neuropathophys york test 1 Flashcards
Posterior Circulation to Brain
Vertebral Artery—- Basilar Artery —— Posterior Cerebellar Artery
Vertebral Artery origin
Subclavian artery
Vertebral Artery supplies
Ventrolateral Medulla
Vertebral Artery branches
Anterior Spinal Artery
Posterior Spinal Artery (2)
Posterior Inferior Cerebellar Artery
Posterior Inferior Cerebellar Artery supplies
Supplies Lateral Medulla + Cerebellum
Posterior Spinal Artery (2) supplies
Supplies Posterior Funiculus + Dorsal Horn; Dorsal Medulla
Anterior Spinal Artery
Supplies Ventral + Lateral Funiculi + Lateral Horn (Symp. T1-L2); Ventral Medulla
Basilar Artery formed by
Vertebral aa. join at the Pontomedullary Junction
Posterior Cerebellar Artery formed by
Basilar a. branches in the Midbrain
Anterior Circulation to Brain
Internal Carotid Artery——> OPAAM
OPAAM
- Internal Carotid Artery
- Ophthalmic Artery
- Posterior Communicating Artery
- Anterior Cerebral Artery
- Anterior Choroidal Artery
- Middle Cerebral Artery
Arteries of the Pons
- Anterior Inferior Cerebellar Artery – Supplies Cerebellum + Pons
- Labyrinthine Artery – Supplies ears
- Pontine Arteries (3) - Supplies Pons
- Superior Cerebellar Artery - Supplies Cerebellum & Pons
Vertebrobasilar Insufficiency (VBI or VBAI) symptoms
- Dizziness
- Diplopia (double vision)
- Drop Attack (spontaneous fall)
- Dysarthria (slurred speech)
- Dysphagia (difficulty swallowing)
- Nausea
- Numbness
- Nystagmus (involuntary rapid eye movement)
- Ataxia (inability to control voluntary muscles)
Arterial Circle of Willis
what is it?
•Anastomose of anterior and posterior circulation of the brain; specifically Posterior Communicating + OPAMM
Most likely place for blood clot in the brain ?
Arterial Circle of Willis
Circle of Willis
arteries included
- Anterior Cerebral Artery
- Posterior Cerebral Artery
- Middle Cerebral Artery
- Anterior Communicating Artery
- Posterior Communicating Artery
Terminal Branches of the Internal Carotid Artery
Anterior Cerebral Artery
Middle Cerebral Artery
Three Main Cerebral Arteries give rise to
give rise to numerous branches that travel in the subarachnoid space over the surface of the Brain and into the sulci
- Anterior Cerebral Artery
- Middle Cerebral Artery
- Posterior Cerebral Artery (terminal branch of Basilar part of posterior circulation)
Middle Cerebral Artery (MCA):key facts
- Supplies 80% of the blood to the brain (forebrain) Telencephalon & Diencephalon
- Telencephalon —–>Limbic System, Corpus Callosum, Corpus Striatum + Olfactory Bulb
- Diencephalon —->Thalamus, Hypothalamus
- Midbrain —->Oculomotor Complex, SC + IC, SN, RN; Hemibolismus + Parkinson’s
What artery is most frequently affected by stroke?
Middle Cerebral Artery
What supplies the entire lateral neocortex?
Middle Cerebral Artery
T or F
The striate cortex is supplied by the MCA.
F
Posterior cerebral artery
Middle Cerebral Artery (MCA)
Superior Division Branches
- Orbitofrontal Arteries: supplies Orbits & Parietal lobes
- Pre-Rolandic Arteries: supplies Area 6 (pre-motor); anterior to the Central fissure (fissure of Rolando)
- Rolandic Arteries: supplies Area 4 (1° Motor)
- Post Rolandic Arteries: supplies Areas 3,1,2 (1° Somatosensory)
- Posterior Parietal Arteries:
- Angular Arteries
Middle Cerebral Artery (MCA)
Inferior Division Branches
- Anterior Temporal Arteries:
2. Posterior Temporal Arteries (Anterior Occipital Arteries): – evidence that it branches from MCA or PCA
Occlusion of the Middle Cerebral Artery (MCA) mostly affects what?
upper body
Superior Division Occluded MCA
symptoms
• Contralateral Paralysis or muscle weakness
• Motor loss in the upper body (Area 4- 1° Motor)
• Sensory loss possible- Contralateral face & arm
• Dysarthria (difficulty speaking)
• Broca’s Aphasia/ Expressive or Non-Fluent Aphasia (inability to form words)
- Left Area 44
- Articulation of speech, Motor Speech and Language
Lower Division Occluded:symptoms
• Confusion
• Agitation
• Wernicke’s Aphasia/ Semantic/ Receptive or Fluent Aphasia (inability to comprehend speech)
- Left Area 22 (Caudal), Areas 40 + 39
- Semantic Speech (the meaning, recognition + comprehension of speech)
Stem of Middle Cerebral Artery Occluded: symptoms
• Symptoms of both upper & lower division
Deep Territory Occluded:symptoms
• Combination of Superior, Lower + Stem
Anterior Cerebral Artery supplies
most of the MEDIAL SURFACE (cortex) of the Brain
Branches of the Anterior Cerebral Artery
- Orbital Artery: supplies orbits & frontal lobe
- Frontopolar Artery: supplies frontal lobe
- Pericallosal Artery:
- Callosomarginal Artery:
Occlusion of the Anterior Cerebral Artery
Orbital Artery or Frontopolar Artery
- Apathy (lack of motivation)
- Some memory loss
- Behavior abnormalities
Occlusion of the Anterior Cerebral Artery
Callosomarginal Artery
• May affect cingulate gyrus, area 3,1,2 (1°Somatic Sensory)
• Contralateral Paralysis and muscle weakness of the lower body
• May lead to urinary incontinence and abnormalities in pain perception (allodynia)
o Urinary Incontinence Possibly Cauda Equina Syndrome due to “Saddle Anesthesia”
Cauda Equina Syndrome
signs
- weakness of the muscles of the lower extremities innervated by the compressed lumbar roots (often paraplegia)
- detrusor weaknesses causing urinary retention and post-void residual incontinence
- there may be decreased anal tone and consequent fecal incontinence; sexual dysfunction; saddle anesthesia; bilateral (or unilateral) sciatic leg pain and weakness; and absence of ankle reflex
acute Cauda equina syndrome
Red Flag Symptoms
sciatic leg pain and/or severe back pain, with altered sensation over saddle area (genitals, uretha, anus, inner thighs), urine retention or incontinence.
Posterior Cerebellar Artery
major branches
- Posterior Temporal Arteries
- Internal Occipital Arteries
- Posterior Choroidal Arteries
- Posterolateral Arteries (Thalamogeniculate Arteries)
- Posteromedial Arteries
Posterior Temporal Arteries supply
Striate Cortex/ Area 17 (1° Visual area)
Internal Occipital Arteries supplies
Striate Cortex/ Area 17 (1° Visual area)
Posterior Choroidal Arteries supplies
Inferior & Superior Colliculus
Posterolateral Arteries (Thalamogeniculate Arteries) supplies
posterior + part of middle thalamus
Posteromedial Arteries supplies
- Hypothalamus, Hypophysis (pituitary stalk)
- Anterior & Middle Thalamus (part of middle not supplied by Posterolateral)- done by Thalamoperforating Artery
- Mammillary Bodies, Subthalamic Nucleus, Red Nucleus, Substantia Nigra, Crus Cerebri
Occlusion of the Posterior Cerebral Artery
symptoms
- Hemianopia (decreased vision or blindness takes place in half the visual field of one or both eyes)
- Aphasia (inability to form words)
- Sensory loss (contralateral)
- Hemiparesis (contralateral)
Thalamoperforating Arteries occlusion symptoms
• Reaches Anterior and Subthalamus
• Damage to Subthalamic Nucleus Hemiballismus (post stroke)
o Basal Gangia: Subthalamic Nucleus, Substantia Nigra, Striatum (Putamen + Caudate Nucleus), Globus Pallidus + Nucleus Accumbens
Thalamogeniculate Arteries occlusion symptoms
- Contralateral numbness
- Damage to VPL (area 3,1,2), VPM, MG, LG
- May get a “Thalamic P! Syndrome” – everything is painful (area 43- pain) including normal movement & touch
Wallenberg Syndrome (Lateral Medullary Syndrome)
• Neurological condition caused by stroke in Vertebral Artery or Posterior Inferior Cerebellar Artery (PICA)
Wallenberg Syndrome (Lateral Medullary Syndrome) symptoms
- Dysphagia (difficulty swallowing)
- Hoarseness
- Dizziness
- Nausea & vomiting
- Nystagmus (involuntary rapid eye movement)
- Problems with balance & gait (ataxia)
Wallenberg Syndrome (Lateral Medullary Syndrome) possible symptoms
- Lack of pain & temperature sensation on ½ of the face
- Pattern of symptoms on opposite side of body
o Numbness + Paralysis on right side of face with Numbness + Weakness of left limbs - Uncontrollable hiccups
- Loss of sensation to ½ of tongue
- Horner’s Syndrome (occurs due to damage of the Medulla)
o Ptosis – drooping eyelid
o Anhydrosis- lack of sweat (sympathetic)
o Miosis- pinpoint pupils (parasympathetic)
Wallenberg Syndrome (Lateral Medullary Syndrome) treatment
Try to fix the symptoms; G-Tube, Epileptic drugs, Speech + Physical Therapy
Wallenberg Syndrome (Lateral Medullary Syndrome) ataxia occurs where in the brain and causes what problem?
- Cerebellum
2. Sensory loss on face
Strokes
general info
- Third Leading cause of death in the US
- 750,000 new cases every year (150,000 die)
- 2/3 of strokes occur over age 65
- Higher incidence in males and African
PCA stroke affects
midbrain
MCA stroke affects
lateral brain
Risk Factors for stroke
- Use of Oral Contraceptives
- Previous Stroke and/or family history
- Systemic or diastolic (bottom number) hypertension (120/80 = normal)
- Smoking
- Hypercholesterolemia
- Heavy alcohol consumption
- Diabetes
- Type A Personality (possibly)
Two Types of Stokes
- Transient Ischemic Attack (TIA)
2. Cerebrovascular Accident (CVA)
Characteristics of Transient Ischemic Attack (TIA)
- Blood flow to area of brain is cut off for a few seconds
- No permanent tissue damage
- Patient will feel weak for a couple minutes to a ½ hr
- At 24 hrs no markings of stroke on CT or MRI
- Usually put patients on blood thinners*
- Predictor of CVA
- Also known as “Mini- Stroke”
Characteristics of Cerebrovascular Accident (CVA)
- Blood Supply cut off to artery long enough to destroy tissue
- Death of some brain tissue
- At 24 hrs damage will be visible on a CT or MRI
- Full Blown Stroke
- Can recover- must build new pathways to destroyed area of brain
Differences btw TIA + CVA:
- Length of time without blood
- Tissue Damage
- Signs + Symptoms
Polio general info
- Fecal/Oral Transmission (water supply 3rd world countries)
* Somatic Alpha Neuron in Lamina IX is destroyed by Retrosynapse- can no longer contract skeletal muscle
Lower Motor Neuron Lesion (LMN)
Muscle Tone
Decreased muscle tone (hypotonic)
Lower Motor Neuron Lesion (LMN)
Paralysis (Flaccid or Spastic)
Flaccid Paralysis
Lower Motor Neuron Lesion (LMN)
Deep Tendon Reflex (DTR)
Hyporeflexia or Absent
Lower Motor Neuron Lesion (LMN)
Superficial Reflex
Absent (only in area affected)
Lower Motor Neuron Lesion (LMN)
Muscle Atrophy
Present
Lower Motor Neuron Lesion (LMN)
Clonus
Absent
Upper Motor Neuron Lesion (UMN)
Muscle Tone
Increased muscle tone (hypertonic)
Upper Motor Neuron Lesion (UMN)
Paralysis (Flaccid or Spastic)
spastic Paralysis
Upper Motor Neuron Lesion (UMN)
Deep Tendon Reflex (DTR)
Hypereflexia
Upper Motor Neuron Lesion (UMN)
Superficial Reflex
Absent (only in area affected)
Upper Motor Neuron Lesion (UMN)
Muscle Atrophy
Absent
Upper Motor Neuron Lesion (UMN)
Clonus
Present
Lower Motor Neuron Lesion (LMN)
Fasciculations or Fibrillations
Both Present
Lower Motor Neuron Lesion (LMN) Pathological Reflex (Babinski)
absent
Upper Motor Neuron Lesion (UMN)
Fasciculations or Fibrillations
Both Absent
Upper Motor Neuron Lesion (UMN) Pathological Reflex (Babinski)
Present
Clonus:
Very rapid movement from contraction to relaxation; Tonic would be sustained relaxation
Fasciculations:
Can be seen, unlike Fibrillations; Occur when only a few fibers of a muscle are contracting
Babinski:
Reflex of foot/toe; Stroke the foot and watch for movement of the toes- Abnormal if big toe and little toes move in opposite direction
LMNL: info/example
All occur in the PNS; Myasthenia Gravis, Bell’s Palsy, Polio