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Blood Supply, Hemorrhage, And Herniation Flashcards

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1
Q

What is the circle of willis?

A

Ring of 9 arteries supplying blood to the cerebral hemispheres

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2
Q

What is the circle of willis composed of?

A

6 large arteries anastomoses via 3 small communicating as.

Communicating (ant.) -1
Anterior cerebral a. -2
Internal carotid -2
Communicating (posterior) -2
Posterior cerebral a. -2
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3
Q

what comes off of basilar a?

A

S.P.A.

Superior cerebellar a.
Pontine as.
Anterior cerebellar a.

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4
Q

What makes the basilar a.?

A

United vertebral arteries

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5
Q

What comes off the vertebral as?

A

Posterior inferior cerebellar a. (PICA)

1 anterior spinal a.

2 posterior spinal a.

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6
Q

What comes off the ICA?

Are they part of circle of willis?

A

Anterior cerebral a. - yes

Middle cerebral a. - no
Ophthalmic a. - no
Anterior choroidal as. - no

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7
Q

What supplies the superior, middle and inferior cerebellar peduncles?

A

Superior — Superior cerebellar a.

Middle — anterior inferior cerebellar a. (And some superior cerebellar a.)

Inferior — posterior inferior cerebellar a. (From Vert. A.)

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8
Q

What vasculature is CN 2 close to?

A

ICA
Ant. Comm. a.
Ant. Cerebral a.

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9
Q

What happens if there is an aneurysm in ICA, Ant. Comm. a. Or ACA?

A

Compression of CN2 - visual deficits

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10
Q

What vasculature is CN 3 close to?

What happens to compress CN 3? Result?

A

B/w Posterior cerebral a. & Superior cerebellar a.

(Post communicating also close)

Aneurysm can compress- Oculomotor pasly (down and out)

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11
Q

What vasculature is CN 6 close to?

What can cause compression of CN 6? Result?

A

B/w labyrinthine and AICA

Aneurysms - Abducens nerve palsy

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12
Q

What vasculature is CN 5 close to?

What can cause irritation of CN5? result?

A

Superior cerebellar a.

Aberrant loops can cause trigeminal neuralgia or Tic Douloureux

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13
Q

What vasculature is CN 7 close to?

What can cause irritation of CN 7? Result?

A

Close to AICA

Aberrant loops - CN 7 palsy with all effects from origin

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14
Q

What are the four parts of the internal carotid a.?

A

Cervical part
Petrous part
Cavernous part
Cerebral part

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15
Q

What does the cervical part of the ICA do?

A

Anterior circulation

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16
Q

When does the cervical part bifurcate?

What does it travel thru?

A

Carotid canal

Anterior to Transverse processes of upper 3 vertebrae

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17
Q

Where is the petrous part of the ICA?

Where does it course?

A

Carotid canal in petrous part of temporal bone

Upward and medially above foramen lacerum

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18
Q

Where is the cavernous part of the ICA located?

What surrounds it?

A

In cavernous sinus

Sympathetic plexus surround it - CN 3, 4, 5, 6 (6 is the closest)

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19
Q

What does the vertebral a. Do?

A

Posterior circulation

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20
Q

What are the 3 parts of the vertebral a. ?

A

Cervical part
Atlantic part
Intracranial part

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21
Q

Where is the cervical parts of Vertebral As. Found?

A

In the transverse foramina of the 1st six cervical vertebrae

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22
Q

Where do you find the Atlantic part of the vertebral a. ?

What does it go thru?

A

Laying on C1 making an Acute angle

Thru perforated dura and arachnoid thru foramen magnum

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23
Q

Where is the intracranial part of the vertebral a. Found?

A

In cranium

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24
Q

What does the intracranial parts of the vertebral As. Do?

A

Unites at caudal border of pons to form basilar a.

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25
When does vertebral basilar insufficiency occur?
Occurs when there is reduced blood flow from Vertebral A. To brain
26
What can cause Vertebral Basilar insufficiency?
1. Hyperextension of head (compressing vertebral A. B/w C1 and occipital bone at that angle) 2. Extreme head rotation “Bow-hunter’s syndrome” (Causes torsion of Vert. A. And narrows it)
27
What is subclavian steal syndrome?
Subclavian a. Steals blood from vertebral as. Blood will go up and down to other subclavian a.
28
When does Subclavian steal syndrome occur?
If there is an occlusion of the subclavian a. PROXIMAL to where the vertebral arteries come off
29
What does the ACA supply?
Most medial and superior surface of frontal and temporal lobes
30
How many segments does the ACA have?
5
31
What is A1 called? | Where is it from?
Precommunicating ICA to ant. Communicating
32
What is A2 called? | Where is it from?
Infracallosal segment Ant. Comm. a. To where rostrum and genus of corpus callosum meet
33
What is A3 called? | Where is it from?
Precallosal Attaches around Genu of corpus callosum - ends when vessels turn caudal
34
What is A4 called? | Where is it from?
Supracallosal Superior to corpus callosum
35
What is A5 called? | Where is it from?
Postcallosal Caudal to corpus callosum
36
Where is the peri colossal a.?
Up against the corpus callosum
37
Where is the callosomarginal a.?
Around cingulate gyri
38
What does the MCA supply?
Lateral surface of frontal and parietal lobes | Superior part of temporal lobe
39
How many segments of the MCA are there?
4
40
What is M1 called? | Where is it from?
Sphenoidal (horiz.) segment ICA to bifurcation at insula
41
What comes off of M1? What do they supply?
Lenticulostriate arteries Supply internal capsule
42
What is M2 called? | Where is it from?
Insular segment Bifurcation at insula to circular sulcus of insula (makes a right turn)
43
What is M3 called? | Where is it from?
Opercular segment Circular sulcus of insula to external surface of lateral fissure
44
What is M4 called? | Where is it?
Cortical segment Out on cerebral cortex
45
What does PCA supply?
Occipital lobe and inferior temporal lobe
46
Where is P1 from and to?
Basilar bifurcation to PCA
47
Where is P2 from and to?
PCA to around midbrain
48
What is P3 called? | Where is P3 from and to?
Quadrigeminal segment Segment w/in quadrigeminal cistern
49
Where is P4 from and to?
Cortical segment Out on cerebral cortex
50
What are the border zones?
Areas between cerebral arteries that are susceptible to damage under conditions of sudden systemic hypotension or hypoperfusion
51
What happens if there is damage in the border zone between: ACA and MCA?
Motor/sensory deficits Language issues Behavioral problems
52
What happens if there is damage in the border zone between: MCA and PCA?
Vision and language deficits
53
What is the blood supply to the medulla?
Vetebral a. 2 posterior spinal a. 1 anterior spinal a. Posterior inferior cerebellar a. (Plus paramedian branches of caudal portions of basilar a.)
54
What do the posterior spinal As. Supply?
Spinal cord | Dorsal aspect of medulla
55
What does PICA supply?
Lateral aspect of medulla
56
What does AICA supply?
Medulla ***Cochlear nuclei for CN 8
57
What does the Anterior Spinal a. Supply?
Medial aspect of the medulla
58
What is the blood supply to the pons?
All basilar branches ``` Paramedian branches Lon circumferential Short circumferential Branches of AICA Branches of Superior Cerebellar a. ```
59
What is the blood supply to the midbrain?
P1’s anteriomedial branches of basilar bifurcation P3 - anterolateral branches of P3 and posteiror medial choroidal as. (At level of superior colliculus) P3 and superior cerebellar as. - at level of inferior colliculus quadrigeminal branches of P3 and Posterior medial choroidal As. At level of superior colliculus Thalamogeniculate as.
60
What are some major arteries to the forebrain?
Thalamogeniculate branches of PCA Anterior choroidal a. Lenticulostriate as.
61
In the medulla: What is supplied by Anterior spinal a.?
Hypoglossal nucleus Medial lemniscus (sensory tract) Pyramid (motor tract)
62
In the medulla, what is supplied by the posterior inferior cerebellar a.?
``` Nucleus ambiguus ALS Rubrospinal tract Spinal trigeminal nucleus Spinal trigeminal tract Solitary nucleus and tract Accessory cuneate nucleus Inferior vestibular nucleus Medial vestibular nucleus Dorsal motor nucleus of vagus ```
63
In the pons what is supplied by Paramedian branches of basilar a.?
``` Abducens nucleus Medial longitudinal fasciculus Abducens n. Medial lemniscus Corticospinal fibers ```
64
In the pons, what is supplied by the Long circumferential branches of the basilar a.
``` Facial n. Mesencephalic nucleus and tract Spinal trigeminal tract and nucleus Facial motor nucleus ALS ```
65
In the midbrain, what is supplied by P1 segment of PCA?
CN 3 nucleus and nerve Medial longitudinal fasciculus Red nucleus Substantia nigra
66
What are the spinal cord arteries?
(1) Anterior spinal a. (2) Posterior spinal a. ``` Ant. spinal medullary Post. Spinal medullary Post. Radicular a. (To post. Root) Ant. Radicular a. (To ant. Root) Arterial vasocorona Segmental a. ```
67
What comes off the anterior spinal a. And what does it supply?
Sulcal artery Dorsal/ventral horns
68
What is supplies the corticospinal tract?
Anterior spinal a. | Posterior spinal as.
69
What space is the circle of willis in?
Subarachnoid space
70
Epidural hematoma: ``` Bleeds into? Common site? Source? Clinical? Ct shape? ```
- potential space b/w skull and dura mater - fx of squamous temporal bone or pterion - middle meningeal a. - lucid period of hours to 1-2 days - lens
71
Subdural hematoma: ``` Bleeds into? When? Common site? Source? Clinical? Ct shape? ```
- Subdural space - when head strikes fixed object or after lumbar punctures - venous- usually cortical veins opening into superior sagittal sinus (bridging veins) - slower accumulation of blood due to pressure and often self limiting - crescent
72
Subarachnoid hemorrhage: ``` Bleeds into? Occurs when? Source? Clinical? Ct shape? ```
- subarachnoid space - rupture of aneurysm or severe head injury - arterial bleeding from cerebral As.(circle of willis) - massive bleeding into CSF compartment; * **”worst headache of my life”***; detoriorating level of consciousness; seen in older people or those postmenopausal -spiderweb
73
Intracerebral (subpial) hemorrage: Bleeds into? Source? Clinical?
- bleeding w/in brain substance (stroke) - middle cerebral a. -complication in 2-3% of all head injuries; common w/ hypertension or degenerative arterial disease; increase risk w/ smoking or genetic FHx Commonly seen at autopsy
74
What are the causes of herniations?
``` Hemorrhage Mass/tumor Trauma Abscess Infection Metabolic conditions ```
75
Where is the supratentorial compartment?
Above tentorium Falx cerebri divides it left and right
76
Where is the infratentorial compartment?
Below tentorium cerebelli
77
What is the tentorial notch?
Continuation of Supra and infratentorial compartment
78
What is a subfalcine herniation?
Herniation in supratentorial compartment that displaces brain tissue under falx cerebri
79
What does a subfalcine herniation compress?
Compress ACA Affects the frontal and parietal lobes and lower limbs (via homunculus)
80
What can a subfalcine herniation evolve into?
Transtentorial herniation
81
What is a transtentorial herniation?
Brain is displace downward toward tentorial notch | Aka a central herniation
82
What can a transtentorial herniation compromise? Causes?
Upper brainstem CN 3 Some lower structure (basilar artery and posterior cerebral a.) Decorticating rigidity Decerebrate rigidity
83
Where is the uncus located?
Most anterior part of parahippocampal gyrus next to temporal lobe
84
What is an uncal herniation?
Uncus and parts of parahippocampal gyrus extrude over edge of tentorium cerebelli and thru tentorial notch
85
What will an uncal herniation impinge on and cause?
Impinges on midbrain Damage cerebral peduncle and motor tracts going thru that CN 3 palsy -ipsilaterally motor deficits - contralaterally
86
What is the Kernoham phenomena?
Uncal herniation that shifts the midbrain left to right -compressed cerebral peduncle on the opposite side CN 3 palsy ipsilaterally Motor deficits IPSIlaterally
87
What is a tonsillar herniation?
Cerebellar tonsils go thru foramen magnum
88
What can a tonsillar herniation compress? | What can this cause?
Medulla and upper cervical spinal cord Since the cardiac and respiratory centers are in the medulla, it can cause no heart beat =death
89
Where else will you see a tonsillar herniation?
Chiari Type II

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