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Neuro Exam 2 > 2 Blood Supply and Ventricular Supply - B > Flashcards

2 Blood Supply and Ventricular Supply - B Flashcards

1
Q

what is a cause of median and lateral aperature obstructions

A

arnold-chiari malformation or dandy-walker cyst (CSF buildup in the lateral, 3rd, and 4th ventricles)

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2
Q

occlusion in the temporal branches of the middle cerebral a cause

A

inability to localize sounds

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3
Q

what do the branches of the parieto-occipital a supply

A

visual association cortex

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4
Q

the middle cerebral a (internal carotid branch) suppplies

A

medial and lateral striate/thalamostriate

  • internal capsule
  • corpus striatum
  • thalamus
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5
Q

occlusion in the angular artery of the middle cerebral a causes

A

wernicke’s aphasia

  • fluent in speech but can’t understand spoken and written comprehension
  • circumlocute with inappropriate word choices and new word creations
  • receptive language disorder
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6
Q

occlusions in the frontal branches of the middle cerebral a can cause

A

broca’s aphagia - understanding speech but unable to recipricolly communicate

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7
Q

labyrinthinitis is

A
  • atherosclerosis or inflammation of the labyrinthine a resulting in irritation of hte vestibulocochlear apparatus
  • disturbs equilibrium and or hearing
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8
Q

what is the progression of an epidural hematoma

A
  • traumatic event
  • unconcious but rapid recovery
  • hematoma presses on cerebral hemisphere
  • causes uncal herniation
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9
Q

the pontine aa are branches off of

A

basilar a

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10
Q

what is frequently a cause of vasular insufficiency to globus pallidus and hippocampus in eldery

A

anterior choroidal a

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11
Q

what is a cause of obstruction of the cerebral aqueduct

A

midbrain astrocytoma (build up in the lateral and 3rd ventricles)

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12
Q

where does the internal cerebral v go

A
  • runs next to the parahippocampal gyrus
  • receives thalamostriate and anterior septal vv
  • drains into the great v of galen and then to the straight sinus
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13
Q

how do you treat an epidural hematoma

A

evacuate the hematoma

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14
Q

where is the 3rd ventricle

A

between thalami

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15
Q

where does the great vein of galen go

A
  • runs next to the posterior portion of the corpus callosum
  • receives the internal cerebral v and basal v of rosenthal
  • drains into straight sinus
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16
Q

what are the clinical signs of hydrocephalus in adults

A

increased intracranial pressure

papillaedema

abducens palsy (eye facing medially - lost lateral rectus m)

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17
Q

what is responsible for draining blood from the spinal cord

A

baston’s plexus

  • located in the epidural space
  • empties into intervertebral vv and then segmental vv
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18
Q

what does the anterior spinal a supply

A

most of the central gray matter of the cord and the anteromedial portion of white matter

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19
Q

what occurs with thrombosis of superior sagittal sinus or right transverse sinus

A

cortical ischemia and or necrosis

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20
Q

the cerebral aa run in subarachnoid space and their branches penetrate into brain parenchyma and are surrounded by what

A

virchow robin space and pia mater

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21
Q

what do the temporal branches of the posterior cerebellar a supply

A

inferior temporal cortex

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22
Q

what type of hydrocephalus is most commonly associated with senile atrophy of the cortex (alzheimers)

A

supratentorial external hydrocephalus

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23
Q

the posterior circulation of the brain is handled by

A

vertebral a

  • anterior spinal a
  • posterior spinal aa
  • posterior inferior cerebellar a

basilar a

  • anterior inferior cerebellar a
  • labyrinthine a
  • superior cerebellar a
  • posterior cerebal a
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24
Q

what connects the 3rd and 4th ventricles

A

cerebral aqueduct

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25
Q

what is internal hydrocephalus

A

noncommunicating type where CSF cannot drain into the subarachnoid space

-results in dilation of ventricles proximal to obstruction

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26
Q

why do we find erythrocytes in CSF

A

subarachnoid hemorrhage

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27
Q

what occurs with occlusion of the great v of galen

A

usually fatal since it drains deep brain

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28
Q

occlusion of the posterior inferior cerebellar a causees

A

lateral medullary syndrome/wallenberg syndrome

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29
Q

what is a cause of interventricular foramen obstruction

A

3rd ventricle choroid plexus ependymoma (backs up into lateral ventricle)

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30
Q

how is a subdural hematoma different from a epidural hermatoma

A

more insidious onset

-can have lethary, seizures, or headaches

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31
Q

what causes communicating hydrocephalus

A

obstruction of the narrow space between the tentorial notch and midbrain

-caused by adhesions in subarachnoid space secondary to:

– previous inflammation (infantile meningitis)

–cerebral edema

–uncal herniation

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32
Q

what do the penetrating branches of the posterior cerebral a supply

A
  • internal capsule
  • thalamus
  • choroid plexus of the lateral ventricle
  • upper midbrain
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33
Q

where is the BBB absent

A
  • pineal body
  • area postrema
  • median eminence of the hypothalamus
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34
Q

which AA supply the brain and where do they run

A

internal carotid and vertebral aa; subarachnoid space and then give off cerebral aa

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35
Q

the 2 posterior spinal a branch off of what

A

vertebral or pica

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36
Q

what is hydrocephalus

A

increase in cerebral mass/size due to CSF

present in:

  • ventricular space
  • subarachnoid space
  • or both
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37
Q

what does the anterior choroidal a supply

A
  • choroid plexus of lateral ventricle
  • internal capsule
  • basal ganglia
  • thalamus
  • rostral midbrain
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38
Q

the posterior inferior cerebellar a supplies

A
  • posterior inferior portion of cerebellum
  • posterolateral aspect of the medulla
  • choroid plexus of the fourth ventricle
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39
Q

what is the difference b/n and epidural hematoma and subdural hematoma

A

epidural is arterial blood; subdural is venous

40
Q

what is communicating hydrocephalus

A

combination of infratentorial external hydrocephalus and internal hydrocephalus

41
Q

the anterior inferior cerebellar a is located

A

in the pontobulbar sulcus

42
Q

what are the symptoms of central cord syndrome

A

–central necrosis and cavitation of the spinal cord

-sensory and motor deficits to UE>LE and distal musculature> proximal

43
Q

what is the major supply to the inferior 2/3 of the spinal cord

A

great anterior artery of adamkiewicz

44
Q

what does the posterior pericallosal a (of the posterior cerebral a) supply

A

anastomoses with anterior pericallosal a of the anterior cerebral a

45
Q

what happens when the great anterior artery of adamkiewicz is compromised

A

ischemic necrosis of spinal chord (partial or complete transection)

46
Q

what allows CSF to go from teh 4th ventricle to the subarachnoid space of the spinal cord

A

foramen of magendie

47
Q

what does the great anterior artery of adamkiewicz arise from

A

left inferior intercostal or superior lumbar aa and contributes to the anterior spinal a

48
Q

how do the pontine aa branch to their locations

A

pie-wedge like

-this is seen also with the necrosis they cause

49
Q

in communicating hydrocephalus, CSF cannot move over brain and be absorbed at arachnoid villi to go into the superior saggital sinus, what does this cause

A
  • hypertropy of ventricles (internal hydrocephalus)
  • accumulation of CSF in infratentorial space (external hydrocephalus)
50
Q

what occurs with thrombosis of straight sagittal sinus or left transverse sinus

A

-ischemia and/or necrosis of deep brain (usually fatal)

51
Q

the anterior cerebral a supplies what

A

runs next to the olfactory and optic nn and supplies:

  • anterior 2/3 of the medial side and supero-lateral portion of the hemisphere
  • paracentral lobule region (sensation and motor to LE)
52
Q

where are athe lateral ventricles

A

between each cerebral hemisphere

53
Q

epidural hematoma is d/t

A

fracture of the pterion that ruptures the meningeal a

-runs b/n dura mater and skull

54
Q

occlusion of the anterior cerebral a affects what

A

paracentral lobule region and causes contralateral paresis and/or paraesthesia of leg and foot

55
Q

the posterior cerebral a has what branches

A
  • penetrating branches
  • temporal branches
  • perieto-occipital a
  • calcarine a
  • posterior pericallosal a
56
Q

the uncus is a part of what lobe

A

temporal

57
Q

what occurs with a great vein of galen varice

A

may compress pineal body and posterior commissure

58
Q

where does the basal v of rosenthal go

A
  • runs next to the cerebral peduncle
  • receives middle deep cerebral and anterior cerebral vv
  • drains into the great v of galen and then to straight sinuses
59
Q

what does the calcarine a of the posterior cerebral a supply

A

primary visual cortex

60
Q

uncal herniation is when

A

uncus hernaites through tentorial notch (opening in tentorium cerebelli)

61
Q

occlusions in the parietal branches of the middle cerebral a cause

A

interpretive disorders and body neglect

62
Q

what are some symptoms of uncal herniation

A

unilateral dilating pupil

-CN 3 compression (down and out)

late sx

  • contralateral hemiparesis and respiratory compromise
  • kernohans notch
63
Q

the superior cerebellar a supplies

A
  • superior lateral portion of cerebellum
  • deep cerebellar nuclei
  • part of pons and midbrain
64
Q

what are the branches of the middle cerebral a

A

central a - primary motor and somesthetic cortices

frontal brs - premotor and prefrontal cortices as well as broca’s area in dominant hemisphere

parietal brs - association cortex

temporal brs - primary auditory cortex

angular a - supramarginal and angular regions as well as wenicke’s area in dominant hemisphere

65
Q

what is tonsilar herniation

A

acute and rapidly fatal

  • cerebellar tonsils herniate through foramen magnum
  • compresses medulla and leads to respiratory arrest
66
Q

the anterior inferior cerebellar a supplies

A
  • anterior inferior portion of cerebellum
  • superior and middle cerebellar peduncles
  • part of brainstem
67
Q

the anterior cerebral a has what branches

A
  • recurrent a of heubner
  • anterior communicating a
  • cortical branches

—anterior pericallosal a

—callosomarginal a

68
Q

why is the anterior choroidal a prone to thrombosis

A

long course in subarachnoid space

69
Q

spinal cord trauma may interrupt blood to spinal cord especially if supplied by 2 arterial supplies such as

A

at C2-3, T1-4, and L1 (at the enlargements)

70
Q

where are the obstruction sites of internal hydrocephalus

A

interventricular foramen

cerebral aqueduct

medial and lateral aperatures

71
Q

the blood brain barrier is made of what structures

A
  • endothelial cell layer
  • basement membrane
  • pericyte
  • foot processes of astrocytes and oligodendrocytes
72
Q

what are the clinical signs of hydrocephalus in infants and young children

A

increased intracranial pressure which can enlarge sutures

papilledema

73
Q

what connects the lateral and 3rd ventricle

A

foramen of monro

74
Q

what can compromise the great anterior artery of adamkiewicz

A

thoracolumbar fracture or surgical repair of AAA

75
Q

the posterior inferior cerebellar a is a branch of

A

the vertebral a

76
Q

the labyrinthine a is a branch of

A

basilar a or off AICA (anterior inferior cerebellar a)

77
Q

what are the symptoms of a falx herniation

A
  • headache
  • contralateral leg weakness
  • sometimes no clinical symptoms
78
Q

which plexus forms the majority of the csf

A

lateral and 4th ventricle

79
Q

the pontine aa supply

A

medial and lateral aspects of the pons

80
Q

what happens with a falx herniation

A

cingulate gyrus can herniate

81
Q

what is external hydrocephalus

A

communicating hydrocephalus (too much CSF in the subarachnoid space)

-the ventricles are normal sized

82
Q

what symptoms can occur as a result of a posterior cerebral a occlusion

A

ischemic necrosis of the primary visual cortex

-causes contralateral homonymous hemianopsia with macular sparing

83
Q

where is the 4th ventricle

A

between the cerebellum and pons

84
Q

what is kernohans notch

A

uncal herniation causes pressure on the ipsilateral brain stem

  • contralateral limb weakness
  • increased pressure pushes brainstem into tenotorium cerebelli
85
Q

the superior cerebellar a is located posterior to

A

CN 3

86
Q

where does the straight sagittal sinus normally drain to

A

left transverse sinus

87
Q

what is the main a of the internal ear

A

labyrinthine a

88
Q

the posterior spinal aa supply

A
  • dorsal roots and about 75% of the posterior columns
  • along with radicular aa they supply peripheral margins of the cord
89
Q

what causes central cord syndrome

A

disruption of blood flow to the anterior spinal a

  • caused by:
  • thrombosis or hyperextension of the neck
  • ischemia of the central region of the cord
90
Q

where does the superior sagittal sinus typically drain to

A

right transverse sinus

91
Q

what aa make up the circle of willis

A
92
Q

what makes up the anterior circulation of the brain

A

internal carotid and branches

  • opthalamic a
  • anterior choroidal a
  • anterior cerebral a
  • middle cerebral a
93
Q

what is associated with children and elderly for subdural hematomas

A
  • children - skull fracture
  • elderly - fragile blood vessels
94
Q

what makes CSF

A

ependymal cells of the choroid plexuses

95
Q

where do we pull CSF

A

L4-5

96
Q

what can cause posterior cerebral a occlusion

A

thrombosis and uncal herniation

97
Q

what is the anterior inferior cerebellar a close to

A

CN 6, 7, 8, and the flocculus of the cerebellum

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