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CNS Blood Supply Flashcards

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1
Q

What blood vessels of the brain are part of the anterior blood supply?

A
  • middle cerebral artery
  • anterior cerebral artery

off of the ICA

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2
Q

What blood vessels of the brain are part of the posterior blood supply?

A

posterior cerebral artery

off of vertebral-basilar artery

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3
Q

What structures of the brain get blood supply from the middle cerebral artery?

A

lateral areas of brain
- broca’s area
- wernicke’s area
- primary motor and somatosensory cortex

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4
Q

What structures of the brain get blood supply from the anterior cerebral artery?

A

supplementary motor area
leg of somatosensory and motor

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5
Q

What structures of the brain get blood supply from the posterior cerebral artery?

A

medial-lower supply
- temporal lobe
- occipital lobe (calcarine fissure)
- medial temporal memory system
- visual system

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6
Q

What is the role of the anterior spinal artery?

A

supply blood to the anterior 2/3 of spinal cord

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7
Q

What is the role of the 2 posterior spinal arteries?

A

supply blood to the posterior 1/3 of spinal cord

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8
Q

What does ischemia mean?

A

to keep back blood

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9
Q

What is cerebrovascular disease?

A

any disease that affects the blood vessels of the brain

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10
Q

What is ischemic stroke?

A

stroke resulting from insufficient blood flow that causes tissue death

80% of all strokes

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11
Q

What is hemorrhagic stroke?

A

rupture of blood vessel causing bleeding effect

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12
Q

What is FAST when it comes to stroke?

A
  • the faster someone gets medical attention better the outcome

Face
Arm
Speech
Time needed to act

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13
Q

What are the risk factors to ischemic stroke?

A
  • age
  • cardiac disease
  • hypertension
  • blood lipids
  • diabetes mellitus
  • smoking
  • obesity
  • excessive alcohol consumption
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14
Q

How does a stroke work?

A
  • lack of oxygen due to obstruction preventing blood supply distally
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15
Q

What is ischemic necrosis?

A

neuronal death caused by lack of blood flow

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16
Q

What is an infarct?

A

area of death brain tissue

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17
Q

What is a thrombus?

A

blood clot attached to the wall of an artery

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18
Q

What is a embolus?

A

fragment of thrombus that has become loose and traveled to another area

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19
Q

What is a factor unique to the cerebral arterial supply that helps mitigate stroke?

A
  • anastomoses help redirect blood if there is an occlusion, stopping a stroke
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20
Q

What is important when it comes to the speed of an occlusion?

A

if a an occlusion forms slowly, it allows for more time for circulation to redirect

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21
Q

What artery connects the ICA and ECA in the skull?

A

opthalmic artery

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22
Q

How can thrombosis cause vascular problems?

A
  • decrease blood flow
  • fragment off and become embolus
  • hemorrhaging center of thrombus creating high pressure, hard for blood to pass
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23
Q

What is cerebral embolism the result of?

A

most often cardiovascular disease

75% of cardiac emboli become lodged in the brain

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24
Q

What is a transient ischemic attack?

A

a “mini stroke” that lasts 2-15 min, rarely 30 min, resolves on its own

strong predictor or stroke

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25
What are the symptoms of ischemic attack?
- numbness, tingling, weakness in face, arm, or leg one side of the body - difficulty walking - difficulty talking or understanding what others say - confusion - difficulty with vision in one/both eyes - dizziness
26
How does the anatomy of arteries impact the effect of stroke?
ACA, MCA, PCA have a stem that if occlusion lies there, affects will happen in areas supplied by penetrating and cortical branches
27
What is important to remember about the location of occlusion?
the more proximal the location of occlusion, more widespread and severe the deficits
28
What artery in the brain is most common to suffer and ischemic stroke?
Middle cerebral artery
29
Why does infarction of the cortical branches of a vessel cause contralateral sensory loss and weakness of the UMN?
b/c it primarily supplies primary motor and somatosensory parts
30
What are the effects of dominant and on-dominant hemispheres suffering ischemic stroke of the MCA?
dominant (left): aphasia non-dominant (right): problems wit prosody and unilateral visuospatial deficits
31
What is prosody?
ability to interpret the meaning behind tone of voice (produce or understand)
32
How does occlusion of the ACA affect the brain?
may cause no symptoms due to collateral circulation
33
What does ischemic stroke of the ACA affect the most?
UMN weakness and sensory deficits of contralateral lower extremity and bowel and bladder dysfunction
34
How does a bilateral ACA infarction occur?
- anomaly in circle of willis - sensory motor syndrome involving both LEs due to no collateral circulation (causing occlusion of both ACAs
35
What does unilateral occlusion of the PCA cause?
contralateral hemianopsia
36
What is bilateral PCA infarction?
- when single embolic or thrombotic occlusion of upper basilar artery
37
What is the result of bilateral PCA infarction?
bilateral homonymous hemianopsia (cortical blindness)
38
What happens when the inferomedial temporal lobes are infarcted?
severe memory problems if also affecting occipital lobe, can't interpret visual info and memorize who someone is
39
How much of the internal carotid artery must be occluded to produce a carotid-border zone syndrome?
70%
40
What is important about carotid-border zone syndrome?
max ischema occurs in watershed areas there is not enough pressure in ICA to get to distal cortical branches
41
What causes Lacunar syndrome?
occlusion of small, deep, penetrating vessels
42
What are the symptoms of lacunar syndrome?
sensory and/or motor deficits occur without cognitive deficits face, leg, arm are typically affected equally
43
When do 1/3 of thrombotic strokes occur?
during sleep
44
What is important about the timing of catching a stroke?
decision if ischemic or hemorrhagic must be made within 2-4.5 hours
45
How are ischemic strokes treated?
anticoagulation, while hemorrhagic cannot
46
How does prognosis look if someone survives a stroke?
favors long term improvement related to edema 3-4 days after
47
What is the prognosis of ischemic stroke syndromes?
severe to least severe - large strokes - presence of edema or hemorrhage - stroke in many territories - single territory MCA > ACA > PCA
48
What is a hemorrhagic stroke?
Avery rupture and blood flows into intracranial structures, brain tissue, ventricles, subarachnoid space
49
What are the types of hemorrhagic stroke?
- primary hemorrhagic stroke - rupture of aneurysms - arteriovenous malformations
50
What are the risk factors of a hemorrhagic stroke?
hypertension anticoagulation inherited coagulation deficits (hemophilia)
51
How does hemorrhagic stroke work?
escaped blood fills intracranial space, increasing pressure and obstructing structures a once broken vessel is likely to break again
52
When do hemorrhagic strokes occur?
mostly in wakefulness and activity as time increases, symptoms worsen usually without headache
53
What is the mortality rate of primary intracerebral hemorrhage?
30-35% if they survive they can have considerable recovery
54
What is primary intracerebral hemorrhage?
occurs when brain penetrating artery is damaged or ruptures higher incidence with those with hypertension can displace and compress adjacent brain tissue can result in coma or death
55
What is a ruptured intracranial aneurysm?
- second most common cause of hemorrhagic stroke - small, localized ballooning of vessel wall
56
Where do most aneurysms occur?
90-95% in circle of willis
57
When do aneurysm ruptures occur?
waking hours with sudden and severe headache, neck pain, and stiffness, altered consciousness and neurological deficits
58
are unruptured aneurysms asymptomatic?
yes
59
What is an arteriovenous malformation?
tangle of dilated blood vessels that form abnormal communications between arteries and veins
60
Where do arteriovenous malformations occur?
brain, brainstem, spinal cord
61
Can arteriovenous malformations be dangerous?
- often asymptomatic, produce symptoms in 30+ year olds - when large can be life threatening
62
What does UMN injury lead to?
lack of descending control, lead to: - spasticity - clonus - hyper reflexia - hypertonia - primitive reflexes - synergies - weakness
63
What is the course of MCA stroke on the left side?
- flaccid hemiparesis, no reflex - after a couple months you could have stiff extremities on the right, high reflex activity - drooping eyelid and lips on the right side
64
What are the characteristics of Broca's aphasia?
broken choppy speech intelligence still intact
65
What are the characteristics of fluent aphasia (wernicke's)?
smooth speech that lacks intelligence and coherence

Neuroscience (15 decks)

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