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Neuroscience BB Exam 1 > Section 5 - Cerebrovascular > Flashcards

Section 5 - Cerebrovascular Flashcards

1
Q

List the most common sites of cerebral aneurysm.

A
  • Jxn of ACA and anterior communicating a.
  • ICA jxn with ACA or posterior communicating
  • Bifurcation of MCA
  • Bifurcation of basilar (either end)
  • Along basilar a.
  • Jxn of vertebral a. and PICA
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2
Q

What is a cerebral embolism?

A

Occlusion of cerebral vessel by extraneous material (clot, tumor cells, clump of bacteria, air, plaque fragments) leading to ischemia (localized anemia) and potentially infarction (necrosis)

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3
Q

What is a transient ischemic attack?

A

Sudden loss of neurological function resolved within minutes usually - small embolisms tend to occlude small cerebral vessels

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4
Q

Large embolisms tend to _____

A

occlude major vessels, causing sudden major neurological problems with permanent deficits or death

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5
Q

Atherosclerotic plaques at bifurcation of common carotid can _____

A

form emboli that occlude ICA

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6
Q

Septic emboli can interrupt blood flow or lead to infection, which can…

A

This can weaken the vessel wall and lead to a mycotic aneurysm

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7
Q

An air embolism can arise from _____

A

Dural venous sinus opened in surgical procedures

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8
Q

What is a penumbra?

A

Area immediately surrounding an ischemic or occlusive stroke which may be salvaged (“Time is brain”)

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9
Q

How do we treat penumbras?

A
  • Tissue plasminogen activator within 3-4.5 hrs. (EXCEPT in hemorrhagic strokes)
  • Endovascular clot removal within 8 hours
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10
Q

What is an arteriovenous malformation?

A

Lesions that consist of masses of tortuous larger arteries connected with large veins (no intervening capillary beds) with little/no brain tissue in mass

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11
Q

Why are arteriovenous malformations dangerous?

A

Dynamic lesions; lead to additional deficits. Can also lead to hemorrhage.

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12
Q

What is the treatment for arteriovenous malformations?

A

Surgical removal or endovascular embolization.

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13
Q

What are symptoms of an arteriovenous malformation?

A
  • Hemorrhage (silent or defective)
  • Seizures
  • Mass effect (cranial nerve signs)
  • Increased intracranial pressure
  • Hydrocephalus
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14
Q

What is a hamartoma?

A

A benign, focal malformation. Tissue is the same as surrounding tissue, just malformed. Arteriovenous malformation is an example.

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15
Q

What is a malformation of the great cerebral vein of Galen?

A

(Special type of AVM) - Usually seen in newborns infants such that vein of Galen is GREATLY enlarged and fed by abnormal branches of cerebral and cerebellar aa.

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16
Q

What are symptoms of malformation of vein of Galen?

A
  • Bulging fontanelles
  • Progressive hydrocephalus
  • Dilated veins on face/scalp
  • HELLA big veinous blob on angiogram
17
Q

Spinal AVMs:

A
  • Usually larger in children
  • Bleed less frequently; more localizing signs/symptoms
  • Lower back pain, impaired micturition, sensory/motor
18
Q

What are some consequences of ophthalmic artery occlusion?

A
  • Significant visual loss ipsilateral

Ophthalmic-carotid intersection aneurysm can lead to visual loss from pressure on optic n.

19
Q

What is Anterior Choroidal Artery Syndrome?

A

Occlusion of anterior choroidal artery

  • Visual deficits
  • Weakness of opposite upper and lower extremities (posterior limb of internal capsule)

(Hemiplegia, hemianesthesia, hemianopia)

20
Q

What are some consequences of aneurysms on anterior communicating a. or anterior cerebral a.?

A
  • Common visual deficits due to optic chiasm proximity (rupture collect blood in interhemispheric fissure)
  • Distal ACA serves lower somatosensory/sensory cortex –> hemimotor and hemisensory deficits in lower extremity
21
Q

What happens when M4 is occluded?

A

Serves trunk, upper extremity, face of somatomotor/sensory cortex, so associated deficits.

22
Q

How do you treat carotid stenosis?

A

Endarterectomy within bifurcation.

23
Q

Aneurysm of AICA may cause ______ symptoms (CN) since it crosses adjacent to them.

A

7 and 8

24
Q

Aneurysms of anterior basilar bifurcation frequently affects _____

A

Oculomotor nerve (3)

25
Q

What is vertebrobasilar insufficiency?

A

In hypertension, vertebral a. can be compressed between occipital bone and posterior arch of atlas (or extreme rotation can put torsion on artery) –> restrict blood flow

26
Q

Occlusion of the P4 branch (mainly calcarine a.) lead to _____

A

Defect of primary visual cortex –> homonymous hemianopia of opposite visual fields (also seen in occlusion of more proximal PCA)

27
Q

What is homonymous hemianopia?

A

Visual field loss on R or L side of vertical midline

28
Q

What is a watershed infarct?

A

In cases of hypotension or embolic showers, border of perfusion between major aa. are particularly dangerous zone for hypoperfusion of distal vascular beds

29
Q

ACA/MCA watershed infarct is “Anterior Watershed Infarct” and will result in:

A
  • Contralateral hemiparesis of lower extremity

- Expressive language deficits, behavioral changes

30
Q

MCA/PCA watershed infarct is “Posterior Watershed Infarct” and will result in:

A
  • Partial visual loss

- Variety of language problems

31
Q

Aneurysm of internal carotid a. in cavernous sinus will result in:

A
  • Deficits in CN 3, 4, 6, V1, V2
  • Partial/complete paralysis of eye movements
  • Loss of corneal reflex
  • Paresthesias or pain within V1 or V2
32
Q

What causes a carotid-cavernous fistula?

A

Rarely results from ruptured aneurysm but may occur from secondary trauma

33
Q

What is a cavernous sinus thrombosis?

A

Tumor or infection in orbit that can cause venous blood to flow toward cavernous sinus and potentially other parts of brain. Infection/tumor can spread from eye.

34
Q

What is cerebral venous thrombosis? What is a symptom?

A

Blood clots within the venous structures of the CNS (resulting infarct is a venous infarct)

Increased intracranial pressure.

35
Q

Where does cerebral venous thrombosis usually occur?

A

Sinuses, usually superior/inferior sagittal, straight, cavernous

36
Q

What can cause cerebral venous thrombosis?

A

Severe dehydration, cachexia (weakness/wasting), hypercoagulable condition, birth control pills, sickle cell, diabetes mellitus, brain surgery, meningitis, traumatic injury

37
Q

What are some complications of cerebral venous thrombosis?

A

Upstream to blockage becomes engorged and potentially edematous (maybe enough to hemorrhage)

38
Q

Why must the artery of Adamkiewicz be protected in surgery?

A

Spinal medullary at T12, L1, L2 on left (large) that is major source of blood to lower thoracic and upper lumbar spinal cord

Neuroscience BB Exam 1 (10 decks)

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