Neurovascular Flashcards
Where does the anterior intracranial circulation originate from?
Internal carotid arteries
Where does the posterior intracranial circulation originate from?
Vertebral arteries (join to form basilar artery)
What connects the right and left anterior cerebral arteries?
Anterior communicating artery
What part of the cerebral hemispheres does the anterior cerebral artery supply?
Medial part back to parietal lobe
What does the middle cerebral artery supply?
Lateral hemispheres
Basal ganglia
Internal capsule
From which artery does the vertebral artery arise?
Subclavian artery
What is the main branch of the vertebral arteries?
Posterior inferior cerebellar arteries
The posterior cerebral arteries come off which artery?
Basilar artery
What is supplied by the posterior cerebral arteries?
Occipital cortex and thalamus
Which arteries connect the anterior and posterior circulations?
Posterior communicating artery
Identify the arteries of the circle of Willis
What are the two parts of the brain’s venous drainage?
Cerebral veins
Dural venous sinuses
What do the dural venous sinuses contain that allow for CSF absorption?
Arachnoid granulations
The superior sagittal sinus drains blood into which sinuses?
Right and left transverse sinuses
Blood drains from the transverse sinuses into which vein?
Internal jugular vein
The superficial cerebral veins drain into which sinus?
Superior sagittal sinus
The deep cerebral veins drain into which sinus?
Straight sinus
What is an arteriovenous malformation?
A complex tangle of arteries and veins connected together with one or more fistulas
What is the commonest feature of an AVM?
Haemorrhage
Give some other clinical features of AVMs
Seizures
Progressive neurological deficit
Headache
What is the main investigation used for AVMs?
Catheter angiography
What investigation is used in an AVM emergency?
CTA
How can AVMs be managed?
Surgical excision
Stereotactic radiosurgery
Endovascular coiling
What occurs in subarachnoid haemorrhage?
The presence of blood in the subarachnoid space
What is the main cause of an SAH?
Head trauma
What is the main cause of non-traumatic SAH?
Berry aneurysm rupture
Give some clinical features of SAH
Thunderclap headache
Neck stiffness & photophobia
N + V
Confusion
What imaging is used to diagnose an SAH?
CT
How is SAH managed?
CT angiography - identifies location and allows for endovascular coiling
Give some neurological complications of SAH
Vasospasm
Re-bleed
Hydrocephalus
Seizures
Hyponatraemia
What is a cavernous malformation?
Well circumscribed benign vascular lesions encompassing sinusoidal spaces
Give some clinical features of cavernous malformation
Seizures
Progressive neurological deficit
Haemorrhage
What is the main investigation used for cavernous malformation?
MRI
Give some risk factors for cranial aneurysms
Older age
Female sex
Smoking
Hypertension
Most aneurysms arise in the anterior/posterior circulation
Anterior
Where are the commonest locations for cranial aneursyms?
Junction of anterior communicating artery and anterior cerebral artery
Junction of posterior communicating artery and internal carotid
What causes a fusiform aneurysm?
Atheromatous degeneration of arterial wall
What causes a mycotic aneurysm?
Septic emboli
How does a posterior communicating artery aneurysm present?
Third cranial nerve palsy
A large anterior communicating artery aneurysm can compress which structure?
Optic chiasm
Give some clinical features of basilar aneurysms
Headache
Third nerve palsy
Confusion
Drowsiness
How are aneurysms treated?
Endovascular coiling
Neurosurgical craniotomy + clipping of aneursymal neck
What is a transient ischaemic attack?
Transient obstruction of blood flow to brain, spinal cord or retina
Give some risk factors for a TIA
Prior TIA
Hypertension
AF
Diabetes
Smoking
Give some clinical features of a TIA
Cortical symptoms (facial/limb weakness)
Speech abnormalities
Visual disturbance
CN involvement
Memory disturbance
What is the main imaging used for TIAs?
MRI
What occurs in a cerebral infarction?
Part of the brain loses blood supply due to arterial occlusion
What occurs in an intracerebral haemorrhage?
Bleeding from an artery onto the brain tissue from a rupture or leak
Give some neurological findings of stroke
Speech disturbance (dysarthia/dysphasia)
Contralateral homonymous hemianopia
Facial weakness
Contralateral limb weakness/sensory loss
A total anterior circulation infarct requires all three of what symptoms?
Higher cerebral dysfunction (dysphasia)
Homonymous visual field defect
Ipsilateral motor and/or sensory deficit
What are signs of a partial anterior circulation infarcts?
Two of three of:
Higher cerebral dysfunction
Homonymous visual field defect
Ipsilateral motor/sensory deficit
What symptoms can present in a posterior circulation infarct?
Ipsilateral CN palsy + contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Cerebellar dysfunction
Isolated homonymous visual field defect
Patients with ischaemic stroke that present within 4.5 hours can be treated with what?
IV alteplase
What drug should be started within hours of ischaemic stroke?
Aspirin
Patients who have had an ischaemic stroke tend to be on which drug for life?
Clopidogrel
