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53 Cards in this Set

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What % of the cardiac output does the brain get?
17%
Strokes are very common (60%) in which area of the brain?
deep forebrain (caudate, putamen, GP, Internal Capsule)
COMMON CULPRIT - Ant. Choroidal
What is critical blood flow to the brain? Explain why there is a range of numbers.
~50 mL/100g/min (range: 50-26 ml)
Range occurs because gray matter requires 4X more blood than white matter does.
What is the blood flow in the ischemic penumbra?
25 mL/100g/min or less.
(Range = 25-8 mL)
What is the amount of blood flow that is considered ischemia?
<8 mL/100g/min.
What is the mean O2 consumption in the brain?
What is the name of this recognition mechanism?
3.3 mL O2/100g/min
Regulated by autoregulation
Two types of autoregulation: Name and explain
1. influenced by mean arterial pressure (ie. incr. BP will vasoconstrict to increase resisitance and lower blood flow. And vice versa for Low BP)
2. Changes in pH or blood gases can increase or decrease flow. (acidic blood will incr. flow)
in autoregulation: increased pCO2 will lead to _____1_______ and ___2___ blood flow. A 5% increase in CO2 will increase blood flow by _3___%, whereas a 7% incr. in CO2 will increase blood flow by __4_%.
1. vasodilation
2. increased
3. 50%
4. 100% (doubles blood flow)
Which blood gas level has more drastic effects: O2 or CO2?
CO2.
in autoregulation: increased pO2 will lead to ____1______ in blood flow. 100% O2 will lead to _____2____ blood flow; 10% O2 will lead to ___3____ blood flow.
1. a decrease
2. decreased
3. increased
How long does brain tissue survive without a blood supply?
~4 min.
Define a TIA
Transient Ischemic Attack. short term vascular insufficiency, usually resolves quickly. Major indicator of future stroke.
Which type of stroke is more common - hemorrhagic or occlusive?
Occlusive (80%)
In general, what is the area of the brain supplied by the MCA? What is the MCA a branch of?
supplies lateral cortex
branch of internal carotid
In general, what area of the brain does the ACA supply? What is it a branch of?
supplies medial cortex
branch of internal carotid
1. Which artery connects the L and R ACAs?
2. Which artery connects the ICA with the ipsilateral PCA?
1. the AcmA
2. the PcmA
Name the terminal branches of the internal carotid.
MCA
ACA
AcmA
PcmA
What is the rostralmost branch of the basilar artery?
What does it supply?
PCA
supplies the rostral midbrain, occipital lobe, some of temporal lobe.
1. The Posterior Choroidal Artery (PChA) is a branch of __________?
2. At what level does the branching occur?
3. What areas does it supply?
1. branch of the PCA
2. branching occurs at the tectum
3. supplies dorsal shell of thalamus and choroid plexus of IIIrd ventricle
What are the 6 vessels that make up the circle of Willis?
1. ICA 4. PCA
2. ACA 5. AcmA
3. MCA 6. PcmA
What is the relationship of the ACA to the optic nerve?
It runs superior to the optic nerve. An aneurism or a clot could cause vision abnormalities
The MCA runs in the _____________ on its way to the lateral cortex.
Lateral (Sylvian) Fissure
Areas of the cortex that are stroke prone due to hypoperfusion are called ____________. Elaborate.
Watershed or rim zone.
2 cm. wide strip - almost no blood supply b/c this is where the distal reaches of the arteries end.
What is a clinically significant area that lies in the cerebral watershed?
What is the result of a stroke here?
Wernicke's area (Area 22)
result - fluent aphasia (language, reading and writing make no sense)
There are 4 groups of cortical branches from the ACA, MCA or PCA. Name them
1. anterolateral striatals (lenticulostriates)
2. anteromedial striatal
3. posterolateral striatal (thalamogeniculates)
4. posteromedial striatal
(thalamoperforants)
Name the vessel thal supplies: choiroid plexus, caudate nucleus, hippocampus, LGN and some of optic radiations, medial edge of PLIC and lateral thalamus?
AChA
Vascular supply to:
1. head of caudate?
2. body of caudate?
3. Tail of caudate?
1. ALS, AMS
2. ALS
3. AChA
Vascular Supply to Putamen?
ALS (most of it)
AChA (caudal end)
Vascular Supply to Globus Pallidus?
1. GPi
2. GPe
1. ALS
2. PMS, AChA
Vascular Supply to ALIC?
ALS - anterolateral ALIC
AMS - anteromedial ALIC
Vascular Supply to Genu of IC?
branches of ICA
Vascular supply to PLIC?
lateral
medial
ALS - to most (lateral) PLIC
AChA - medial edge of PLIC next to thalamus
Vascular Supply to rentrolenticular PL (initial part of optic radiations)?
AChA
Vascular Supply to Hippocampus, temporal horn of the lateral ventricle and Dentate Gyrus?
AChA
What are the "zones of vulnerability" in the spinal cord?
1. anterior aspect(2)
2. posterior aspect(3)
1. T4, L1
2. T1, T2, T3
the radicular arteries are segmental arteries that come from which blood vessel?
the aorta
What is a vasocorona?
The vasculature surrounding the spinal cord (excluding the radicular arteries)
T/F: the Thalamus, along with the midbrain, pons and medulla, makes up the midbrain.
True (reike says it is "by definition")
At what (spinal cord or midbrain) level do the vertebral arteries converge to "make" the Basilar artery?
The pontomedullary junction
Which artery supplies the pyramids, pyramidal decussation, internal arcuate fibers and early medial meniscus?
ASA
In the closed medulla: Which artery supplies the spinal tract of V, internal arcuate fibers, LST, part of nucleus cuneatus?
Vertebral
In the closed medulla: what artery supplies the fasciculus and nucleus gracilis & cuneatus?
PSA
In the open medulla: what is the blood supply to the spinal tract and nucleus of V, LST, nucleus cuneatus, vestibular nuclei and ICP?
PICA
Which blood vessel supplies the roots of CN VI, VII and VIII for sure, (and sometimes CNs IX, X and V)?
AICA - clinically significant because problems with AICA may directly affect 6 crainal nerves.
What is the blood supply to the roots and nucleus of CN XII?
ASA
Which artery supplies the MLF?
Paramedian
At what level does the trochlear nerve (CN IV) exit the brainstem?
the rostral pons
At what brainstem level are the trochlear nuclei found?
medial caudal midbrain
What is the blood supply to the decussation of the superior cerebellar peduncle?
mainly PM, a little bit SCA
At what level of the brainstem is the decussation of the superior cerebellar peduncle found?
Caudal to middle midbrain
At what level of the brainstem is the superior colliculus found?
Rostral midbrain
In the brainstem, which artery supplies only the rostral midbrain?
PCA (also supplies other non-brainstem areas)
Brainstem strokes are known to be fatal. Why are they more fatal than, say, an MCA stroke?
There is not much space in the brainstem, and if there is a hemorrhage the space will fill up fast. This leads to increased intracrainial pressure, which compresses the brainstem. This results in shutting down of the critical functions found in this area (respiration, cardiac centers) = death