Highlighted content lectures 2.1 & 2.2

Question 1

If a patient has a gaze toward the side of the lesion, what kind of stroke may they have had?

Answer 1

MCA (middle cerebral artery)

Question 2

What causes a watershed zone?

Answer 2

When the blood supply to 2 adjacent cerebral arteries is compromised

Question 3

What are two causes of two adjacent cerebral arteries being compromised? [and thus causing watershed infarction]

Answer 3

1) Sudden occlusion of the internal carotid or
2) A drop in BP in setting of carotid stenosis

Question 4

What are the 3 main somatosensory and motor pathways? List what each does

Answer 4

1) Lateral corticospinal tract: Motor
2) Anterolateral columns: Sensory; pain, temperature & crude touch
3) Posterolateral columns: Sensory; vibration, fine touch, proprioception

Question 5

1) Where is the primary motor cortex?
2) Where is the primary somatosensory cortex?

Answer 5

1) Primary motor = precentral
2) Primary somatosensory = postcentral

Question 6

1) What is the most important descending motor pathway of the nervous system?
2) What does it do?

Answer 6

1) Lateral corticospinal tract
2) Controls the movement of extremities

Question 7

1) What forms the anterior spinal artery?
2) What supplies most of the cord?
3) What forms the posterior spinal artery?

Answer 7

1) Vertebral arteries
2) Anterior spinal artery
3) Vertebral arteries

Question 8

Where is venous return for the spinal cord?

Answer 8

Epidural space

Question 9

Where does pyramidal decussation occur?

Answer 9

At medulla/spinal cord junction

Question 10

Where does the corticospinal tract go?

Answer 10

Posterior limb

Question 11

Is the ANS afferent, efferent, or both?

Answer 11

Only efferent pathways

Question 12

What are the two ANS divisions?

Answer 12

Sympathetic and parasympathetic divisions

Question 13

1) What do sympathetic neurons release to end organs?
2) What about parasympathetic?

Answer 13

1) Sympathetic: norepinephrine to the end organs
2) Parasympathetic: acetylcholine

Question 14

What 3 things control the ANS?

Answer 14

Hypothalamus, brainstem nuclei, and the amygdala

Question 15

What are the 3 long tracts of the spinal cord?

Answer 15

1) Posterior column-medial leminiscal system
2) Anterolateral systems
3) Corticospinal tract

Question 16

1) What does the Posterior column-medial leminiscal pathway convey?
2) Where does it decussate?

Answer 16

1) Proprioception, vibration sense, and fine touch
2) In lower medulla

Question 17

What pathway’s nerves cross over at the same level?

Answer 17

Anterolateral pathway **

Question 18

What can vitamin B12 deficiency affect?

Answer 18

Posterior cord

Question 19

Anterior cord syndrome damage causes what?

Answer 19

Loss of pain and temperature sensation below the level of the lesion
**anterior spinal artery infarct is a common cause

Question 20

What are the 4 dermatomes we need to know?

Answer 20

T4 – nipple line
T10 – umbilicus
C6 – thumb (6 shooter)
S5 - perianal

Question 21

What is the biggest cause of radiculopathy?

Answer 21

Diabetes

Question 22

1) What can cauda equina syndrome cause?
2) What can this then cause?

Answer 22

1) Saddle anesthesia (sensory loss in S2-5, numbness in inguinal area)
2) Bladder disfunction, constipation, fecal incontinence and loss of erections

Question 23

Almost all pathways projecting into the cerebral cortex, relay through the thalamus; which one doesn’t?

Answer 23

Olfactory

Question 24

1) What supply anterior hemispheres?
2) What about posterior hemispheres?
3) What forms the basilar artery?
4) What forms the Circle of Willis?

Answer 24

1) Internal carotid arteries
2) Vertebral arteries
3) Vertebral arteries
4) The anterior and posterior blood supplies form the anastomotic ring

Question 25

1) What come off the aorta? 2) What does the common carotid arteries split into? 3) List the arteries that supply the cerebral hemispheres

Answer 25

1) Common carotid arteries 2) Internal and external carotid arteries 3) Anterior, middle and posterior cerebral arteries (ACA, MCA, PCA)

Question 26

What are the anterior and middle cerebral arteries (ACA & MCA)?

Answer 26

The termination of the internal carotids

Question 27

What supply the Wernicke's and Broca's areas?

Answer 27

Middle cerebral artery

Question 28

What supply the basal ganglia and the internal capsule?

Answer 28

Branches of the MCA

Question 29

What can cause lacunar infarctions?

Answer 29

HTN

Question 30

What is the watershed?

Answer 30

The region in-between the 2 adjacent compromised vessels

Question 31

What are watershed infarcts?

Answer 31

2 adjacent cerebral arteries are compromised

Question 32

1) What type of stroke is caused by lack of adequate blood supply to the brain for long enough to cause cell death? 2) What can cause it?

Answer 32

1) Ischemic stroke 2) Can be caused by embolus or thrombus

Question 33

1) What links the anterior cerebral arteries together? 2) What do the posterior communicating arteries do? Be specific

Answer 33

1) The anterior communicating artery 2) Link anterior and posterior circulations; specifically they join the internal carotids and the posterior cerebrals

Question 34

1) Where does the anterior cerebral artery (ACA) go? 2) What does it supply?

Answer 34

1) Travels forward, splits into 2 main branches, then turns back over the corpus collosum 2) The cortex on the anterior medial surface of the brain from frontal to anterior parietal lobe. -Includes the medial sensorimotor cortex.

Question 35

1) Where does the middle cerebral artery (MCA) go? 2) What does it supply?

Answer 35

1) Enters Sylvian Fissure and then splits into 2-4 main branches, which form loops. 2) The cortex above and below the Sylvian Fissure; including the lateral temporal lobe and parts of the parietal lobe. -Also includes thalamus and posterior limb of the internal capsule

Question 36

1) Where does the posterior cerebral artery (PCA) go? 2) What does it supply?

Answer 36

1) Curves back off the basilar artery 2) Through its many branches supplies: the inferior and medial temporal lobes and the medial occipital cortex.

Question 37

1) What artery supplies the medial sensorimotor cortex? 2) What supplies the the inferior and medial temporal lobes? 3) What supplies the lateral temporal lobes?

Answer 37

1) ACA 2) PCA 3) MCA

Question 38

1) What supplies blood to the thalamus and posterior limb of the internal capsule? 2) What could a lacunar infarction in this area cause?

Answer 38

1) Small branches of the MCA 2) Contralateral hemiparesis

Question 39

1) What is lacunar infarct syndrome? 2) What is it characterized by? 3) Give examples

Answer 39

1) The clinical manifestations of a lacunar infarct 2) Pure motor hemiparesis. 3) Contra/Unilateral face, arm and leg weakness. -Location ex/posterior limb of internal capsule.

Question 40

1) What strokes are most common, MCA, ACA, or PCA? 2) What is its unique symptom?

Answer 40

1) MCA 2) Patients often have a gaze toward the side of the lesion

Question 41

What two things can watershed infarctions cause?

Answer 41

1) Sudden occlusion of the internal carotid 2) Drop in BP in setting of carotid stenosis

Question 42

1) How long does a TIA last? 2) Give 4 common causes

Answer 42

1) <24 hours (usually closer to 10 minutes) 2) Migraines, seizures, arrhythmias and hypoglycemia

Question 43

_____% of patients with TIAs with have a stroke within ___ months and most of those within the next _____ hours

Answer 43

10%; 3 months; 48 hours

Question 44

What is leading cause of significant disability?

Answer 44

Strokes

Question 45

1) What are the two main types of strokes? 2) What type of stroke is caused by a thrombus or embolus?

Answer 45

1) Ischemic and hemorrhagic 2) Ischemic

Question 46

What is the biggest difference between a thrombus and embolus?

Answer 46

1) Embolus: travels 2) Thrombus: doesn't travel

Question 47

1) What type of stroke is usually caused by an embolus, large vessel or small vessel? 2) What are small vessel strokes also called?

Answer 47

1) Large vessel 2) Lacunar infarcts

Question 48

1) What are emboli most often made of? 2) Where do they commonly come from?

Answer 48

1) Most often blood clots. 2) The heart

Question 49

Define dissection [in the context of strokes]

Answer 49

Tear on the inner surface of an artery

Question 50

1) What do cortical signs come from? 2) What are they?

Answer 50

1) Lobar strokes 2) Aphasia, neglect, homonymous visual field defects, apraxia, hemiparesis, and sensory loss

Question 51

What sometimes causes headaches with ischemic strokes?

Answer 51

Innervation of the blood vessels and meninges

Question 52

What is usually the cause of strokes in younger patients?

Answer 52

Dissection/trauma

Question 53

What do the internal jugular veins do?

Answer 53

Drain the dural sinuses (which is where the veins that drain the brain go)