Neuro Blood Supply

Front 1

What is the normal amount of Cerebral Blood Flow?

Back 1

50 ml/100mg/min

Front 2

If Cerebral Blood Flow is 8 ml/100 g/min than what can happen?

Back 2

complete loss of fxnl neurons

Front 3

If Cerebral Blood Flow is 25 ml/100g/min than what can happen?

Back 3

ischemic penumbra

Front 4

What is the normal blood flow?

Back 4

700-750 ml/min

Front 5

CMR02 (Cerebral Metabolic Rate of Oxygen Consumption) arises from neurons utilizing energy for what 2 fxns?

Back 5

1. maintenance of cell integrity (homeostasis) which uses 40% 2. Conduction of electrical impulses

Front 6

What is the penumbra?

Back 6

It is the area of collateral blood flow around a central core that provides marginal oxygenation that may maintain cellular fxn without immediate irrev. Damage

Front 7

What is diminution of cerebral blood flow to a critical threshold that propagates brain damage involving entire brain or selective region.

Back 7

Ischemia---will have fxnl changes before structural changes

Front 8

Consciousness is lost with in ____________ seconds of cessation of blood supply to brain.

Back 8

10 seconds

Front 9

What are 3 Neuron populations sensitive to Hypoxic Ischemic Injury?

Back 9

1. Hippocampal Pyramidal Cells of Sommers Sector 2. Purkinje Cells 3. Neurons of Cortical Layers 3,5, 6

Front 10

What are 4 gross findings of Hypoxia-Ischemia?

Back 10

1. Diffuse Brain swelling with widened gyri and narrow sulci 2. Watershed infarc in end-artery regions of the vascular supply 3. Necrosis of vulnerable regions (CAI Sommers sector, Purkinje Cells) 4. Laminar necrosis of cerebral cortex

Front 11

What are the microscopic ACUTE changes of Hypoxia-Ischemic Brain?

Back 11

acute neuronal changes and eosinophilic

Front 12

What are the microscopic SUBacute changes of Hypoxia-Ischemia Brain?

Back 12

appearance of macrophages, capillary proliferation, astrocytes

Front 13

what are the microscopic CHRONIC changes of Hypoxia-Ischemia Brain?

Back 13

Liquefactive Necrosis

Front 14

Neurons in penumbra undergo what neuronal injury mechanism?

Back 14

Apoptosis

Front 15

Neurons in the core undergo what neuronal injury mechanism?

Back 15

Necrosis

Front 16

What is cell death that is assoc. with genomic fragmentation?

Back 16

Apoptosis

Front 17

What is a consequence of severe cerebral ischemia charac. By disruption of cellular homeostasis from energy failure due to severe mitochondrial injury, leading to cellular swelling, membrane lysis, inflammation, vascular damage and edema?

Back 17

Necrosis

Front 18

It is thought that exposure to Excitatory AA will trigger ____________.

Back 18

Neuronal Necrosis

Front 19

Exposure to _________ results in apoptosis in neurons that survive the early necrotic phase and have partial recovery of mitochondrial fxn.

Back 19

Glutamate

Front 20

What is the CRITICAL factor in determining the degree and progression of neuronal injury?

Back 20

Mainetance of Mitochondrial Function

Front 21

What BV arises at the level of the THYROID cartilage and enters cranial cavity thru carotid canal?

Back 21

ICA

Front 22

What is a way to find the ICA?

Back 22

penetrates the dura just ventral to the optic nerve

Front 23

What supplies the retina and cranial dura?

Back 23

Opthalmic A

Front 24

What arises at the level of the optic chiasm and will join the PCA?

Back 24

Posterior Communicating A

Front 25

What courses posterolaterally above the oculomotor N to join the PCA?

Back 25

PCOM A

Front 26

What is it called when diameter of vessel is same as PCA (unilaterally 20%, bilaterally 8%)?

Back 26

Fetal-type PCOM

Front 27

What is the incidence of Cerebral Aneurysms?

Back 27

0.2-7.9 %

Front 28

What is the ratio of ruptured aneurysm to unruptured aneurysms?

Back 28

5:03

Front 29

What is a Sentinel Headache?

Back 29

Warning headache. Common w/ misdiagnosed subarach. Hemorrhage but really an aneurysm

Front 30

What artery travels rostrally thru the INTERhemispheric fissure?

Back 30

ACA

Front 31

Occlusion of the ACA can result in what?

Back 31

loss of motor control and loss of sensation on contralateral leg

Front 32

What has a 20-25% incidence of Intercranial aneurysm?

Back 32

ACOM A

Front 33

What artery enters the Transverse foramen of C6 and enters via Foramen Magnum?

Back 33

Vertebral A

Front 34

What is found within the Cavernous Sinus?

Back 34

ICA, Sympathetic plexus, CN VI

Front 35

What is found withing the LATERAL walls of the Cavernous Sinus?

Back 35

CN III, IV, V1, V2. Opthalmic V and Superficial Middle Cerebral V drain into these sinuses

Front 36

What supplies blood to the Hypophysis, Hypothalamus, Hippocampus, Infundibulum, and Thalamus?

Back 36

Posterior Communicating A

Front 37

What supplies the Olfactory Bulb blood supply?

Back 37

Anterior Cerebral A

Front 38

What supplies the preoptic and suprachiasmatic areas?

Back 38

Anterior Communicating A

Front 39

What provides blood supply to the Precuneous Area?

Back 39

Pericallosal A

Front 40

What provides blood supply to the Lateral Occiptal lobe?

Back 40

Posterior Temporal A

Front 41

What provides blood supply to the medial strx of the medulla?

Back 41

Anterior Spinal A

Front 42

What provides blood supply to the lateral strx of the medulla?

Back 42

Posterior Inferior Cerebellar A

Front 43

What provides blood supply to the caudal strx of the medulla?

Back 43

Posterior Spinal A

Front 44

What provides blood supply to the ventral and inferior cerebellum and the lateral pons?

Back 44

Anterior Inferior Cerebellar A

Front 45

What supplies the medial portion of lower and upper pons?

Back 45

Pontine A----which branches to Paramedian A

Front 46

What supplies the substantia nigra and lateral midbrain tegmentum?

Back 46

Circumferential A

Front 47

What supplies the caudal midbrain, rostral pons, superior cerebellum, sup and mid cerebelar peduncles, medial and lateral lemniscus, spinal trigeminal tract and SpinoTHAL tract?

Back 47

Superior Cerebellar A

Front 48

What supplies the midbrain, thalamus, and Subthalamic Nuclei?

Back 48

Posterior Cerebral A

Front 49

What supplies the primary visual cortex?

Back 49

Calcarine Br

Front 50

What supplies the dura of the meninges?

Back 50

most MCA, but Post. Meningeal A supplies the post. Fossa and the Ant. Meningeal A supplies the Ant. Fossa

Front 51

Where does the Superior Sagittal Sinus Drain?

Back 51

Confluence of Sinuses

Front 52

What joins to form the Straight Sinus?

Back 52

Great Cerebral of Galen and the Inferior Sagittal Sinus

Front 53

Where does the Straight Sinus Drain?

Back 53

empties into Caudal SUPERIOR SAGITTAL sinus

Front 54

Where does the Sigmoid Sinus Drain?

Back 54

Into the IJV

Front 55

What 4 things drain to the Confluence of Sinuses?

Back 55

1. Superior Sagittal Sinus 2. Straight 3. Transverse 4. Occipital

Front 56

What sinus ASCENDS from the Foramen Magnum?

Back 56

Occipital Sinus

Front 57

What are the 3 Superficial Cerebral Veins?

Back 57

1. Superficial Middle Cerebral V 2. Superior Anastomosic V of Trolard 3. Inferior Anastomotic V of Labbe

Front 58

What connects the Superficial Middle Cerebral V with the transverse Sinus?

Back 58

Inf. Anasto. Of Labbe

Front 59

What connects the Superficial Middle Cerebral V with the Superior Sagittal Sinus?

Back 59

Superior Anasto. Of Trolard

Front 60

What is the largest vein draining into the Transverse Sinus?

Back 60

Labbe

Front 61

What are the 3 Major Deep Cerebral Veins?

Back 61

1. Great Cerebral V of Galen 2. Basal V of Rosenthal 3. Internal Cerebral V

Front 62

What joins the Inferior Sagittal Sinus to form the Straight Sinus?

Back 62

Great V of Galen

Front 63

What is the union of 2 Internal Cerebral V?

Back 63

Galen

Front 64

What drains the Thalamus, Striatum, Caudate, Internal Capsule, Choroid Plexus, and Hippocampus?

Back 64

Internal Cerebral Veins

Front 65

What drains the Corpus Callosum?

Back 65

Basal V of Rosenthal

Front 66

What drains the Cerebellum and Medulla---"the Posterior Fossa"?

Back 66

Great Galen, Straight, Transverse, Sup and Inf. Petrosal Sinuses

Front 67

What arises from the Segment A and communicates with the Post. And Ant. Spinal A?

Back 67

Spinal Medullary A

Front 68

What supplies the Thor, Lumbar, and Sacral regions of the spinal Cord?

Back 68

Radicular A

Front 69

Where does the Posterior Spinal A arise from?

Back 69

PICA (75%)

Front 70

What cooresponds to the lobulated focal outpouchings of the wall of the arteries of the Circle of Willis?

Back 70

Berry Aneurysms

Front 71

Where exactly on the artery do Berry Aneurysms arise?

Back 71

at the artery bifurcation, usually at the CONVEXITY of the CURVE

Front 72

The wall of an aneurysm consists of what?

Back 72

Intima and Adventia

Front 73

How is a Saccular Aneurym classified if the maximal diameter of the sac ranges from 10-25 mm?

Back 73

Large

Front 74

What is a aneurysm larger than 25mm (comprises about 5% of all aneurysms)?

Back 74

Giant

Front 75

What is the rupture rate for pts with an UNRUPTURED aneurysm of 10mm or larger?

Back 75

1% a year

Front 76

What is the rupture rate for pts with an UNRUPTURED aneurysm of less than 10mm?

Back 76

.1% a year

Front 77

What is the rupture rate for pts with Giant Unruptured aneurysms?

Back 77

6% in the first year

Front 78

What aneurysm location is a good predictor of rupture?

Back 78

PCOM A, Vertebral/Basilar A, PCA, Basilar tip

Front 79

What is the single BEST predictor of future aneursym rupture??

Back 79

SIZE----matters most

Front 80

What artery supplies the Choroid Plexus of the Inferior horn of the Lateral Ventricle?

Back 80

Anterior Choroidal A

Front 81

What should you think if your pt present with a stroke and the leg is involved??

Back 81

ACA

Front 82

What is the Incidence of Intracranial Aneurysm at the A Commun. A jxn with the ACA?

Back 82

20-25%

Front 83

Hyalinization of vessels due to Hypertension are a prob in what artery?

Back 83

Lenticulostriate A (br. Of the MCA)

Front 84

What are the 2 branches of the Lenticolustriate A and what do they supply?

Back 84

1. Internal Striate--- Putamen, Caudate, Ant. Limb Internal Capsule 2. External Striate--- Caudate, Thalamus

Front 85

What provides blood supply to the Internal Capsule and the Basal Ganglia?

Back 85

Lateral Striate A, Medial Striate A, Anterior Choroidal A, ACA

Front 86

What can happen with a patient with Chronic Hypertension?

Back 86

Lacunar Infarction---also can be a cause of dementia

Front 87

What supplies the SpinoTHAL tract, SpinoCERE tract, desc. SYMP. Tract, desc.V tract, and Nucleus AMBIGUUS?

Back 87

PICA

Front 88

PICA damage to the Lateral medulla where the Nucleus Ambiguus is will give what probs?

Back 88

Wallenbergs Syndrome---- dysphonia, dysphagia

Front 89

What supplies the vermal region and Inf. Lateral Surface of the Cerebellar Hemisphere?

Back 89

PICA

Front 90

What supplies the gracile and cuneatus nuclei?

Back 90

Posterior Spinal A

Front 91

What supplies the Spinal Trigeminal Nucleus?

Back 91

Posterior Spinal A

Front 92

What supplies the Solitary Tract?

Back 92

Posterior Spinal A

Front 93

What supplies the Dorsal Motor Nucleus of X?

Back 93

Posterior Spinal A

Front 94

What supplies the Ventral & Inferior Surface Cerebellum and Lateral Pons?

Back 94

AICA

Front 95

What artery is a branch of the AICA and is at the Cerebello-Pontine angle (CP)?

Back 95

Labrinythe A (aka Internal Auditory A)--- supplies the cochlea and labrinythe

Front 96

Where is the Cavernous Sinus Located?

Back 96

on each side of the SPHENOID bone, and surrounds the Sella Turcica and the Body of the Sphenoid

Front 97

Where do the Sphenoparietal Sinuses drain?

Back 97

located below the sphenoid bone and drain into the cavernous sinus