of the Lateral pons?

A
  • Paralysis & loss of pain/temp sensation of face*
  • Vomiting
  • Vertigo
  • Nystagmus
  • Dec lacrimation
  • Salivation
  • Dec taste from anterior 2/3 of tongue
  • Dec corneal reflex
  • Ipsilateral loss of hearing/Horner’s synd
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19
Q

What are the structures of the Lateral pons?

A
  • Cranial nerve
  • Vestibular nuclei
  • Facial nucleus
  • Spinal trigeminal nucleus
  • Cochlear nuclei
  • Sympathetic fibers
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20
Q

What are specific to PICA lesions?

A

Nucelus ambiguus effects

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21
Q

What are specific to AICA lesions?

A

Facial nucleus effects

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22
Q

What are the stroke effects of a stroke in the AICA area of the Middle & Inferior cerebellar peduncles?

A

Ataxia & dysmetria

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23
Q

What are the effects of a stroke in the PCA area of the Occipital cortex or Visual cortex area?

A

Contralateral hemianopia w/ macular sparing

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24
Q

Whare are the common sites of saccular (berry) aneurysms?

A

PComm & AComm (impingement on cranial nerves)

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25
Q

What are the effects of a AComm saccular (berry) aneurysm?

A

Visual field defects

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26
Q

What are the effects of a PComm saccular (berry) aneurysm?

A

CN III palsy– eye is “down & out” w/ ptosis & pupil dilation

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27
Q

What is an aneurysm?

A

ABN dilation of artery dute to weaking of vessel wall

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28
Q

What is a Berry aneurysm?

A

Occurs at the bifurcations in the circle of Willis

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29
Q

What is the MC site of Berry aneurysm?

A

Bifurcation of the anterior communicating artery

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30
Q

What is the MC complication of a Berry aneurysm?

A

Rupture leads to subarachnoid hemorrhage (“worst headache of life”) or hemorrhagic stroke

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31
Q

What can Berry aneurysm cause?

A

Bitemproal hemianopia via compression of optic chiasm

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32
Q

What are Berry aneurysms assoc w/?

A
  • ADPKD
  • Ehlers-Danlos synd
  • Marfan’s synd
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33
Q

What are the risk factors of a Berry aneurysm?

A
  • Advanced age
  • HTN
  • Smoking
  • Race (high risk in blacks)
34
Q

What is Charcot-Bouchard mircoaneurysm?

A

Assoc w/ chronci HTN

Affects small vessels

35
Q

What is an Epidural hematoma?

A

Rupture of Middle Meningeal artery (branch of maxillary a.), often 2° to a fracture of temporal bone

36
Q

What do Epidural hematomas cause?

A

Lucid Interval

Rapid expansion under systemic arterial pressure→ transtentorial herniation, CN III palsy

37
Q

What does CT of an Epidural hematoma show?

A

Biconvex (lentiform), hyperdense blood collection not crossing suture lines.

Can cross falx, tentorium

38
Q

What is a Subdural hematomoa?

A

Rupture of bridging veins

39
Q

What does a Subdural hematoma lead to?

A

Slow venous bleeding

(less pressure= hematoma develops over time)

40
Q

Who are Subdural hematomas seen in?

A
  • Elderly
  • Alcoholics
  • Blunt trauma
  • Shaken baby
41
Q

What is seen on CT of a Subdural hematoma?

A

Cresecent-shaped hemorrhage that crosses suture lines. Midline shift. Cannot cross the falx, tentorium

42
Q

What is a Subarachnoid hemorrhage?

A

Rupture of an aneurysm or an arteriovenous malformation (AVM)

43
Q

What does a Subarachnoid hemorrhage cause?

A

Rapid time course

Pts complain of “worst headache of my life” (WHOML)

44
Q

What is seen on spinal tap of a Subarachnoid hemorrhage?

A

Bloody or yellow (xanthochromic)

45
Q

What are the risks 2-3 days after a Subarachnoid hemorrhage?

A

Risk of vasospasm d/t blood breakdown (not visible on CT, tx w/ nimodipine) & rebleed (visible on CT

46
Q

What is the MC of Intraparenchymal (hypertensive) hemorrhage?

A

Systemic HTN

47
Q

What can Intraparenchymal hemorrhage be seen in?

A
  • Amyloid angiopathy
  • Vasculitis
  • Neoplasm
48
Q

Where does Intraparenchymal hemorrhage occur?

A

Typically Basal ganglia & internal capsule but can be lobar

49
Q

What can Athersclerosis cause?

A

Thrombi lead to ischemic stroke w/ subsequent necrosis

Form cystic cavity w/ reactive gliosis

50
Q

What is a Hemorrhagic stroke?

A

Intracranial bleeding

51
Q

What can cause Hemorrhagic stroke?

A
  • HTN
  • Anticoagulation
  • Cancer (ANB vessels can bleed)
52
Q

What can a Hemorrhagic stroke be 2° to?

A

Ischemic stroke followed by reperfusion (Inc vessel fragility)

53
Q

What is Ischemic brain dz/stroke?

A

Irreversible damage begins after 5 min of hypoxia

54
Q

What areas of the brain are most vulnerable to Ischemic brain dz/stroke?

A
  • Hippocampus
  • Neocortex
  • Cerebellum
  • Watershed areas
55
Q

What is the time frame of irreversible nueronal injury?

A
  • Red neurons (12-24 hours)
  • Necrosis + neutrophils (24-72 hours)
  • Macrophages (3-5 days)
  • Reactive gliosis + vascular prolif (1-2 weeks)
  • Glial scar (>2 weeks)
56
Q

What does a stroke show on diffusion-wt MRI?

A

Bright in 3-30 min & remains bright for 10 days

57
Q

What does a stroke show on noncontrast CT?

A

Dark in ~24 hours

Bright areas indicate hemorrhage (tPA contraindicated)

58
Q

What is an Ischemic stroke?

A

Atherosclerotic emboli block large vessels

59
Q

What can cause an Ischemic stroke?

A
  • Atrial fibrillation
  • Carotid dissection
  • Patent foramen ovale
  • Endocarditis
60
Q

What are Lacunar strokes?

A

Ischemic strokes that block small vessels

May be 2° to HTN

61
Q

What is the tx of an Ischemic stroke?

A

tPA w/in 4.5 hours

(so long as pt presents w/in hours of onset & there is no major risk of hemorrhage)

62
Q

What is a Transietn ischemic attack (TIA)?

A

Brief, reversible episode of focal neurologic dysfunction typically lasting <1 hour w/o acute infarction (neg MRI)

63
Q

What are the deficits in a TIA d/t?

A

Focal ischemia

64
Q

What are the Dural venous sinuses?

A

Large venous channels that run through the dura

65
Q

What do the Dural venous sinuses do?

A

Drian blood from cerebral veins & receive CSF from arachnoid granulations

66
Q

Where do the dural venous sinuses empty?

A

Internal jugular vein

67
Q

Where is CSF made?

A

Ependymal cells of choroid plexus

68
Q

What is CSF reabsorbed by?

A

Arachnoid granulations

69
Q

Where does CSF drain?

A

Dural venous sinuses

70
Q

Where does the Lateral ventricle drain?

A

3rd ventricle via right & left intraventricular foramina of Monro

71
Q

Where does the 3rd ventricle drain?

A

4th ventricle via cerebral aqueduct of Sylvius

72
Q

Where does the 4th ventricle drain?

A

Subarachnoid space via Foramina of Luschka (lateral) & Foramen of Magendie (medial)

73
Q

What is Communicating hydrocephalus?

A

Dec CSF absorption by arachnoid granulations, which can lead to inc ICP, papilledema & herniation

74
Q

What is normal pressure hydrocephalus?

A

Results in inc subarachnoid space volume but no inc in CSF pressure. Expansion of ventricles distorts the fibers of the corona radiata.

75
Q

What is the Clinical Triad of normal pressure hydrocephalus?

A

Urinary incontinence, ataxia & cognitive dysfunction

“Wet, wobbly & wacky”

76
Q

What is Hydrocephalus ex vacuo?

A

Appearance of inc CSF in atrophy

77
Q

What dz are hydrocephalus ex vacuo seen in?

A
  • Alzheimer’s dz
  • Advanced HIV
  • Pick’s dz
78
Q

What are the clinical features of Hydrocephalus ex vacuo?

A

ICP normal & triad not seen

79
Q

What is seen on imaging in Hydrocephalus ex vacuo?

A

Apparent increase in CSF observed on imaging is actually result of dec neural tissue d/t neuronal atrophy

80
Q

What causes Noncommunicating hydrocephalus?

A

Structural blockage of CSF circulation w/in the ventricular system

Neurology (9 decks)

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