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36 Cards in this Set
- Front
- Back
what does the MCA supply?
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- lateral surface of brain & basal ganglia & internal capsule
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what does the ACA supply?
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- medial surface of brain & narrow strip around parasagittal lateral surface
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what does PCA supply?
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- distributed to medial surface of occipital lobe - including primary visual cortex & visual association cortex
- also supplies thalamus |
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what does variations in the circle of willis do to infarcts?
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- end up different because of their different circle of willis & collateral blood flow
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how can the external help communicate with internal carotid if it is occluded?
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- back flow from the opthalmic connecting to the external going into the internal carotid
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much of the sensory & motor cortex is supplied by who?
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- MCA
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how does ACA infarct present?
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- Leg > arm
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how does MCA infarct present?
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- arm > leg
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what do the lenticulostriate arteries do? where do they come from? what kinds of strokes are they associated with?
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- supply the internal capsule & are involved with HTN & lacunes
- small vessel disease, come off of the MCA |
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lenticulostriate: what does lenticulate supply? striate?
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- lenticulate supplies lenticular nucleus which has the putamen & globus palldus
- striatal supplies striatum (with putamen & caudate) - also supply the posterior internal capsule |
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how does the MCA run (along what fissure)? what does it do in this fissure?
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- along the sylvian fissure
- bifurcates into superior & inferior division |
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what does a lenticulostriate infarct present like?
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- arms = legs (b/c supplies posterior internal capsule where CST fibers run)
- language spared |
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what happens if the MCA infarct is on the left? on right?
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- arm > leg
- language difficulty on left - dysprosody on right (difficulty putting out emotional content of language) |
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what is dysprosody on right?
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- happens with right MCA infarct
- difficulty putting emotion into language |
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what artery interferes with language?
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- MCA
- NOT ACA or lenticulostriate |
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what do the superior & inferior portions of the MCA supply?
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- superior: motor & sensory strip, Broca's area, frontal eye fields, superior parietal lobes
- inferior: wernicke's area, much of temporal lobe, inferior parietal lobule |
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what happens with superior vs inferior MCA infarct?
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- superior: motor cortex, hemiparesis (arms/face > legs), brocas aphasia (on left) & confabulation (on right)
- inferior: no hemiparesis, wernicke's aphasia (on left) & spatial problems (on right), visual deficit ("pie in sky" = contralateral superior quadrantanopia) |
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what happens with PCA infarct?
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- contralateral hemianopia (can have alexia without agraphia if interrupt fibers crossing in corpus callosum)
- if occlusion before branches to thalamus then there will be contralateral hemisensory deficit |
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when do you get alexia without agraphia?
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- left PCA infarct that disrupts posterior corpus callosum
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what is Anton's syndrome?
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- bilateral PCA infarcts (maybe emboli @ top of basilar artery)
- cortical blindness, sometimes with denial of deficit |
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where do watershed infarcts occur?
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- at areas of overlap between vascular territories
- can get these if have quick drop in BP with preexisting atherosclerosis |
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what in "man in barrel" syndrome?
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- watershed infarct b/w ACA & MCA
- sensorimotor strip in proximal arm & proximal leg |
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where do hemorrhages most likely occur?
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- 50% occur in basal ganglia (putamen)
- everything else is 10% - these are complications of HBP, small vessel disease, same kinds that gave rise |
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which type of hemorrhage do you get TIA with?
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- thrombosis = TIA
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how does hemorrhagic stroke develop? what comes along with it?
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- gradual development, headache & vomiting
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what kind of stroke do you commonly get coma with?
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- hemorrhagic
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which kind of stroke is an early CT good? early MRI?
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- early CT good for hemorrhagic
- early MRI good for thrombosis & embolism, usually neg for hemorrhagic |
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where do fusiform aneurysms exist? saccular or "berry"?
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- fusiform are the rest of the body (atherosclerosis, large arteries)
- saccular are in the brain & at vascular bifurcations |
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why do aneurysms commonly occur in intracerebral arteries?
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- have no external lamina
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where are cerebral aneurysms most common?
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- anterior circulation = 85%
- posterior circulation = 15% (at top of basilar) |
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ruptured cerebral hemorrhages are associated with what type of hemorrhage?
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- widespread subarachnoid hemorrhage
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how do you treat cerebral aneurysms?
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- clipping
- coiling - put clips and hope radiologists can put coils in there to thrombose the aneurysm |
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what is an AV malformation?
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- direct connection b/w arterial & venous circulation without capillary bed
- veins under arterial pressure - hemorrhage from venous side (intraparenchymal or subarachnoid) |
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how do you treat AVM?
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- usually resect part of brain, embolization, radiation
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what types of glutamate receptors are thought to be involved in neurotoxicity in hypoxia or ischemia?
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- ionotropic glutamate receptors (AMPA, kainite, NMDA)
- NMDA is what is permeable to Ca ions |
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what happens if you block the glycine site on NMDA receptor?
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- prevents channel from opening in response to glutamate
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