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neuro14 Flashcards

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1
Q

anterior brain vasculature

A

anterior (carotid) supplies the cerebral hemispheres except for medial temp lobes and a portion of the occipital lobes

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2
Q

posterior cerebral circulation

A

aka vertebrobasilar circ; supplies the brainstem, thalami, cerebellum, and the posterior portions of the cerebral hemisphere

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3
Q

right versus left common carotid arteries

A

right comes from the brachiocephalic (aka innominate); left comes from the aorta

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4
Q

common carotid divides where and into what

A

in the neck into the internal carotid and external cartoid

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5
Q

how does the internal cartoid artery

A

behind the pharynx, entering the skull where it forms an S shaped curve (the carotid siphon)

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6
Q

first branch of the internal carotid

A

opthalmic

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7
Q

subsequent branches off the ICA after the opthalmic

A

penetrates the dura and gives off the anterior choroidal and posterior communicating arteries; then divides into the anterior cerebral artery and the middle cerebral artery

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8
Q

what does the Anterior cerebral Artery supply

A

anterior medial cerebral hemispheres, the caudate nuclei, and the basal frontal lobes

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9
Q

what connects the two anterior cerebral arteries

A

anterior communicating arteries

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10
Q

MCA gives off what branches

A

lenticulostriate artery branches to the basal gang and internal capsule

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11
Q

MCA trifurcates into what

A

small anterior temporal branches and large superior (to lateral cerebral hemisphere) and inferior divisions (temporal and inferior parietal lobes)

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12
Q

anterior choroidal artery

A

arises from the internal carotid artery after the opthalmic and posterior communicating arteries; courses along the optic tract giving off branches to the globus pallidus and posterior limb of the internal capsule and then supplies the medial temporal lobe and the lateral geniculate body

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13
Q

what does the anterior choroidal artery supply?

A

branches to the globus pallidus and posterior limb of the internal capsule and then supplies the medial temporal lobe and the lateral geniculate body

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14
Q

posterior circulation comes off what

A

subclavian artery

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15
Q

first branch of each subclavian artery

A

vertebral artery

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16
Q

how does vertebral artery course

A

enters the transverse foramina of the C5 or C6 vertebrae and runs within the intravertebral foramina, exiting to course behing the atlas and then piercing the dura mater to enter the foramen magnum

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17
Q

the intracranial vertebral arteries join to form what

A

basilar artery at the pontomedullary junction

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18
Q

the intracranial vertebral artery gives off what branches

A

posterior and anterior spinal arteries, penetrating arteries to the medulla, and the posterior inferior cerebellar artery

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19
Q

what does the basilar artery give off

A

antierior inferior cerebellar arteries (AICA) and superior cerebellar arteries (SCA), before dividing at the pontomesencephalic junction nt the posterior cerebral arteries (PCA)

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20
Q

small penetrating arteries off the basilar

A

supply the medial portions of the midbrain and thalami

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21
Q

vascular supply of the brainstem

A

large paramedian arteries and smaller short circumferential arteries that penetrate the basal portions of the brainstem into the tegmentum

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22
Q

what does the PCA give off

A

penetrating arteries to the midbrain and thalamus, then supplies the occipital lobes and inferior surface of the temporal lobes

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23
Q

circle of wiliis

A

anterior communicating artery and the posterior and communicating arteries

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24
Q

each carotid artery supplies two-fifths of the brain and the basilar circulation one-fifth

A

right

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25
paradoxical embolism
when clots from the venous system travel to the arterial system through defects in the heart like a PFO or Asd
26
watershed regions
where poor perfusion is most critical because it is at the perihery of the major vascular supply territories
27
symptoms of left cerebral hemisphere stroke
right hemiparesis, right hemisensory loss, aphasia, in large lesions you see conjugate deviation of eyes to left, right hemianopia or hemi-inattention
28
left ICA occlusive disease symptom
transient left monocular visual loss (opposite for right)
29
symptoms of right cerebral hemisphere stroke
left hemiparesis, left hemisensory loss, poor drawing and copying, left visual field neglect, in large lesions conjugate deviation of the eyes to the right, left hemianopia
30
what usually causes a right or left cerebral hemisphere stoke?
these are anterior circulation issues: carotid artery occlusion, embolism to the MCA or its branches, or basal ganglionic intracranial hemorrhages
31
symptoms of lateral medullary stroke
ipsilateral facial pain or reduced pain and temp on the ipsilateral face or both; loss of pain and temp in the contralat limbs and body; ipsilat horners; nystagmus
32
other symptoms of lateral medullary stoke
incorrdination of the ipsilateral arm; leaning while sitting or walking with gait ataxia; in deep lesions, dysphagia and hoarseness
33
what is lateral medullary stoke also called
wallenberg syndrome,
34
lateral medullary stroke normally due to
intracranial vertebral artery occlusion
35
bilateral pontine base and medial tegmental stroke
quadriparesis; uni or bilateral conjugate gaze paresis, sometimes INO or 6th nerve palsy; when medial tegmentum is involved bilaterally, coma
36
bilateral pontine base and often medial tegmentum stoke due to what?
basilar artery occlusion or pontine hemorrhage
37
cerebellar infarction
gait ataxia, dysarthria, ipsilateral arm dysmetria
38
causes of cerebellar infarction
embolism to the PICA or SCA, or cerebellar hemorrhage
39
Left PCA territory stroke
right homonymous hemianopia; at times, amnesia; alexia without agraphia when the splenium of the corpus callosum is involved
40
cause of left PCA territory stroke
embolism arising from the heart, aorta, or Vas to the left PCA
41
right PCA territory stroke
left homonymous hemianopia; at times, left-sided visual neglect
42
lacunar stroke cause
occlusion of a penetrating artery; can occur in either the anterior or posterior circulations
43
pure motor lacunar stroke
weakness of contralat arm, face, and leg without sensory, visual, or cognitive or behavioral signs
44
pure sensory lacunar stroke
paresthesiae of the contralateral body, limbs, and face without motor, visual, or cognitive abnormalities
45
dysarthira-clumsy hand syndrome
slurred speech and clumsiness of the contralateral hand; caused by lacunar stroke
46
ataxia hemiparesis
weakness and ataxia of the contralat limbs, often greater in the leg and foot than arm and hand; caused by lacunar stoke
47
presentation of carotid dissection
severe retro-orbital headache ipsilateral to the lesion; ipsilateral Horner's due to involvement of ascending oculosympathetic tract; perspiration is preserved
48
how do you get a stroke with carotid dissection
thrombosis of the ICA or more commonly by an embolus arising from the dissection
49
how do you get a vertebral artery dissection
manipulation of the neck or trauma
50
signs of vertebral artery dissection
ipsilateral neck pain and strok ein the posterior circulation
51
most sensitive imaging for acute brain infarction
MRI with diffusion-weighted imaging
52
what to give stroke patients
tPA within 4.5 hours of stroke onset
53
dabigatran
direct thrombin inhib that may be approp for some patients with stroke due to a fib
54
patients with lacunar stroke or non-occulsive artherosclerotic lesions
aspirin, clopidogrel, or a combo of aspirin and modified release dipyidamole
55
cause of subarachnoid hemorrhage
bleeding from an enurysm located within the circle of Willis
56
signs of SAH
sudden onset severe headache; vomit' with increased ICP, coma or death may ensue
57
treatment of SAH
aneurysms can be clipped surgically or coiled; CCB nimodipine is used to minimize vasoconstriction and delay brain ischemia
58
earliest signs of intracerebral hemorrhage
neurologic sgns related to the area involed
59
most common cause of intracerebral hemorrhage
hypertension; most common locations are basal gang-internal capsule, caudate nuc, thalamus, pons, and cerebellum
60
cerebral amyloid angiopathy
can be a cause of intracerebral hemorrhage in the elderly; preferentially affects the parietal and occipital lobes
61
AVM
contain arteries that empty into arteriolized veins; AVMs can cause intracerebral hemorrhage and can result in seizures
62
treatment for AVMs
embolization or surgical resection
63
cavernous angiomas
compact mass of sinusoidal vessels close together without intervening brain parenchyma
64
developmental venous anomalies
anomalous veins separated by normal brain; does not typically require intervention
65
telangiectasia
dilated capillaries with intervening brain; does not typically require intervention
66
in a patient with suspected acute stroke, what imaging do you do first?
CT without contrast because it can exclude hemorrhage so you can start thrombolysis;
67
if CT of person with suspected stroke is normal, then what?
CBC, glucose, and coags to make sure they are not at risk for bleeding when you give them tPa, then give tPA
68
treatment for acute VA dissection
IV heparin (not TPA), with conversion to warfarin for 3 to 6 mos; Antiplatelet agents are also an approp treatment;

Neuro (43 decks)

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