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COM: Neuro (Exam I) > Lecture 3: Craniofacial Vasculature I & II > Flashcards

Lecture 3: Craniofacial Vasculature I & II Flashcards

1
Q

The vertebral artery supplies _____% of the blood supply to the brain and terminates as the ________ artery.

A

20%; basilar

  • Supplies posterior circulation -> brainstem, cerebellum, occipital lobe
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2
Q

Internal carotids supply 80% of the blood to the ____________________

A

Circle of Willis -> anterior circulation of the brain, which is most of the cerebral hemispheres and upper brainstem

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3
Q

Significant shunting of blood from one region of circulation of the brain to another, such as anterior to posterior, may result in what 2 conditions?

A

Hyperperfusion and cerebral edema

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4
Q

What is subclavian steal syndrome?

A

During exercise, blood is shunted from the vertebral system, which supplies the brain, into the distal subclavian artery, which supplies the ipsilateral extremity -> this is due to the obstruction of the subclavian artery proximal to the vertebral artery

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5
Q

What are the clinical signs and symptoms of vertebro-basilar insufficiency?

A

Dizziness
Cranial nerve dysfunction
Paralysis
Loss of consciousness

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6
Q

What are the 3 possible causes of subclavian steal syndrome?

A

Obstruction of the subclavian artery proximal to the vertebral artery

Episodic increase in peripheral circulatory demand in associated extremity (usually due to physical work or exercise)

Shunting of blood from the vertebro-basilar circulation into the distal subclavian artery

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7
Q

**Subclavian steal syndrome is due to an obstruction of the ___________________

A

Proximal Subclavian artery

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8
Q

**Regarding blood supply to the brain, subclavian steal syndrome may cause ______________

A

Vertebro-basilar insufficiency

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9
Q

**The basilar artery receives its blood supply from the ____________

A

Vertebral artery

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10
Q

**The terminal branches of the external carotid artery are the ____________ and __________

A 
Superficial temporal (very clinically relevant)
Maxillary
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11
Q

What is the termination of the maxillary artery?

A

sphenopalatine artery

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12
Q

**The facial artery courses thorugh the ___________

A

Submandibular salivary gland

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13
Q

**The vertebral artery passes through the _________ of cervical vertebrae _________

A

Courses superiorly through the transverse foramina of cervical vertebrae 6-1

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14
Q

**The ________ is embedded in prevertebral fascia just posterior to the common carotid artery

A

Cervical Sympathetic trunk (deepest structure you will see in the neck)

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15
Q

**The retromandibular vein has a direct relationship with the _________ nerve

A

Facial

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16
Q

**The thoracic duct drains into the _________

A

Junction of the IJV (brachiocephalic subclavian area)

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17
Q

**The posterior group of superficial cervical LNs are distributed adjacent to the _________

A

External jugular vein

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18
Q

**The distal branches of the inferior thyroid artery have a direct relationship with the _______ nerve

A

Phrenic nerve

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19
Q

What s external hydrocephalus?

A

An excess accumulation of CSF in the subarachnoid space with concomitant enlargement of that space by compression of the CNS

May be supratentorial, infratentorial, or both

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20
Q

What is supratentorial external hydrocephalus most commonly associated with?

A

Senile atrophy of the cortex -> ex. Alzheimer’s disease

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21
Q

Infratentorial external hydrocephalus is seen in combination with what?

A

Communicating hydrocephalus

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22
Q

What is internal hydrocephalus?

A

Noncommunicating hydrocephalus

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23
Q

What is internal hydrocephalus due to?

A

The obstruction of…

Intraventricular foramen (3rd ventricle choroid plexus ependymoma)

Cerebral aqueduct (midbrain astrocytoma)

Medial and lateral foramina (Arnold Chiari malformation, dandy walker cyst)

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24
Q

What does internal hydrocephalus result in?

A

Dilation of the ventricles proximal to the obstruction -> it may be present in combination with external hydrocephalus (communicating hydrocephalus)

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25
Q

What is communicating hydrocephalus?

A

Combination of infratentorial external and internal hydrocephalus -> communicating means the CSF is getting out of the ventricles into the subarachnoid space

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26
Q

Where is the most common point of obstruction in communicating hydrocephalus?

A

Subarachnoid space at the level of the tectorial notch -> my prevent the flow of CSF from infrantentorial to supratentorial regions

**This space may become obstructed due to adhesions and fibrosis in the subarachnoid spaces from past inflammation (infantile meningitis), cerebral edema or uncalled herniation

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27
Q

What is the result of communicating hydrocephalus?

A

Hypertrophy of the ventricles and an accumulation of CSF in the infratentorial subarachnoid space.

  • Neurosurgically, a CSF shunt or tube is inserted into the cerebellomedullary cistern (cisterna magna) in order to drain the excess amount of CSF
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28
Q

**Where is CSF produced?

A

Choroid plexus

29
Q

**Where is CSF resorbed?

A

Arachnoid villi

30
Q

**Atrophy of the cerebral cortex may result in what?

A

External hydrocephalus

31
Q

**Occlusion of the cerebral aqueduct would result in ________ of the __________ and ________

A

Hydrocephalus, 3rd and lateral ventricles

32
Q

**Occlusion of the right interventricular foramen would result in ___________ of the _________

A

Hydrocephalus of the 3rd and lateral ventricles

33
Q

**Occlusion of the right interventricular foramen would result in ____________ of the __________

A

Hydrocephalus of the lateral ventricle

34
Q

**Obstruction of the subarachnoid space at the level of the tectorial notch may result in _____________________

A

Communicating hydrocephalus

35
Q

***CSF enters the subarachnoid space via the ____________ and __________

A

Medial and lateral foramina

36
Q

**Secondary to a subarachnoid hemorrhage blood in the CSF may occlude the _________ and result in ________

A

Arachnoid villi, secondary (chemical) meningitis

37
Q

Regional cerebral blood flow of _________ml/100gm tissue/min is classified as ischemic penumbra

A

10-20

**normal is 53

38
Q

What is an ischemic penumbra?

A

Watershed region that is too ischemic to function, yet critically viable. Stroke therapy is directed at rescuing this ischemic penumbra by improving tissue acidosis and oxygen delivery

39
Q

What are autoregulation dysfunction and edema seen with an ischemic penumbra due to?

A

Ischemic tissue acidosis and resultant “luxury perfusion” of adjacent normal tissue

40
Q

The internal carotid and vertebral arteries pierce the dura, course in the _______________ and their branches penetrate into the brain parenchyma. As they do so, they are surrounded by the tapered ________________

A

Subarachnoid space; perivascular space (Virchow-Robin)

41
Q

The terminations of the internal carotid artery, vertebral artery and the circle of willis are located in the _________________

A

Subarachnoid space

42
Q

The circle of willis is comprised of which arteries?

A

ANterior cerebral artery
Anterior communicating artery
Posterior communicating artery
Posterior cerebral artery

43
Q

The parade trial lobular and occlusion of the anterior cerebral artery or superior sag git always sinus may result in sensory and/or motor deficits where?

A

In the contralateral leg and foot

44
Q

Middle cerebral artery occlusion may result in sensory and/or motor deficits where?

A

In the contralateral upper limb and head

45
Q

What are the 3 main arteries responsible for posterior circulation to the brain?

A

Vertebral artery
Basilar artery
Posterior cerebral

46
Q

Disruption of blood flow to the ___________ artery results in central cord syndrome

A

Anterior spinal artery

47
Q

**What is central cord syndrome?

A

An ischemia of the central region of the spinal cord due to disruption of blood flow to the anterior spinal artery.

48
Q

The __________________ artery usually arises from the left inferior intercostal or superior lumbar arteries and contributes to the anterior spinal artery. It is the major blood supply to the inferior 2/3 of the spinal cord and may be compromised secondary to thoracolumbar fracture or surgical repair of an abdominal aortic aneurysms

A

Great anterior artery of Adamkiewicz

49
Q

Blood supply to the cervical and lumbar enlargements is fairly consistent. However, trauma to the spinal cord may interrupt the blood supply to the cord, especially in those vulnerable regions served by 2 arterial supplies. The result of ischemic necrosis is a partial or complete transaction of the spinal cord. The areas that are most frequently involved are adjacent to the enlargements at what 3 spinal segments?

A

C2-3, T1-4 and L1

50
Q

What is the major blood supply to the inferior 2/3 of the spinal cord?

A

Great anterior artery of Adamkiewicz

51
Q

**The vertebral arteries merge to form the _______

A

Basilar artery

52
Q

**The anterior spinal artery is usually a branch of the ___________

A

Vertebral artery

53
Q

**The posterior spinal artery is usually a branch of the ____________

A

Posterior inferior cerebellar artery (PICA)

54
Q

**The internal carotid artery bifurcates into the _________ and _______

A

Middle cerebral artery (MCA) and anterior cerebral artery (ACA)

55
Q

**The arterial circle (of willis) is located in the _________

A

Subarachnoid space

56
Q

**Rupture of the anterior communicating artery results in the presence of blood in the _____________

A

Subarachnoid space

57
Q

**The most common area for infarcts in the cerebrum is in the region of the __________

A

Basal ganglia, internal capsule

58
Q

**The superior saggital sinus usually empties into the _____________

A

Right transverse venous sinus

59
Q

**The sigmoid sinus empties into the ___________ at the _______

A

IJV at the jugular foramen

60
Q

**The superior opthalmic vein empties into the _________

A

Cavernous sinus

61
Q

What is the superior sagittal sinus?

A

A large venous sinus that extends from the crista a galli to the confluens in the area of the attached border of the falx.

It drains most of the cerebral cortex and in most cases opens into the right transverse sinus

62
Q

**The confluens receives the superior sagittal, straight and occipital sinuses. In 2/3 of cases, the superior sagittal sinus empties directly into the _________ sinus and the straight sinus drains directly into the _________ sinus

A

Right transverse sinus; left transverse sinus

63
Q

What does thrombosis of the posterior portion of the superior venous sinus or right transverse sinus result in?

A

Cortical ischemia and/or necrosis

64
Q

What does thrombosis of the posterior portion of the straight venous sinus or left transverse venous sinus result in?

A

Ischemia and/or necrosis of structures in the deep cerebrum -> this is usually fatal!

65
Q

Describe a falx herniation

A

Because the falx only partially separates the cerebral hemispheres, unilateral space-occupying lesions of the cerebrum may cause the cingulate gyrus to herniate across the midline beneath the free edge of the falx, AKA midline shift.

66
Q

What is a Tentorial/uncal herniation?

A

The profuse, high pressure bleeding rapidly expands the epidural space, thereby pressing upon the adjacent cerebral hemisphere and herniating the cerebrum under the falx cerebri (falx herniation) and/or through the tentorial notch

Herniation of the uncut through the incisura compresses and displaces the midbrain. Bilateral compression of the midbrain reticular formation results in a progressive decrease in the level of consciousness

67
Q

Describe a tonsillar herniation

A

Space expanding or occupying masses in the posterior cranial fossa may cause the cerebellar tonsil to herniate through the foramen magnum, which can compress the lower medulla/upper cervical spinal cord -> seen in Arnold-Chiari malformation

68
Q

Describe an epidural hematoma

A

A fracture at the pterion may rupture the middle meningeal artery (or one of its branches) and result in an epidural hematoma. The pressing upon the adjacent cerebral hemisphere can cause a midline shift of the cerebral hemispheres (falx herniation) and/or an uncal herniation

69
Q

What is papilledema?

A

Increased intracranial pressure applies a cuff-like pressure to the small veins on the optic nerve of the adjacent subarachnoid extension. The decreased venous drainage Fromm the retina results in edema of the retina and swelling of the optic disc

COM: Neuro (Exam I) (13 decks)

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