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Medical Neuroscience Block 1 > Webcast - Arterial Supply of the Cerebral Hemispheres > Flashcards

Webcast - Arterial Supply of the Cerebral Hemispheres Flashcards

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USMLE® Step 1 flashcards
1
Q

What arteries supply the cerebral hemispheres and deep cerebral structures (forebrain)?

A

The internal carotid artery and vertebral arteries.

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2
Q

How are the internal carotid artery and the vertebral arteries connected?

A

Via the cerebral arterial circle of Willis.

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3
Q

What are two types of major blood vessels of the circle of willis that

A

Long circumferential branches that supply the lateral and distal areas.

Short penetrating branches that supply the medial and proximal areas.

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4
Q

What are the long branches of the internal carotid artery? What are the short/penetrating branches?

A

Long: Middle cerebral and anterior cerebral arteries.

Short: posterior communicating a. and anterior choroidal a.

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5
Q

What parts of the brain are fed by the Anterior Cerebral artery?

A

The medial aspect of the frontal and parietal lobes including the motor and somatosensory areas of the cortex which represent the lower limbs.

The corpus callosum, cingulate gyrus, and optic chiasm.

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6
Q

What regions of the brain are fed by the middle cerebral artery?

A

The frontal, parietal, and temporal lobes.

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7
Q

What long/circumferential branches does the vertebral artery give off? What about short branches?

A

Long: Posterior inferior cerebellar a. (PICA) and posterior spinal a.

Short: Anterior spinal a.

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8
Q

What long/circumferential branches does the basilar artery give off? What about short branches?

A

Long: Superior cerebellar a, pontine arteries, anterior inferior cerebellar a. (AICA).

Short: pontine arteries

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9
Q

What regions of the brain are fed by the posterior cerebral a?

A

The occipital lobe, medial aspect of the temporal lobe, and the thalamus.

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10
Q

What arteries make up the cerebral arterial circle of willis?

A

Internal carotid arteries

Anterior cerebral arteries

Anterior communicating artery

Middle cerebral arteries

Vertebral artery

Basilar artery

Posterior communicating artery

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11
Q

What are the four branches of the internal carotid artery? Describe each part

A

C1 - Cervical : from bifurcation to carotid canal

C2 - Petrous : within carotid canal

C3 - Cavernous : within cavernous sinus

C4 - Supraclinoid : pierces dura mater.

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12
Q

What branches off of the internal carotid artery? What does each feed?

A

The ophthalmic artery: supplies orbit and optic n

Posterior communicating a: anastomose with posterior cerebral a.

Anterior choroidal a: feeds deep cortical structures

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13
Q

Where are the anterior cerebral arteries located when looking at a gross specimen?

A

Within the longitudinal fissure.

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14
Q

What does the anterior cerebral artery split into? Where can these be seen?

A

The callosomarginal artery in the cingulate sulcus and the pericallosal artery in the collosal fissure.

These can be seen in the half brain view.

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15
Q

What are the deep branches of the anterior cerebral arteries called? What do they supply?

A

The medial striate artery supplies the internal capsule.

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16
Q

What are signs and symptoms of an infarct in the anterior cerebral artery territory?

A
  1. Behavior changes (frontal lobe)
  2. Contralateral leg and foot weakness (precentral gyrus) and/or
  3. Contralateral leg and foot sensory loss (postcentral gyrus).
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17
Q

Where does the middle cerebral artery run?

A

In the lateral sulcus (sylvian fissure).

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18
Q

What are the signs and symptoms of an infarct of the MCA in the right superior territory?

A

Weakness and/or sensory loss of left face, hand, arm, and trunk.

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19
Q

What are the signs and symptoms of an infarct of the MCA in the left superior territory?

A

Weakness and/or sensory loss of the right face, hand, arm, and trunk.

Broca’s aphasia - “word salad”

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20
Q

What are the signs and symptoms of an infarct of the MCA in the right inferior region?

A

Sensory loss from the left face, hand, and arm.

Left hemineglect: pt unaware of left side

21
Q

What are the signs and symptoms of an infarct of the MCA in the left inferior region?

A

Sensory loss from right face, hand, and arm.

Wernicke’s aphasia (superior temporal gyrus) - impaired comprehension of spoken or written words. Can speak but is incomprehensible.

22
Q

What is the path of the vertebral arteries? What do they anastomose with?

A

The branch off of the subclavian and pass through the transverse foramina of the cervical vertebrae end go through the foramen magnum.

They anastomose with the basilar artery.

23
Q

What is the anterior spinal artery a branch of? What doe it supply?

A

It is formed by the two vertebral arteries when they form a single branch that supplies the anterior 2/3 of the cervical spinal cord and anterior and median medulla

24
Q

What is the posterior spinal artery a branch of? What is its path? What does it supply?

A

The vertebral artery or the posterior inferior cerebellar artery.

Descends near the dorsal roots and supplies the posterior 1/3 of the cervical spinal cord.

25
Q

What is the posterior inferior cerebellar artery (PICA) a branch of? What does it supply?

A

The vertebral artery.

Supplies the inferior surface of the cerebellum, lateral part of the rostral medulla, and the choroid plexus of the fourth ventricle.

26
Q

What is the location and branching of the basilar artery?

A

Runs rostrally along the anterior pons.

Bifurcates into two posterior cerebral arteries (PCAs).

Branches: anterior inferior cerebellar a. (AICA), superior cerebellar a, short and long pontine a, and the internal auditory a.

27
Q

What do the posterior cerebral arteries (PCA’s) supply?

A

The midbrain, the medial and inferior surfaces of the temporal and occipital lobes (visual areas), thalamus and globus pallidus.

28
Q

What are some signs and symptoms of an infarct in the posterior cerebral arteries (PCAs)?

A

Visual field defects (occipital lobe)

Contralateral hemiparesis (weakness on one side of the body) or contralateral hemianesthesia (loss of sensation) if thalamus and internal capsule are affected.

29
Q

Define the characteristics of a stroke?

A
  1. Acute onset - usually no warning
  2. Focal neurologic deficit: unilateral, finite domains (motor, sensory, language, and visual), usually NOT unaltered consciousness.
  3. Cerebrovascular cause
30
Q

What does it mean if someone has an episode with loss of consciousness? Does this indicate a stroke?

A

Both sides of the brain are impacted.

Usually does not occur with a stroke, unless it’s massive, hemorrhage (because the blood impacts both sides), or brainstems.

31
Q

What are the two types of strokes? What percentage of all strokes does each make up?

A

Hemorrhagic (15%)

Ischemic (85%)

32
Q

What are the types of a hemorrhagic stroke?

A

Subarachnoid hemorrhage (SAH), intracerebral hemorrhage (blood within the parenchyma of the brain) which is usually caused by hypertension.

33
Q

What are the types of Ischemic stroke? Describe each.

A

Thrombotic: blood clot formed in situ and causes occlusion.

Embolic: traveling clot, air bubble, or fatty deposit that lands in the head (usually from the heart)

34
Q

What is a subarachnoid hemorrhage and what is it caused by?

A

Rupture of blood vessels in the subarachnoid space that can be caused by an aneurysm or trauma.

35
Q

What is ischemic penumbra?

A

The ischemic part of the brain that has not yet infarcted.

This is the at risk region that is trying to be saved from infarct after a stroke.

36
Q

What can reduce the size of the penumbra following a stroke?

A

Good collateral vessels.

37
Q

What regions of the brain are fed by the ACA, MCA, and PCA when looking at a transverse cut of the brain?

A

ACA - up the middle in the frontal portion of the brain

MCA - middle/side (2/3 of the hemisphere including basal ganglia)

PCA - up the middle in the back portion, including the thalamus

38
Q

An 80 yo with gradual lethargy, inattention, global confusion, and illogical speech. Is this a stroke? Why or why not?

A

No, not acute onset.

No focal neurologic deficit.

No cerebrovascular cause.

39
Q

An 80 yo with sudden garbled, nonsensical speech (in isolation). Is this a stroke? Why or why not?

A

Yes, there is acute onset, a focal neurologic deficit (language), and a cerebrovascular cause (aphasia could be from a L MCA infarct)

40
Q

A 78 yo with sudden vertigo, lateropulsion, dizziness, and emesis. Is this is stroke? Why or why not?

A

Yes.

Acute onset, focal neurologic deficit (sensory and motor), and a cerebrovascular cause (brainstem)

41
Q

What are the steps to the management of strokes?

A
  1. Rescue - the penumbra
  2. Recovery - in the hospital
  3. Prevention of secondary stroke (similar to preventing a heart attack)
42
Q

What can be done to rescue the panumbra?

A

IV thrombolysis with tissue plasminogen activator - but this can only be done within 4.5 hours of stroke symptoms and can only be done for ischemic stroke

43
Q

What can be done to rescue the clot?

A

Mechanical thrombectomy (MT) - where you go in and remove the clot mechanically.

44
Q

What are some modifiable and unmodifiable risk factors for stroke?

A

Unmodifiable: age, gender, race, and heredity.

Modifiable: HTN, hyperlipidemia, hear disease, obesity, diabetes, smoking, carotid disease, and heavy alcohol use.

45
Q

If a patient has an infarct in the left PCA, what symptoms will they present with?

A

Right body numbness and right homonymous hemianopia (affecting sight).

46
Q

If a patient has an infarct in the left MCA, what symptoms will they present with?

A

Right arm and face weakness and aphasia.

47
Q

What body parts are associated with the ACA?

A

Foot and leg.

48
Q

What body parts are associated with the MCA?

A

Lateral hemisphere - face and arm

49
Q

What are two terminal branches of the internal carotid artery?

A

The ACA and MCA

Medical Neuroscience Block 1 (10 decks)

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