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neuro14 Flashcards

1
Q

anterior brain vasculature

A

anterior (carotid) supplies the cerebral hemispheres except for medial temp lobes and a portion of the occipital lobes

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2
Q

posterior cerebral circulation

A

aka vertebrobasilar circ; supplies the brainstem, thalami, cerebellum, and the posterior portions of the cerebral hemisphere

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3
Q

right versus left common carotid arteries

A

right comes from the brachiocephalic (aka innominate); left comes from the aorta

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4
Q

common carotid divides where and into what

A

in the neck into the internal carotid and external cartoid

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5
Q

how does the internal cartoid artery

A

behind the pharynx, entering the skull where it forms an S shaped curve (the carotid siphon)

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6
Q

first branch of the internal carotid

A

opthalmic

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7
Q

subsequent branches off the ICA after the opthalmic

A

penetrates the dura and gives off the anterior choroidal and posterior communicating arteries; then divides into the anterior cerebral artery and the middle cerebral artery

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8
Q

what does the Anterior cerebral Artery supply

A

anterior medial cerebral hemispheres, the caudate nuclei, and the basal frontal lobes

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9
Q

what connects the two anterior cerebral arteries

A

anterior communicating arteries

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10
Q

MCA gives off what branches

A

lenticulostriate artery branches to the basal gang and internal capsule

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11
Q

MCA trifurcates into what

A

small anterior temporal branches and large superior (to lateral cerebral hemisphere) and inferior divisions (temporal and inferior parietal lobes)

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12
Q

anterior choroidal artery

A

arises from the internal carotid artery after the opthalmic and posterior communicating arteries; courses along the optic tract giving off branches to the globus pallidus and posterior limb of the internal capsule and then supplies the medial temporal lobe and the lateral geniculate body

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13
Q

what does the anterior choroidal artery supply?

A

branches to the globus pallidus and posterior limb of the internal capsule and then supplies the medial temporal lobe and the lateral geniculate body

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14
Q

posterior circulation comes off what

A

subclavian artery

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15
Q

first branch of each subclavian artery

A

vertebral artery

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16
Q

how does vertebral artery course

A

enters the transverse foramina of the C5 or C6 vertebrae and runs within the intravertebral foramina, exiting to course behing the atlas and then piercing the dura mater to enter the foramen magnum

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17
Q

the intracranial vertebral arteries join to form what

A

basilar artery at the pontomedullary junction

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18
Q

the intracranial vertebral artery gives off what branches

A

posterior and anterior spinal arteries, penetrating arteries to the medulla, and the posterior inferior cerebellar artery

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19
Q

what does the basilar artery give off

A

antierior inferior cerebellar arteries (AICA) and superior cerebellar arteries (SCA), before dividing at the pontomesencephalic junction nt the posterior cerebral arteries (PCA)

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20
Q

small penetrating arteries off the basilar

A

supply the medial portions of the midbrain and thalami

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21
Q

vascular supply of the brainstem

A

large paramedian arteries and smaller short circumferential arteries that penetrate the basal portions of the brainstem into the tegmentum

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22
Q

what does the PCA give off

A

penetrating arteries to the midbrain and thalamus, then supplies the occipital lobes and inferior surface of the temporal lobes

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23
Q

circle of wiliis

A

anterior communicating artery and the posterior and communicating arteries

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24
Q

each carotid artery supplies two-fifths of the brain and the basilar circulation one-fifth

A

right

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25
Q

paradoxical embolism

A

when clots from the venous system travel to the arterial system through defects in the heart like a PFO or Asd

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26
Q

watershed regions

A

where poor perfusion is most critical because it is at the perihery of the major vascular supply territories

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27
Q

symptoms of left cerebral hemisphere stroke

A

right hemiparesis, right hemisensory loss, aphasia, in large lesions you see conjugate deviation of eyes to left, right hemianopia or hemi-inattention

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28
Q

left ICA occlusive disease symptom

A

transient left monocular visual loss (opposite for right)

29
Q

symptoms of right cerebral hemisphere stroke

A

left hemiparesis, left hemisensory loss, poor drawing and copying, left visual field neglect, in large lesions conjugate deviation of the eyes to the right, left hemianopia

30
Q

what usually causes a right or left cerebral hemisphere stoke?

A

these are anterior circulation issues: carotid artery occlusion, embolism to the MCA or its branches, or basal ganglionic intracranial hemorrhages

31
Q

symptoms of lateral medullary stroke

A

ipsilateral facial pain or reduced pain and temp on the ipsilateral face or both; loss of pain and temp in the contralat limbs and body; ipsilat horners; nystagmus

32
Q

other symptoms of lateral medullary stoke

A

incorrdination of the ipsilateral arm; leaning while sitting or walking with gait ataxia; in deep lesions, dysphagia and hoarseness

33
Q

what is lateral medullary stoke also called

A

wallenberg syndrome,

34
Q

lateral medullary stroke normally due to

A

intracranial vertebral artery occlusion

35
Q

bilateral pontine base and medial tegmental stroke

A

quadriparesis; uni or bilateral conjugate gaze paresis, sometimes INO or 6th nerve palsy; when medial tegmentum is involved bilaterally, coma

36
Q

bilateral pontine base and often medial tegmentum stoke due to what?

A

basilar artery occlusion or pontine hemorrhage

37
Q

cerebellar infarction

A

gait ataxia, dysarthria, ipsilateral arm dysmetria

38
Q

causes of cerebellar infarction

A

embolism to the PICA or SCA, or cerebellar hemorrhage

39
Q

Left PCA territory stroke

A

right homonymous hemianopia; at times, amnesia; alexia without agraphia when the splenium of the corpus callosum is involved

40
Q

cause of left PCA territory stroke

A

embolism arising from the heart, aorta, or Vas to the left PCA

41
Q

right PCA territory stroke

A

left homonymous hemianopia; at times, left-sided visual neglect

42
Q

lacunar stroke cause

A

occlusion of a penetrating artery; can occur in either the anterior or posterior circulations

43
Q

pure motor lacunar stroke

A

weakness of contralat arm, face, and leg without sensory, visual, or cognitive or behavioral signs

44
Q

pure sensory lacunar stroke

A

paresthesiae of the contralateral body, limbs, and face without motor, visual, or cognitive abnormalities

45
Q

dysarthira-clumsy hand syndrome

A

slurred speech and clumsiness of the contralateral hand; caused by lacunar stroke

46
Q

ataxia hemiparesis

A

weakness and ataxia of the contralat limbs, often greater in the leg and foot than arm and hand; caused by lacunar stoke

47
Q

presentation of carotid dissection

A

severe retro-orbital headache ipsilateral to the lesion; ipsilateral Horner’s due to involvement of ascending oculosympathetic tract; perspiration is preserved

48
Q

how do you get a stroke with carotid dissection

A

thrombosis of the ICA or more commonly by an embolus arising from the dissection

49
Q

how do you get a vertebral artery dissection

A

manipulation of the neck or trauma

50
Q

signs of vertebral artery dissection

A

ipsilateral neck pain and strok ein the posterior circulation

51
Q

most sensitive imaging for acute brain infarction

A

MRI with diffusion-weighted imaging

52
Q

what to give stroke patients

A

tPA within 4.5 hours of stroke onset

53
Q

dabigatran

A

direct thrombin inhib that may be approp for some patients with stroke due to a fib

54
Q

patients with lacunar stroke or non-occulsive artherosclerotic lesions

A

aspirin, clopidogrel, or a combo of aspirin and modified release dipyidamole

55
Q

cause of subarachnoid hemorrhage

A

bleeding from an enurysm located within the circle of Willis

56
Q

signs of SAH

A

sudden onset severe headache; vomit’ with increased ICP, coma or death may ensue

57
Q

treatment of SAH

A

aneurysms can be clipped surgically or coiled; CCB nimodipine is used to minimize vasoconstriction and delay brain ischemia

58
Q

earliest signs of intracerebral hemorrhage

A

neurologic sgns related to the area involed

59
Q

most common cause of intracerebral hemorrhage

A

hypertension; most common locations are basal gang-internal capsule, caudate nuc, thalamus, pons, and cerebellum

60
Q

cerebral amyloid angiopathy

A

can be a cause of intracerebral hemorrhage in the elderly; preferentially affects the parietal and occipital lobes

61
Q

AVM

A

contain arteries that empty into arteriolized veins; AVMs can cause intracerebral hemorrhage and can result in seizures

62
Q

treatment for AVMs

A

embolization or surgical resection

63
Q

cavernous angiomas

A

compact mass of sinusoidal vessels close together without intervening brain parenchyma

64
Q

developmental venous anomalies

A

anomalous veins separated by normal brain; does not typically require intervention

65
Q

telangiectasia

A

dilated capillaries with intervening brain; does not typically require intervention

66
Q

in a patient with suspected acute stroke, what imaging do you do first?

A

CT without contrast because it can exclude hemorrhage so you can start thrombolysis;

67
Q

if CT of person with suspected stroke is normal, then what?

A

CBC, glucose, and coags to make sure they are not at risk for bleeding when you give them tPa, then give tPA

68
Q

treatment for acute VA dissection

A

IV heparin (not TPA), with conversion to warfarin for 3 to 6 mos; Antiplatelet agents are also an approp treatment;

Neuro (43 decks)

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