Cerebrovascular Anatomy, Pathology, Patient History & Physical, Symptoms

Question 1

what are the aortic arch branches

Answer 1

innominate artery, left CCA, and Left subclavian artery

Question 2

what are the branches of the innominate artery

Answer 2

right CCA, right subclavian

Question 3

what is the first brach off the subclavian arteries

Answer 3

vertebral arteries

Question 4

ICA is the primary blood supply to

Answer 4

the brain, low resistance

approx. 80% of volume moves through the CCA to the ICA

ICA rarely has branches

Question 5

how many PRIMARY branches does the ECA have, what are they called

describe ECA flow pattern and supply

Answer 5

8 primary branches

SUPERIOR THYROID, ascending pharyngeal, lingual, occipital, FACIAL, posterior auricular, maxillary, SUPERFICIAL TEMPORAL ARTERY

ECA supplies face and scalp, high resistance

Question 6

collateral pathway for ECA-ICA

Answer 6

via ophthalmic and orbital artery

Question 7

collateral pathway for occipital branch of the ECA

Answer 7

Atlantic branch of the vertebral

Question 8

collateral pathway for cervical subclavian branches

Answer 8

vertebral artery branches

Question 9

what is the largest collateral pathway in the brain, and explain what it does and why

Answer 9

circle of willis

provides pathway from left to right hemispheres as well as the anterior and posterior circulation

right and left ICA and right and left vertebral arteries join into an anastomotic “ring” of arteries located at the base of the brain (circle of willis)

Question 10

describe posterior circulation of circle of willis

Answer 10

first branch of the subclavian unites to form the basilar artery
basilar artery divides into the posterior cerebral arteries

Question 11

atherosclerosis obliterans (ASO)

Answer 11

most common pathology affecting the extracranial carotid vessels
deposition of plaque components within the arterial wall (between the intimal and media)

Question 12

type of atherosclerotic plaque: fatty streak

Answer 12

thin layer of lipid material in the intimal layer

Question 13

type of atherosclerotic plaque: fibrous plaque

Answer 13

accumulation of lipids

Question 14

type of atherosclerotic plaque: complicated lesion

Answer 14

a fibrous plaque that includes fibrous tissue and collagen

Question 15

type of atherosclerotic plaque: ulcerative lesion

Answer 15

fibrous cap deteriorates - increased incidence of embolus

Question 16

type of atherosclerotic plaque: intraplaque hemorrhage

Answer 16

rupture of the vase vasorum with bleed inside the plaque

Question 17

most common location for fibromuscular dysplasia

Answer 17

distal ICA

Question 18

neointimal hyperplasia

Answer 18

intimal thickening from rapid, smooth muscle cell growth

identified following trauma/endarterectomy (causes damage to endothelium and subsequent regeneration

occurs 6-24 months post injury

Question 19

carotid body tumor

Answer 19

a small sensory organ just above the bifurcation

also known as paraganglioma, highly vascular structure, usually fed by branches of the external carotid artery

asymptomatic until large

treatment is usually ligation of feeding vessels and/or surgical excision

Question 20

fibromuscular dysplasia (FMD)

Answer 20

rare condition resulting in abnormal cellular growth in the walls of medium and large arteries

primarily affects the carotid and renal arteries

most common in women 40-60 years old

increased risk of aneurysm or dissection

“string of pearls appearance on ultrasound”

Question 20

carotid dissection

Answer 20

tear in the intimal lining
creates false lumen
different flow patterns in true and false lumens - typically high resistance in false lumen