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X. MRCS: Pathophysiology > Neurovascular > Flashcards

Neurovascular Flashcards

1
Q

Internal carotid

A 
Branch of common carotid (at C4)
Enters cranium via carotid canal of temporal bone
Branches:
Ophthalmic artery
Posterior communicating artery
Anterior cerebral artery
Anterior choroidal artery
Middle cerebral artery
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2
Q

Vertebral artery

A 
Enters via foramen magnum
Branches:
Meningeal branches
Anterior and posterior spinal arteries
Posterior inferior cerebellar artery
Forms basilar artery
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3
Q

Circle of Willis

A

Anterior cerebral arteries (branch of ICA)
Internal carotids
Posterior cerebral arteries (branch of BA)
“Connecting vessels”:
Anterior communicating (connects anterior cerebral arteries)
Posterior communicating (connects ICA with posterior cerebral)

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4
Q

Basilar arteries

A 
Formed by two vertebral arteries over junction of medulla and pons
Branches:
Anterior inferior cerebellar artery
Pontine arteries
Superior cerebellar arteries
Posterior cerebral arteries
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5
Q

Stroke syndromes

A

Anterior cerebral artery syndrome
Middle cerebral artery syndromes
Poster cerebral artery
Anterior inferior cerebellar artery (AICA)
Posterior inferior cerebellar artery (PICA)

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6
Q

Anterior cerebral artery syndrome

A

Rare due to collateral flow
Contralateral hemiparesis of lower limbs
Contralateral sensory loss of lower limbs
Anosmia

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7
Q

Middle cerebral artery syndromes

A 
Contralateral weakness
Contralateral sensory loss
Contralateral hemineglect
Contralateral homonymous hemianopia
Global aphasia (receptive and expressive)
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8
Q

Basilar artery

A

Locked in syndrome

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9
Q

Anterior inferior cerebellar artery (AICA)

A

Lateral pontine syndrome: Marie-Fox Syndrome
Ipsilateral cerebellar ataxia (arm and leg)
Ipsilateral facial weakness
Ipsilateral hearing loss, vertigo and nystagmus

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10
Q

Posterior inferior cerebellar artery (PICA)

A

Lateral medullary syndrome (Wallenberg Syndrome)

Ipsilateral:
Facial sensory loss
Nystagmus
Horner's syndrome
Loss of gag reflex
Ipsilateral ataxia with a tendency to fall to the ipsilateral side
Contralateral:
Pain and temperature sensory loss in the extremities
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11
Q

Dural venous sinuses

A

Lie between periosteal and meningeal dural layers
Drain into internal jugular vein
11 sinuses in total

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12
Q

Superior sagital sinus

A

Runs in falx cerebri
Collects from Superior cerebral veins
Connects with confluence of sinuses at internal occipital protuberance

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13
Q

Confluence of sinuses

A

Collection of:
Superior sagital sinus
Straight sinus
Occipital sinus

Drains into
R & L transverse sinuses

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14
Q

Inferior sagital sinus

A

Runs in falx cerebri in midline

Connects with great cerebral “vein of Galen” into: Straight sinus

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15
Q

Inferior sagital sinus

A

Runs in falx cerebri in midline

Connects with great cerebral “vein of Galen” into: Straight sinus

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16
Q

Great cerebral vein “Of Galen”

A

formed by joining of internal cerebral vein and basal vein of Rosenthal.
Joins with inferior sagital sinus to from straight sinus

17
Q

Transverse sinus

A

Right and left
Drains from confluence of sinuses
Drains into sigmoid sinus

18
Q

Cavernous sinus

A

Venous plexus on each side of sella turcica
CN3, CN4, CNV1, CNV2, CN6 and ICA travel though it.
Collects from inferior and superior ophthalmic veins
Drains into superior and inferior petrosal sinuses (onto transverse sinus and IJV)

19
Q

Functions of CSF

A

Protection
Buoyancy
Chemical stability

20
Q

Ventricles of the brain

A

Lateral ventricle
Third ventricle
Fourth ventricle

21
Q

Lateral ventricle

A

R & L. Located within hemispheres of cerebrum.

“Horns” project into frontal, occipital and temporal lobes

22
Q

Third ventricle

A

Connects to the lateral ventricles by the foramen of Munro

Situated between right and left thalamus

23
Q

Fourth ventricle

A

Receives CSF from third ventricle via cerebral aqueduct
Lies within brainstem at junction of medulla and pons
Drains into:
Central spinal canal: bathes spinal cord
Subarachnoid cisterns: bathes brain between arachnoid and Pia

24
Q

Production of CSF

A

Produces by choroid plexus, located in lining of ventricles.

25
Q

Drainage of CSF

A 
Occurs in subarachnoid space.
Arachnoid granulations (small projections) into dura mater. Allowed fluid to drain into dural venous sinuses.
26
Q

Cavernous Venous Sinus Thrombosis

A

Clot in Cavernous sinus
Most common cause: infection.
Typically spreads from extracranialu location: orbit, paranasal sinuses or “danger zone” of face. (Connection between ophthalmic veins and CS)
Sx: headache, unilateral periorbital oedema, proptosis, CN palsy (CN6 most common).
Can rapidly progress to meningitis

27
Q

Neural tube normal embryology

A

Neural groove –> neural fold –> neural tube
Closes at approx day 28
4 divisions:
1. Forebrain (prosencephalon –> telencephalon: cerebrum & diencephalon: optic nerve/hypothalamus)
2. Midbrain (mesencephalon)
3. Hindbrain (rhombencephalon –> metencephalon: pons/cerebrum & myelencephalon: medulla oblongata)
4. Spinal cord

28
Q

Neural tube defects

A 
Failure of neural tube to close (day 28)
Anencephaly
Encephaloceles
Hydranencephaly
Iniencephaly
Spina bifida (most common)
29
Q

Anencephaly

A

Severe.
Failure for anterior most part of neural tube to fuse. Leading to lacking most parts of forebrain (cerebrum)
Infants die within hours/days of birth

30
Q

Encephalocele

A

Protusions of cerebral material through skull into sac covered with membranes/skin

31
Q

Hydranencephaly

A

Cerebral hemispheres are missing and filled with fluid

32
Q

Spina bifida: types

A

Myelomeningocele
Meningocele
Spina bifida occulta

33
Q

Spina bifida: Risk factors

A

Folate deficiency
Obesity
DM
Anti epileptics

34
Q

Myelomeningocele

A

Most severe type
Spinal cord, meninges protrude from spinal column
If no skin covering: “open spina bifida”
Associated with Arnold-Chiari II malformation

35
Q

Meningocele

A

Only meninges protruding through unformed spinal column

36
Q

Spina bifida occulta

A

Most common. Least severe.
Spinal cord/surrounding tissue does not protrude.
Hair/dimple/birth mark at site of lesion.

X. MRCS: Pathophysiology (13 decks)

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