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Neuro Exam 2 > 3. Blood supply, hemorrhage & herniation > Flashcards

3. Blood supply, hemorrhage & herniation Flashcards

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1
Q

What are the parts of the internal carotid A? & what are their characteristics

A
  1. Cervical: bifurcation to carotid canal
  2. Petrous: carotid canal in petrous part of temporal B
  3. Cavernous: in cavernous sinus, surrounded by sym plexus (CN 3, 4, V1, 6)
  4. Cerebral part
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2
Q

What are the parts of the Vertebral A & what are the respective characteristics?

A
  1. Cervical part: transverse foramina of C1-C6
  2. Atlantic part: lay on C1 - pass dura/arachnoid & pass thru foramen magnum
  3. Intracranial part: cranium, unite at caudal border of pons to form basilar A
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3
Q

what is vertebral insufficency & what causes it?

A

reduced blood flow from vertebral A to brain (2 possible ways)

  1. extreme hyperextension of head: compress vertebral A btn C1 & occipital bone
  2. extreme rotation of head (Bow Hunters syndrome): torsion and narrowing of vessel as you turn
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4
Q

when will the subclavian A “steal” blood from the vertebral A

A

occlusion of subclavian A proximal to vertebal A

= Subclavian Steel Syndrome

instead of blood flowing up after the 2 vertebral As converging, it goes back down to feed into the subclavian A

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5
Q

What are the relationships of CNs & the Circle of Willis?

A
  • CN II - near ICA & Anterior Communication A
  • CN III - inbtn Posterior Cerebral A, Superior Cerebellar A & close to Posterior Communicating A
  • CN V: sup cerebellar A
  • CN VI - near labyrinthine & AICA (Ant Inf. Cerebellar A)
  • CN VII: AICA
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6
Q

What are the characterisitics of the Circle of Willis?

A

= ring of 9 As that supply the cerebral hemisphere ( 6 large As anastomose via 3 small As)

= 2 Ant. Cerebral As, 2 Post. Cerebral A & 2 Internal Carotid As

=via 1 Ant. Communicating A & 2 Post. Communicating As

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7
Q

What does the Anterior Cerebral A (ACA) supply?

A

most of the medial & superior surface of the frontal & parietal lobes

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8
Q

What does the Middle Cerebral A (MCA) supply?

A

lateral surface of the frontal & parietal lobes

and superior part of the temporal lobe

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9
Q

Wht does the Posterior Cerebral A (PCA) supply

A

occipital lobe and inferior temporal

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10
Q

How are cerebral As susceptible to damage?

A

at border zones: btn As = area where terminal branches reside

damage when –> sudden systemic hypotension or hypoperfusion

anterior border zone - motor/sensory/language/behavior probs

posterior border zone - visual/language probs

*RMR brain has poor anastomoses*

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11
Q

What are the names of the segments of the ACA?

A
  1. Precommunicating: ICA to AcomA (anterior communicating A)
  2. Infracallosal: AcomA to the jxn of rostrum & genu of corpus callosum (below corpus callosum)
  3. Precallosal: arch around genu
  4. Supracallosal: superior to corpus callosum
  5. Postcallosal: caudal to corpus callosum
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12
Q

What are the segments of the MCA?

A
  1. Sphenoidal/horizontal: ICA to bifurcation at insula
    1. –> Lenticulostriate A comes off of M1
  2. Insular: in front of insula (circular sulcus of insula)
  3. Opercular: operculum area (external surface of lateral fissure)
  4. Cortical: on cortex - thru lateral sulcus
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13
Q

What are the segments of the PCA?

A
  1. Basilar bifurcation to PcomA (posterior communicating A)
  2. PcomA to around midbrain
  3. Quadrigeminal: w/i quadrigeminal cistern (*location of superior & inferior colliculi*)
  4. Cortical
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14
Q

What space is btn the cranium and periosteal dura

A

Epidural (extradural space) = potential!

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15
Q

What space is at the dura-arachnoid interface?

A

Subdural = potential

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16
Q

What is the “real space” btn the meninges? What does it contain

A

Subarachnoid space: btn arachnoid & pia

contains CSF, Circle of Willis & Vs

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17
Q

What type of hemorrhage has MCA as the source?

A

Intracerebral (subpial) hemmorrhage

  • 2-3% of all head injuries
    clinical: HTN or degenerative arterial disease
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18
Q

What are the causes of Herniation syndromes?

A

Hemorrhage

Mass/tumor

Trauma

Abscess

Infection

Metabolic conditions

=overall increased ICP

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19
Q

What are the divisions of herniation syndromes?

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A
  1. Supratentorial compartment: divided into right/left by falx cerebri
  2. Infratentorial compartment: below tentorium cerebelli
  3. Tentorial Notch: continuation of supra & infratentorial compartment

(supra / infratentorial compartment seperated by tentorium cerebelli)

20
Q

What are the characteristics of Subfalcine Herniation

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A

(AKA cingulate/falcine/falx herniation)

= Supratentorial compartment - f_alx cerebri shifted bc of mass & then displace brain tissue underneath_

  • May compress ACA (frontal/parietal lobes) => lower limb probs, both motor & sensory
  • May turn into transtentorial herniation
21
Q

What are the characteristics of transtentorial herniation?

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A

(AKA central herniation)

=brain displaced down toward tentorial notch bc increased pressure in supratentorial compartment

-hurts upper brainstem, CN III & maybe lower structures (& maybe basilar A and PCA)

(CN III compromised = parasym fibers not working –> dilated eyes bc cant constirct)

Decorticate/Decerebrate rigidity

22
Q

What can the Uncal Herniation Impinge?

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A

Impinge midbrain

-uncus & parts of parahippocampal gyrus extend over edge of tentorium cerebelli & thru tentorial notch

23
Q

Which herniation compressed the medulla and the upper cervical sp. cord?

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A

Tonsillar Herniation

  • cerebellar tonsils thru foramen magnum
  • medulla contains cardio & resp centers –> damage = dont breath & no heart rate
24
Q

What comes off of ICA

Study These Flashcards
A

ACA, MCA & PComA

25
what comes off MCA
lenticulostriate A & ant. choroidal A **_MCA is NOT apart of circle of willis!!!_**
26
What comes off of basilar A
AICA, Labyrinthine A, Superior Cerebellar A & PCA
27
what comes off the vertebal A
- anterior spinal A (supply sp. cord & medulla) - PICA (give off posterior spinal A & supply sp cord & medulla)
28
where is CN II located & how can it be injured
close to ICA, ACA & AcomA -aneurysm of any of these = compression --\> visual defects
29
where is CN III located & how can it be injured
btn PCA & superior cerebellar A close to PComA -aneurysm in any of these --\> compress --\> oculomotor palsy
30
Where is CN V located & how can it be injured
close to superior cerebellar A -if aberrant loops --\> irritate N --\> trigeminal neuralgia
31
Where is CN VI located and how can it be injured
btn labyrinthine A & AICA -aneurysm of either of these --\> compression--\> abducens N palsy
32
where is CN VII located & how can you injure it
close to AICA -aberrant loops --\> compress --\> all facial N defects
33
what A's supply the medulla
Ant. spinal A (medial) Post. spinal A (dorsal) PICA (lateral) AICA (cochlear nuclei) vertebral A & paramedian branches basilar A (upper medulla, medial)
34
what is supplies the medial medulla
ant. spinal a = hypoglossal nucleus, medial lemniscus, pyramid
35
What supplies to lateral medulla
PICA
36
what As supply the Pons
branches of basilar A -paramedian branch = medial long circumferential branch = lateral
37
what supplies the medial pons?
paramedian branch of the basilar A
38
what supplies the lateral pons?
long circumferential branches of the basilar A
39
what As supply the midbrain?
many of the As from PCA P1 (paramedian branch) = medial P3 (quadrigeminal branch) = lateral
40
what supplies the medial midbrain
P1 segment of PCA
41
What As supply the forebrain? (3 big ones mentioned in class)
1. thalamogeniculate branches of PCA ==\> lateral/medial geniculate nucleus 2. lenticulostriate As & anterior choroidal A ==\> internal capsule
42
what is the blood supply to the spinal cord
* (2) posterior spinal As- dorsal (posterior) columns & corticospinal tract * Anterior spinal A --\> sulcal A - doral/ventral horns & corticospinal tract
43
In epidural hematomas: 1. you are bleeding into \_\_\_\_\_\_ 2. the common site of injury is ______ & the source of bleed is \_\_\_\_\_\_\_ 3. you feel \_\_\_\_\_\_\_\_\_\_\_ 4. the CT shows \_\_\_\_\_\_\_
1. bleeding into **epidural space (potential space)** btn skull & dura 2. common site = **pterion &/or squamous part of temporal B** & source = **middle meningeal A** 3. you feel **poorly**/unconscious for a **little bit --\> then feel better --\> then rapid decline** 4. CT shows **lens shape** treat: surgically
44
Which hematoma is a result of venous bleeds?
**Subdural Hematomas** Source: **venous blood; cortical Vs like BRIDGING Vs that open up into superior sagittal sinus** 1. bleed btn dura & arachnoid 2. due to head strike, fall, car accident 3. causes a **slow accumulation** of blood b/c of pressure; self limiting (may occur after lumbar puncture) 4. CT = crescent
45
What are the clinical signs & source of bleeding for subarachnoid hemorrhages
clinical signs "worst headache ever" ; deteriorating levels of consciousness (CT = spider like) source = ARTERIAL blood - _circle of willis_ (commonly with rupture of aneurysm)
46
what are the two possible ways uncal herniations can be a problem
1. damage cerebral pedencle & CN III on same side --\> CN III prob same side and motor deficit opp side 2. _Kernoham phenomenon:_ herniation shifts midbrain & affects CN III on side of herniation but also cerebral peduncle on OPP side of herniatio --\> CN III & motor deficit on SAME SIDE!
47
What is a Subpail hemorrhage
aka intracerebral/ intraparanchymal/ hemorragic stroke = bleeding w/i brain tissue (stroke) Source: **MCA** risk factors: HTN, degnerative arterial disease, genetics, smoking

Neuro Exam 2 (23 decks)

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