Lecture 12 - Cerebral Blood Supply Flashcards Preview

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Flashcards in Lecture 12 - Cerebral Blood Supply Deck (14):
1

Circle of Willis

Made by Ant. cerebral artery, Middle cerebral artery (internal carotid artery), Post. comm. artery, and Post. cerebral artery, which joins together to form basilar artery
-PCA just anterior to CN3

2

Middle Cerebral Artery

-blood supply to most of the cerebral hemisphere
-lateral frontal, parietal, temporal lobes
-most of BG
-most of deep white matter (usually including internal capsule)

3

Anterior Cerebral Artery

-medial frontal and parietal lobes
-wraps around corpus callosum

4

Posterior Cerebral Artery

-medial temporal and occipital lobes
-most or all of thalamus

5

Variable arterial supply

deep branches of the ACA, MCA or PCA
-posterior limb of the internal capsule and lateral thalamus

6

Border zone

AKA watershed zone
-meeting between MCA and other (ACA or PCA) supply territory
-anastomosis

7

Cerebral arterial imaging

Ultrasound - carotid duplex (fast, safe, variable resolution)
Magnetic resonance angiogram
-slow, safe, good resolution
-magnet contraindications
Computed tomographic angiogram (CTA
-fast, better resolution
-iodinated contrast and radiation
Catheter angiogram
-best resolution
-iodinated contrast, radiation, catheter risks

8

Cerebral venous sinuses

between dural layers

9

Syndrome: Retinal artery

internal carotid --> ophthalmic --> retinal
-common
-complete (or entire retina) or branch (infarct)
-monocular visual loss
-altitudinal (shade coming down)
-transient (amaurosis fugax)
***vision flipped
--> superior infarct = lower vision field affected

10

Syndrome: Left MCA

-common
lateral frontal (face & arm) affected
-motor cortex (hemiparesis, dysarthria, dysphagia, apraxia)
-frontal eye field (gaze preference/paresis)
> eyes rest IPSI, paresis is CONTRA
-broca's area (Broca's aphasia)
-prefrontal cortex (decreased motivation, attention, exec fx)

lateral parietal (face & arm)
-somatosensory cortex (hemisomatosensory loss, apraxia)
-optic radiation (quadrantanopsia - inf. vision, CONTRA loss)

Lateral temporal
-Wernicke's area (Wernicke's aphasia)
-Optic Radiation

Deep white matter
-Long tracts (hemiparesis, hemisomatosensory loss)

11

Syndrome: Right MCA

lateral frontal same as left MCA, except not aphasia (language is mostly on left side)

Lateral parietal
-add association cortex (hemineglect, anosognosia) to left MCA

Lateral temporal = optic radiation, no Wernicke's

12

Syndrome: ACA

UNCOMMON
Medial frontal
-motor cortex (leg weakness, apraxia)
-prefrontal/cingulate cotex (decreased motivation, attention and exec fx)

Medial parietal
-somatosensory cortex (leg somatosensory loss)

13

Syndrome: PCA

common
Medial occipital
-visual cortex (hemianopsia with macular sparing)
>macula is more central and superficial, so there is enough collateral flow from MCA to keep macula alive

Medial temporal - usually nothing obvious

Thalamus - somatosensory loss

14

Syndrome: Lacunes

small subcortical cerebral arteries
common
internal capsule = subcortical weakness
thalamus = subcortical somatosensory loss
lacunes are left as arteries deteriorate and are often asymptomatic