Test 3 - 10/7 lecture Flashcards by Amanda M.

Cerebral circulation does a good job _____

auto regulating

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Running longitudinally along the spine we have ____ main arteries. They are called _____

(1) Anterior spinal artery
(2) Posterior spinal arteries

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The anterior spinal artery is located within the _____

anterior median fissure

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The superior portion of the posterior arteries get their blood supply from?

mainly vertebral and (anterior inferior and posterior) cerebellar arteries.

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The three main cerebellar arteries are

Superior cerebellar artery
anterior inferior cerebellar artery
posterior cerebellar artery

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Radicular arteries are

Branches of the intercostal arteries

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Radicular arteries feed into

the anterior or posterior spinal arteries

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______ arteries are found in the neck and are the rear posterior source of blood going into the COW

Vertebral

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Intercostal arteries are found _______ and we have _____ sets of them

Between each of our ribs.
12 sets.

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What is the source of blood supply for the spinal arteries in the lower portion of the cord?

Primarily intercostal arteries that branch into radicular arteries.

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What does the typical branching of radicular arteries is _____ and will feed into the spinal cord every ____ vertebral levels

Irregular
5 or 6 levels

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What are the three different names for the feed arteries?

Radicular (our primary focus)
Medullary
Segmental

Sometimes used in combination.

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The posterior segmental medullary artery is what?

The feed artery that feeds into the posterior spinal artery.

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The arteries found on the outer surface of the cord that are not continuous

Coronal arteries “crown”

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What is different between the arteries in the spine vs the brain?

The brain (COW) has collateral circulation, if one part gets blocked blood will still move through. The spinal arteries dont have that feature

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The difference between the posterior spinal vein and the posterior spinal arteries is what?

The vein is midline, the arteries are on each side

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True/False. Veins typically follow the same pattern that arteries do.

True

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Intercostal arteries come off of the _______ and majority will wrap around the sides of the rib cage.

Thoracic aorta

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From the Thoracic aorta what route would arterial blood take to feed the anterior spinal artery

1- Intercostal artery
2- Dorsal branch
3- Spinal branch
4-Anterior radicular artery
5- Anterior spinal artery

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At every level of the spinal cord, regardless of having radicular arteries we will have a

Spinal branch

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The spinal branch sits on top of

dorsal root ganglion

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Intercostal arteries are responsible for

keeping the ribcage healthy and perfused

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Artery that perfuses the small intestines

mesenteric artery

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When clamping the aorta, we worry about anything _____ to the clamp

distal/inferior

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The anterior spinal artery perfuses _______ of the spinal cord

75%

Both posterior spinal arteries perfuse _____ of the cord combined

25%

There are usually _____ feed vessels to the anterior spinal artery in the cervical potion

Usually _____ feed vessels in to the anterior spinal artery in the thorax

2-3

Usually ______ feed vessels into the anterior spinal artery in the lumbar potion

1-2

Typically the posterior spinal arteries have _______ feed vessels than the anterior spinal artery

The arterial flow of the lower 2/3 of the anterior spinal cord is fed by the

Great Radicular Artery (GRA) (Artery of Adamkiewicz)

The most common place to find the Great Radicular artery would be the

Left side of T10

A typical range for the location of the great radicular artery (75% of patients)

T9-T12

What are the possible levels that the greater radicular artery could be found?

T5-L5

Surgery requiring an aortic clamp above the level of the artery of Adamkiewicz puts the patient at a much greater risk of

paralysis or loss of motor function

Surgery requiring aortic clamping blow the GRA would?

likely have less issues

Normal perfusion pressure for the cerebral circulation is typically

50-150mmHg

Perfusion pressure is measured by

taking MAP - ICP

Normal healthy patient ICP should be

10 mmHg

Aortic cross clamping will increase your CSF pressure that surrounds the spinal cord ______

~10 mmHg

If we have low MAP and our ICP is doubled following aortic cross clamp we would worry about what? What could we do to help?

The pressure being so high that the cord isn't being perfused. We could put in a drain to relieve some of the pressure

The damage of ischemia reperfusion injury is done by

Excess Oxygen levels

A typical defense mechanism to keep oxygen induced damage in check

antioxidants

Oxidative potential of oxygen in the immune system?

immune system uses oxygen to destroy stuff

spinocerebellar tracts

carry information about muscle or tendon stretch to the cerebellum

The cerebellum helps us

coordinate complicated movements (walking)

We have 4 sections of the spinocerebellar tracts. What are they called and what kind of information do they carry?

1- Posterior/Dorsal Cerebellar tract (located bilaterally on the lateral portions of the cord) 2- Anterior/Ventral Cerebellar tract (located bilaterally on the lateral portions of the cord) They carry sensory information to the cerebellum

The anterior/ventral spinocerebellar tract is responsible for information about

The level of motor activity at that level of the spinal cord

The anterior/ventral spinocerebellar tract ascends and passes through the

Superior Cerebellar Peduncle

The posterior/dorsal spinocerebellar tract is responsible for information about

tendons and muscle spindle (stretch sensors)

The posterior/dorsal spinocerebellar tract ascends and passes through the

Inferior cerebellar peduncle

The two categories of things that can cause us pain are

Chemical and mechanical

Examples of chemical that can cause pain (9)

1. Bradykinin 2. Serotonin 3. Histamine 4. K 5. ACh 6. H+ 7. Proteolytic enzymes 8. Ischemia/muscle spasm 9. PG's

How do PG's relate to pain?

not directly painful but augments pain

How does ischemia relate to pain?

build up of metabolic waste products (lactic acid)

pain threshold

amount of stimulation required before a person experiences the sensation of pain

Chronic pain will have what effect on pain threshold?

It will typically reduce pain threshold, meaning it will be easier to stimulate a pain response than it was before.

In regards to pain, if we have a lower threshold potential it would be _____ to stimulate and we would experience _____ pain. If we have a higher threshold potential it would be ______ to stimulate and we would experience ______ pain.

easier; more harder; less

Visceral pain

Internal organ pain transmitted by the autonomic nerve bundles.

Visceral pain is difficult to ________ and is usually ________

localize; referred

Parietal pain is pain of

connective tissue

Parietal pain is highly

localized

Why do we have poor localization of visceral pain?

Because organs lack tactile sensors

The liver and the soft tissue of the lungs do not

have pain sensors

Parietal pain is described as being ____ and uses ____ fibers

sharp. A delta

Visceral pain is described as being ____ and uses ____ fibers

dull/achy. C

Appendix can have _____ pain.

Dual

If you are having an appendicitis attack and have pain in the RLQ this is a ______ pain

Parietal pain (it is localized to the actual location of the tissue)

If you are having and appendicitis attack and have pain above your umbilicus this is a ______ pain

Visceral pain (it is referred to a site other than the actual site of the painful stimuli)

Why is visceral appendix pain higher up? Where is it located?

The visceral pain fibers are routed up to the sympathetic chain and gets fed into autonomic ganglia and then ascends 2-3 levels and then enters cord. T10/umbilicus

Because it is not localized well visceral pain will not decrease via ______ like other more localized painful stimuli can be.

lateral inhibition

Referred pain: Ischemia in the heart would cause pain in ____. Bad heartburn could cause pain in _____. Kidney pain is referred to _____

L arm. higher than umbilical region Lower back

Slow pain signals that terminate in the brain stem make up the

reticular formation

The limbic system is made up of what deep brain structures? (3)

Amygdala (the MVP) Hypothalamus Cingulate gyrus

Cingulate gyrus is located

superior to the corpus callosum

Motor neurons are typically _______ fibers

A-alpha

What kind of fibers are used in the autonomic nervous system

Non or Lightly myelinated fibers

What part of the cerebral cortex is involved in slow pain?

Cingulate Gyrus

Muscle spindle and tendon feedback is likely sent on fibers that can be described as

Large and myelinated

The DCML pathway typically has neuronal fibers ranging from

A-alpha (A-beta) to A-gamma

What type of fiber is involved in lateral inhibition

A-beta

Aching/dull/nausea is sent via ___ fibers

C fibers

Fast pain usually travels via

A-delta fibers