neurovasculature

Question 1

termination of the internal carotid artery

Answer 1

terminates into a bifurcation as the middle cerebral artery and anterior cerebral artert

Question 2

what does the anterior cerebral artery supply

Answer 2

medial part of the cerebral hemispheres back to the parietal lobe
supplies most of the corpus callosum, anterior limb of the internal capsule and part of the caudate nucleus

Question 3

what does the middle cerebral artery supply

Answer 3

majority of the lateral hemisphere, basal ganglia and internal capsule

Question 4

origin of the vertebral artery

Answer 4

arise from the subclavian artery

Question 5

what does the posterior cerebral artery supply

Answer 5

the occipital cortex and gives off branches to supply the thalamus

Question 6

venous system of the brain divided into two

Answer 6

cerebral veins: consists of superficial and deep veins
dural venous sinuses

Question 7

what are dural venous sinuses

Answer 7

large venous channels that are contained within the dura
also contain arachnoid granulations that allow CSF to be absorbed from the subarachnoid space

Question 8

what is the superior sagittal sinus

Answer 8

a large unpaired venous sinus that runs from the anterior aspect of the falx cerebri and terminates at the confluence of sinuses

Question 9

what is an arteriovenous malformation

Answer 9

complex tangle of arteries and veins connected together with one or more fistulas, creating a shunt
common cause of haemorrhage in young adults

Question 10

investigations for AVM

Answer 10

catheter angiography
CTA

Question 11

what is a SAH

Answer 11

blood in the subarachnoid space between pia and arachnoid membrane

Question 12

presentation of SAH

Answer 12

sudden onset of thunderclap headache
neck stiffness and photophobia due to meningeal irritation
nausea and vomiting
third nerve palsy- if due to posterior communicating artery aneurysm

Question 13

investigations for SAH

Answer 13

CT scan
- if scan normal: LP (xanthochromia)
CTA then performed to identify the location of the vascular abnormality

Question 14

complications of SAH

Answer 14

vasospasm
re-bleed
hydrocephalus
seizures
hyponatraemia

Question 15

what is a vasospasm post SAH

Answer 15

prolonged arterial contraction leading to delayed ischaemia
3-14 days post haemorrhage
new focal neurological deficit or altered state of consciousness
diagnosed clinically or angiogram or doppler

Question 16

treatment of vasospasm after a SAH

Answer 16

nimodipine (prevent spasmodic effects) and blood pressure control

Question 17

what is a cavernous malformation

Answer 17

well circumscribed benign vascular lesions encompassing sinusoidal spaces lined by endothelium and separated by elastin

Question 18

presentation of cavernous malformation

Answer 18

seizures
progressive neurological deficit
haemorrhage

Question 19

investigations for cavernous malformation

Answer 19

CT
MRI: gold standard (popcorn-like)
angiography to rule out other stuff

Question 20

most common type of cerebral aneurysm resulting in subarachnoid haemorrhage

Answer 20

saccular aneurysm (berry)

Question 21

presentation of PCOM aneurysms

Answer 21

can compress on the oculomotor nerve causing third nerve palsy
- dilated pupil that is unreative to light

Question 22

treatment of aneuryms

Answer 22

symptomatic: endovascular coiling or neurosurgical craniotomy + clipping of the aneurysm

Question 23

long term management of strokes

Answer 23

aspirin 300 mg daily for two weeks
then clopidogrel for life