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COM: Neuro - Exam 2 > Lecture 1: Blood & Ventricular Systems > Flashcards

Lecture 1: Blood & Ventricular Systems Flashcards

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1
Q

Where is the basal v of Rosenthal located, where does it receive blood from and what does it drain into?

A

Runs next to the cerebral peduncle

Receives middledeep cerebral and anterior cerebral veins

Drains into the great vein of Galen

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2
Q

What is a falx herniation?

A

Falx cerebri partially separates the cerebral hemisphere

If unilateral space-occupying lesion is present the cingulate gyrus can herniate -> pushes beneath the free edge of the falx cerebri

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3
Q

What are the clinical signs of subdural hematoma?

A

Same symptoms as epidural hematoma however more insidious -> delayed due to slower pooling of blood and have more acute onset

Lethargy, seizures or headaches

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4
Q

Is an occlusion of the great vein of Galen usually fatal? Why?

A

Yes because it drains the deep cerebrum

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5
Q

What are the 4 structures that make up the blood brain barrier?

A

Endothelial cell layer (has tight junctions)

Basement membrane

Pericyte

Foot processes of astrocytes and oligodendrocytes

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6
Q

What do the penetrating branches of the posterior cerebellar artery supply?

A

Internal capsule, thalamus, choroid plexus of the lateral ventricle and upper midbrain

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7
Q

Spinal cord trauma may interrupt blood to the spinal cord especially if supplied by 2 arterial supplies, most frequently adjacent to the enlargements at ________, ________ and ______

A

C2-3, T1-4, and L1

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8
Q

Where are posterior spinal arteries found and what do they supply?

A

Course in postero-lateral sulci on each side

Supply dorsal roots and about 75% of the posterior columns

Along with radicular arteries they supply peripheral margins of the cord

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9
Q

When CSF pressure gets high, it pushes valves n the _____________________ open, allowing CSF to drain into the superior sagittal sinus

A

Arachnoid granulation

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10
Q

What does occlusion of the anterior cerebral arterial supply to the paracentral lobule region cause?

A

Contralateral paresis and/or parasthesia of the leg and foot

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11
Q

What are the branches of the posterior cerebral artery?

A

Penetrating branches

Temporal branches

Parieto-occipital artery

Calcarine artery

Posterior pericallosal artery

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12
Q

The great anterior artery of Adamkiewicz arises from the ___________________ or _________________ arteries and contributes to the _____________________ artery

A

Left inferior intercostal or superior lumbar arteries; anterior spinal artery

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13
Q

What does the anterior choroidal artery (branch of ICA) supply?

A

The choroid plexus of the lateral ventricle, internal capsule, basal ganglia, thalamus and rostral midbrain

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14
Q

What are the branches of the middle cerebral artery?

A 
Central artery 
Frontal branches 
Parietal branches 
Temporal branches 
Angular artery
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15
Q

Where is the great vein of Galen located, where does it receive blood from and what does it drain into?

A

Runs next to the posterior portion of the corpus callosum

Receives internal cerebral vein and basal vein of rosenthal

Drains into straight sinus

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16
Q

Where are cerebral arteries found?

A

They run in the subarachnoid space and branches penetrate into the brain parenchyma surrounded by Virchow-robin space (perivascular space) & pia mater

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17
Q

What do the frontal branches of the middle cerebral artery supply?

A

Premotor and prefrontal vortices

Broca’s speech area in dominant hemisphere (usually left)

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18
Q

What symptoms are seen with central cord syndrome?

A

Sensory and motor defects to upper extremities

More to distal musculature than proximal

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19
Q

Which branch of the ICA is prone to thrombosis and why?

A

Anterior choroidal artery due to the long course it takes in the subarachnoid space

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20
Q

What does occlusion of the central artery (branch of middle cerebral a) cause?

A

Contralateral spastic paralysis and/or parasthesia of the head and upper 1/2 of the body

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21
Q

What does occlusion of the posterior inferior cerebellar artery (branchof vertebral a) cause?

A

Lateral medullary syndrome/Wallenberg syndrome

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22
Q

Where is the internal venous plexus of Bateson located and where does it receive blood from and empty into?

A

Located in epidural space

Receives drainage from spinal cord

Empties into intervertebral veins and then segmental veins

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23
Q

What does the posterior inferior cerebellar artery (branch of vertebral artery) supply?

A

Posterior inferior portion of cerebellum

Posterolateral aspect of medulla

Choroid plexus of the fourth ventricle

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24
Q

What does the posterior pericallosal artery (branch of the posterior cerebral a) supply?

A

Anastomoses with anterior pericallosal artery of the anterior cerebral artery

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25
What are the symptoms of uncal herniation when there is midbrain involvement?
Contralateral hemiparesis and respiratory compromise Kernohans notch
26
What does occlusion of the angular artery (branch of middle cerebral artery) of the dominant hemisphere cause?
Wernicke’s aphasia -> fluent in speech but lacks content or meaning in spoke and written comprehension
27
What are the early clinical signs of uncal herniation?
Unilateral dilating pupil due to CNIII compression (occulomotor nerve palsy) **Complete palsy = closed eyelid and deviation of eye down and out
28
What does the anterior inferior cerebellar artery supply?
Anterior inferior portion of cerebellum Superior and middle cerebellar peduncles Part of brainstem
29
The superior sagittal sinus typically empties directly into the ___________________ sinus and thrombosis of either typically causes what?
Right transverse sinus; occlusion of either causes cortical ischemia and/or necrosis
30
The great anterior artery of Adamkiewicz can be compromised secondary to thoracolumbar fracture or surgical repair of abdominal aortic aneurysms. What does this result in?
Ischemic necrosis of the spinal cord (partial or complete transaction)
31
Obstruction of the cerebral aqueduct (midbrain astrocytoma) would cause what ventricles to get bigger?
3rd and lateral ventricles
32
The anterior choroidal artery (branch of ICA) is frequently a cause of vascular insufficiency to what 2 regions in the brain of the elderly?
Globus pallidus | Hippocampus
33
What does the angular artery (branch of middle cerebral a) supply?
Supramarginal & angular regions Wernicke’s area in dominant hemisphere (usually left)
34
What 2 structures might the great vein of Galen’s varix compress?
Pineal body | Posterior commissure
35
What does the anterior cerebral artery supply?
Anterior 2/3 of the medial side and supero-lateral portion of the hemisphere Paracentral lobule region -> sensation and motor to the LE **
36
What are the branches of the anterior cerebral artery (branch of ICA)?
Recurrent artery of Heubner Anterior communicating artery Cortical branches -> anterior pericallosal a and callosomarginal a
37
What does the parieto-occipital artery (branch of the posterior cerebral a) supply?
Visual association cortex
38
What is a posterior cerebral artery occlusion usually due to and what does it result in?
Due to thrombosis or compression from uncal herniation Results in ischemic necrosis of the primary visual cortex (contralateral homonymous hemianopsia with macular sparing)
39
What is the major arterial supply to the inferior 2/3 of the spinal cord?
Great anterior artery of Adamkiewicz
40
What does occlusion of the temporal branches of the middle cerebral artery cause?
Difficulty localizing sound
41
What are the clinical signs of hydrocephalus in infants and young children versus adults?
Infants & young children: increased intracranial pressure is partially/completely compensated via enlargement of cranial sutures Adults: sutures are fused which prevents head enlargement and causes increased intracranial pressures
42
What is communicating hydrocephalus?
Combination of infratentorial external hydrocephalus and internal hydrocephalus -> obstruction of the narrow space between the tentorial notch and midbrain CSF can move through the ventricular system into the infratentorial subarachnoid space **CSF cannot circulate over the cerebrum to be restored at the arachnoid villi near the superior sagittal sinus
43
What is central cord syndrome?
Disruption of blood flow to the anterior spinal artery due to thrombosis or hyperextension injury of the neck causing ischemia of the central region of the spinal cord Abrupt onset
44
Where do the internal carotidand vertebral arteries run?
Pierce dura and run in the subarachnoid space before giving off the cerebral arteries which supply blood to the brain
45
What are the branches of the internal carotid artery?
Ophthalmic artery Anterior choroidal artery Anterior cerebral artery Middle cerebral artery
46
What are the results of communicating hydrocephalus?
Hypertrophy of ventricles (internal hydrocephalus) Accumulation of CSF in the infratentorial space (external hydrocephalus)
47
What is a subdural hematoma?
Head trauma causes cerebral veins to rupture as they cross the subdural space. Ruptured veins cause blood to slowly accumulate in subdural space
48
What do pontine branches of the basilar artery supply?
Medial and lateral aspects of the pons **Branches distribute to regions of the brainstem in a “pie wedge” pattern -> this pattern of distribution is seen with necrosis in some brainstem lesions
49
What is a subarachnoid hemorrhage?
All major blood vessels supplying the CNS run in the subarachnoid space with surrounding CSF -> rupture causes presence of erythrocytes in the CSF **Lumbar puncture will show this
50
What is an epidural hematoma?
Fracture at the pterion ruptures the middle meningeal artery and runs between dura matter and skull High pressure arterial bleeding expands the epidural space pushing the dura mater from the bone creating a blood filled space which pushes upon cerebral hemisphere causing uncal herniation which compresses midbrain and progressive decrease in level of consciousness occurs **Tx = evacuation of hematoma
51
What is internal hydrocephalus?
CSF produced in the ventricular system doesnt drain into the subarachnoid space resulting in dilation of the ventricles proximal to the obstruction
52
Where is the anterior spinal artery found and what does it supply?
Deep to anteromedian sulcus Supplies most of the central gray matter and anteromedial portion of white matter
53
What is the main artery to the internal ear?
Labyrinthine a
54
What are the clinical symptoms of a falx herniation?
Headache Contralateral leg weakness May not present clinical deficits
55
What do the parietal branches of the middle cerebral artery supply?
Association cortex
56
Where is the internal cerebral v located, where does it receive blood from and what does it drain into?
Runs next to parahippocampal gyrus Receives thalamostriate and anterior septal veins Drains into Great veins of Galen
57
What are the branches of the vertebral artery that contribute to posterior circulation of the brain?
Anterior spinal artery Posterior spinal arteries Posterior inferior cerebellar artery
58
What does occlusion of the frontal branches of the middle cerebral artery in the dominant hemisphere cause?
Broca’s aphasia -> they can hear andcomprehend but cant respond appropriately ->problem in initiation of speech motor patterns
59
What is uncal herniation?
Uncus pushes through tentorial notch due to an opening in the tentorium cerebelli Usually acute
60
What does the calcarine artery (branch of the posterior cerebral a) supply?
Primary visual cortex
61
What does the superior cerebellar artery supply?
Superior lateral portion of cerebellum Deep cerebellar nuclei Part of pons and midbrain
62
The straight sagittal sinus typically empties directly into the __________ sinus and occlusion of either of these typically causes what?
Left transverse sinus; ischemic and/or necrosis of deep cerebrum -> typically fatal
63
What is tonsillar herniation?
Cerebellar tonsils herniate thorugh foramen magnum compressing the medulla and leading to respiratory arrest Acute and rapidly fatal
64
What are the branches of the basilar artery that contribute to the posterior circulation of the brain?
Anterior inferior cerebellar artery Labyrinthine a Superior cerebellar a Posterior cerebellar a
65
What does the central artery (branch of middle cerebral a) supply?
Primary motor and somesthetic vortices -> UE
66
What doe the temporal branches of the posterior cerebral artery supply?
INferior temporal cortex
67
What is supratentorial external hydrocephalus most commonly associated with?
Senile atrophy of the cortex -> Alzheimer’s disease
68
What is the function of astrocyte foot processes in the blood brain barrier?
Secrete paracrines that promote tight junction formation **Tight junctions prevent solute movement between the endothelial cells**
69
What do temporal branches of the middle cerebral artery supply?
Primary auditory cortex
70
Where is the anterior inferior cerebellar artery located?
In pontobulbar sulcus next to CN VI, VII, and VIII and the flocculus of the cerebellum
71
What causes subdural hematomas in children versus the elderly?
Children: associated with skul fracture Elderly: fragile blood vessels
72
What is external hydrocephalus?
Excessive accumulation of CSF in the subarachnoid size -> compression of CSF but normal ventricular size
73
What does occlusion of parietal branches of the middle cerebral artery cause?
Variety of interpretive disorders including body neglect, agnosia and apraxia
74
What is kernohans notch?
Uncal herniation causes pressure on the ipsilateral brainstem resulting in contralateral limb weakness Increased pressure pushes brainstem into tentorium cerebelli causing ipsilateral limb weakness
75
***Atrophy of the cerebral cortex may result in _____________________
External hydrocephalus
76
*** Obstruction of the subarachnoid space at the level of the tentorial notch may result in _______________________
Communicating hydrocephalus
77
***CSF enters the subarachnoid space via the ________ and __________
Medial and lateral foramina
78
***Secondary to a subarachnoid hemorrhage blood in the CSF may occlude the _____________ and result in _________________
arachnoid villi; Secondary (chemical) meningitis
79
***The anterior spinal artery is usually a branch of teh ______________
Vertebral artery
80
***The posterior spinal artery is usually a branch of the _____________
Posterior inferior cerebral artery
81
***The internal carotid artery bifurcated into the ___________ and ________
Middle cerebral a and anterior cerebral a
82
**The circle of willis is located in the ________________
SUbarachnoid space
83
***Rupture of the anterior communicating artery results in the presence of blood in the __________________
Subarachnoid space
84
***regarding the primary cortex, the posterior cerebral artery supplies the ______________
Primary visual cortex
85
***The paracentral lobule is supplied by the ____________
Anterior cerebral a
86
***Brocas area is supplied by the ____________
Middle cerebral a
87
***Wernicke’s area is supplied by the _____________
Middle cerebral a
88
***The motor cortex associated with the hands is supplied by the _____________
Middle cerebral a
89
***An infarct of the central region of the spinal cord indicates occlusion of the ______________ artery
Anterior spinal artery
90
***The most common area for infarcts in the cerebrum is in the region of the ______________
Basal ganglia, internal capsule
91
***The sigmoid sinus empties into the ____________ at the __________
IJV; jugular foramen
92
***The superior ophthalmic vein empties into the _______________
Cavernous sinus

COM: Neuro - Exam 2 (19 decks)

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