Vascular Neurology 1: Anatomy, Clinical Syndromes, and Cerebral Hemorrhage

Question 1

How much of the body’s total blood flow get? Does this change during exercise?

Answer 1

20%, nope, it stays constant.

Question 2

Does blood flow to the brain vary between systole and diastole?

Answer 2

Nope, stays constant (somehow…)

Question 3

From which major artery does the vertebral a. branch?

Answer 3

The subclavian.

Question 4

How many people actually have a full Circle of Willis?

Answer 4

About 35%. (not that important… a lot of the arteries that get occluded wouldn’t have redundancy anyway)

Question 5

In broad strokes, how would you describe the territories supplied by the anterior cerebral artery (ACA)?

Answer 5

rostral, and quite medial

Question 6

In broad strokes, how would you describe the territories supplied by the middle cerebral artery (MCA)?

Answer 6

Lateral, not covering the occipital lobe much.

Question 7

In broad strokes, how would you describe the territories supplied by the posterior cerebral artery (PCA)?

Answer 7

caudal, posterior (mostly the occipital lobe), with some coverage of the posterior/inferior temporal lobes.

Question 8

Name 4 signs that will be present in a MCA stroke.

Answer 8

Contralateral hemiparesis (more affecting face and arm than leg), hemisensory loss, field cut (loss of visual field opposite lesions), neglect.
(recall that the leg is more medial on the motor and somatosensory cortices, and thus less in the MCA's territory)

Question 9

What is “neglect” in the context of lesions to a side of the brain?

Answer 9

Ignoring the side of the body opposite the lesion (really unusual behaviors, like not eating food on one side of plate, etc.)

Question 10

What particular deficit might be more prominent in a left MCA stroke vs. a right MCA stroke?

Answer 10

Aphasia

Question 11

3 signs of an ACA stroke?

Answer 11

Contralateral hemiparesis (mostly leg), sensory loss, variable behavioral change

Question 12

Major sign of a PCA stroke?

Answer 12

Contralateral visual field cut.

Question 13

Why will an occlusion of the ACA often cause bilateral signs/symptoms?

Answer 13

In up to 25% of people, both ACAs arise from a single trunk.

Question 14

What is an occlusion of the distal basilary artery / proximal PCA called? Common signs? (name 2)

Answer 14

Weber / Medial Midbrain Syndrome. Signs: Ipsilateral CN III lesion, contralateral hemiparesis.

Question 15

What is an infarction of the proximal basilar artery* called? Signs? (name 3)
*the slide seems to be referring to a proximal branch of the basilar artery, not the whole thing

Answer 15

If the dorsal pons is spared… Pontine (or locked-in) Syndrome. Gaze palsy, facial palsy, contralateral hemiparesis (or quadraparesis).
*if dorsal pons is not spared, coma and death.

Question 16

What is an occlusion of the PICA called? Signs? (name 5)

Answer 16

Wallenberg / Lateral Medullary Syndrome. Knocks out inferior cerebellar peduncle. Signs: Ipsilateral face sensory loss, contralateral body sensory loss, Horner’s syndrome, ataxia, vertigo.

Question 17

What are 4 signs of a cerebellar infarction?

Answer 17

Ataxia, ipsilateral dysmetria, vertigo*, nausea.

*wtf? ……this directly contradicts the next lecture.

Question 18

What’s a Lacunar stroke? Signs?

Answer 18

Occlusion of small vessel without cortical involvement. Usually causes a contralateral sensory or motor deficit without cortical signs.

Question 19

3 signs of a vertebral artery occlusion?

Answer 19

Ipsilateral lower CN deficits, ataxia, contralateral sensory deficits.

Question 20

R face/arm/leg weakness & trouble finding words. What vessel might be occluded?

Answer 20

Left MCA

Question 21

R leg weakness & confusion. What vessel might be occluded?

Answer 21

Left ACA

Question 22

R face/arm/leg weakness without cortical signs. What vessel might be occluded?

Answer 22

Left MCA deep perforator (a Lacunar stroke)

Question 23

Are subarachnoid hemorrhages usually caused by large or small vessels?

Answer 23

Large vessels

Question 24

What’s the primary symptom of a subarachnoid hemorrhage (SAH)?

Answer 24

Worst headache of life

Question 25

How does one detect a subarachnoid hemorrhage?

Answer 25

95% are caught on a CT, lumbar puncture required for the remaining 5%.

Question 26

2 root causes of subarachnoid hemorrhages (SAH)?

Answer 26

Aneurysms, arterial-venous malformations (AVMs)

Question 27

What are the 3 most common sites of cerebral aneurysm?

Answer 27

Anterior communicating artery (ACom), posterior communicating artery (PCom), and the MCA bifurcation.

Question 28

3 complications of SAH?

Answer 28

Rebleeding
Vasospasm (narrowing of vessel -> ischemia)
Hydrocephalus

Question 29

Treatment for SAH? (2 specific things)

Answer 29

Early cliping or coiling. Nimodipine (Ca++ channel blocker) to reduce injury from vasospasm

Question 30

What are AVMs? Where do they come from?

Answer 30

Aterio-venous malformations: high pressure arterial blood going directly into veins that can’t handle it. Formed during development.

Question 31

What’s an intracerebral hemorrhage (ICH)?

Answer 31

Spontaneous bleeding into brain parenchyma.

Question 32

What’s the main cause of intracerebral hemorrhage?

Answer 32

Hypertension!

Question 33

Most common sites for ICH? What actually happens there?

Answer 33

microvasculature has microscopic “Charcot-Bouchard aneurysms”

Question 34

Where are ICHs most common? (5 places) Why?

Answer 34

Putamen, lobar white-grey junction, thalamus, pons, and cerebellum. Have 90 degree arteriolar / small penetrating artery branch points, which are susceptible to “Charcot-Bouchard aneurysms”

Question 35

What’s the demographic for cerebral amyloid angiopathy (a type of ICH)?

Answer 35

Being >90 years old.

Question 36

Is an ICH more likely to produce a worst headache of life or focal deficits?

Answer 36

Focal deficits.

Question 37

R face/arm/leg weakness with headache. Could be...
A. SAH from L MCA aneurysm
B. ICH from L deep perforating arteries
C. Ischemic stroke of L MCA
D. All of the above.

Answer 37

All of the above. (that’s why you need to get scans)

Question 38

Is there a lot of variability in the veins of the head?

Answer 38

Yup.