Neuropath - Vascular

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Author:
jollyvulcan
ID:
148539
Filename:
Neuropath - Vascular
Updated:
2012-07-29 07:25:40
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Stroke Blood Supply Brain
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Questions concerning the blood supply to the brain and Stroke Syndromes
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  1. The Anterior Choroidal Artery supplies the ...
    • Hippocampus (partial)
    • Optic Tract (partial)
    • Thalamus (VA, VL, LGN)
    • Caudate (tail)
    • Red Nucleus
    • STN
    • SN
    • GP (medial)
    • Uncus
    • Cerebral Peduncle
    • Choroid Plexus
    • Internal Capsule
  2. The Anterior Cerebral Artery supplies ...
    Medial frontal lobe and anterior/medial parietal lobe.

    Results in contralateral weakness / sensory loss Leg > Arm > Face.
  3. The Recurrent Artery of Heubner is ...
    A branch off the Anterior Cerebral Artery.

    Supplies the Caudate (head), Internal Capsule (anterior limb), and Putamen (anterior).

    Results in contralateral face and arm weakness.
  4. The branches of the Middle Cerebral Artery are ...
    • Superior Division
    • Inferior Division
    • Lenticulostriate Perforators
  5. The Superior Division of the Middle Cerebral Artery supplies ...
    Lateral aspect of the cerebral cortex superior to the sylvian fissure.
  6. The Inferior Division of the Middle Cerebral Artery supplies the ...
    Lateral aspect of the cerebral cortex inferior to the sylvian fissure.
  7. The Lenticulostriate Arteries ...
    Are branches off the Middle Cerebral Artery.

    Supply the bulk of the Basal Ganglia, Internal Capsule, Caudate, and Corona.
  8. The Internal Capsule is supplied by the ...
    Recurrent Artery of Heubner (Anterior Limb)

    Anterior Choroidal Artery (Genu and Posterior Limb)

    Lenticulostriates (Posterior Limb)
  9. Middle Cerebral Stem Infarction will cause ...
    • Contralateral Hemiplegia
    • Contralateral Sensory Loss
    • Ipsilateral Gaze Preference
    • Global Aphasia (dominant hemisphere)
    • Neglect (non-dominant hemisphere)
  10. Infarction involving the Superior Division of the Middle Cerebral Artery results in ...
    • Contralateral Hemiplegia (Face + Arm > Leg)
    • Contralateral Sensory Loss
    • Ipsilateral Gaze Preference
    • Broac's Aphasia (dominant hemisphere)
    • Neglect (non-dominant hemisphere)
  11. Infarction involving the Inferior Division of the Middle Cerebral Artery results in ...
    • Wernike's Aphasia (dominant hemisphere)
    • Neglect (non-dominant hemisphere)
    • Visual Field Cut
  12. Infarction of the Lentriculostriate Arteries results in ...
    Contralateral Hemiparesis
  13. The Posterior Inferior Cerebellar Artery (PICA) supplies the ...
    Is the largest branch of the vertebral artery

    Supplices the Inferior Cerebellum and Dorsolateral Medulla
  14. Infarctin of the PICA causes ...
    Lateral Medullary Syndrome (Wallenberg Syndrome):
  15. The Anterior Spinal Artery ...
    Is formed by contributions from both vertebrals.

    Supplies the anterior aspect of the spinal cord.
  16. The Posterior Spinal Artery ...
    Supply the dorsal aspect of the spinal cord.
  17. The branches of the Basilar Artery include ...
    • Paramediand and Circumferential Perforators
    • Anterior Inferior Cerebellar Artery (AICA)
    • Superior Cerebellar Artery (SCA)
    • Internal Auditory Artery
    • Posterior Cerebral Arteries
  18. Infarction of the Anterior Inferior Cerebellar Artery (AICA) results in ...
    • Lateral Inferior Pontine Syndrome:
    • Unilateral Deafness
  19. The Anterior Inferior Cerebellar Artery (AICA) supplies the ...
    • Caudo-lateral Pontine Tegmentum
    • Ventrolateral Cerebellum
  20. The Superior Cerebellar Artery supplies the ...
    Surface of the cerebellum, superior cerebellar peduncle, and the lateral lsuperior pons
  21. Infarction of the Superior Cerebellar Artery causes ...
    • Nystagmus
    • Ipsilateral Ataxia
    • COntralateral loss of paint and temperature
    • Ipsilateral Horner's
    • Partial Deafness
    • Palatal Myoclonus
  22. Branches of the Posterior Cerebral Artery include ...
    • Mesencephalic Artery (supplies the red nuclei, substantia nigra, medial lemnisci, MLF, MCP, and CN III / IV)
    • Thalamoperforators (thalamus)
    • Thalmogeniculate
    • Posterior Choroiral Artery (posterior thalamus, posterior hippocampus, choroid plexus)
    • Cortical Branches (inferior temporal, parieto0occipital, and calcarine)
  23. Blood supply to the thalamus ...
    • Four divisions:
    • Anterior - Polar / Tuberothalamic Artery --> Abulia and Apathy
    • Dorsal - Posterior Choroidal Artery --> Visual Field Deficit
    • Paramedian - Posterior Thalamoperforators --> AMS and Vertical Gaze Abnormalities
    • Posterolateral - Thalamogeniculate Artery --> Pure Sensory Stroke, Sensorimotor Stroke, or Dejerine Roussy Syndrome
  24. Weber Syndrome
    Lesion in the ventral midbrain affecting the cerebral peduncle and CN III leading to an Ipsilateral CN III Palsy and Contralateral Weakness.

    *** Weber's Syndrome is assocaited with Weakness ***
  25. Claude's Syndrome
    Lesion of the Midbrain Tegmentum affecting the Red Nucleus, CN III, and Brachium Conjunctivum resulting in Ipsilateral CN III Palsy and Contralateral Ataxia / Tremor.

    *** Clumsy Santa Clause in a Red Suit ***
  26. Benedickt's Syndrome
    Leison in the Midbrain Tegmentum affecting the Red Nucleus, CN III, Corticospinal Tract and Brachium Conjunctivum resulting in Ipsilateral CN III Palsy, Contralateral Weakness, Ataxia, and Tremor.

    *** Benedickt deserves beneficence because he is clumsy like Claude and weak like Weber ***
  27. Perinaud's Syndrome ...
    Caused by a leison affecting the Dorsal Midbrain and Pretectal Region resulting in Convergence-Retraction Nystagmus, Lid Retraction, Light-near Dissociation, and Impaired Upgaze.

    *** Perinaud's involved the Pretectum ***
  28. Millard-Grubler Syndrome ...
    Caused by a lesion in the Ventral Pons affecting CN VI and VII resulting in an Ipsilateral Lateral Rectus Palsy, Ipsilateral Peripheral VII, and Contralateral Hemiparesis (sparing the face).

    *** Millard has 7 letters and Gubler has 6 ***
  29. Locked-in-Syndrome ...
    Caused by a bilateral ventral pontine lesion (e.g. central pointine myolinolysis) resulting in Quadraparesis and Loss of SPeech but can move their eyes vertically and blink.
  30. Lateral Inferior Pontine Syndrome ...
    Caused by occlusion of the AICA affecting CN 5, 7, 8 as well as the Paramedian Pontine Reticular Formation, Spinothalamic Tract, MCP, and Cerebellum resulting in Ipsilateral Decreased Facial Sensation / Facial Paralysis, Nystagmus / Emesis / Vertigo, Deafness / Tinnitus, Gaze Paresis to the side of the lesion, Contralateral Decreased Pain / Temp, Ipsilateral Ataxia.
  31. Medial Medullary Syndrome ...
    Caused by infarction in the territory of the oaramedian branches of the vertebral arteries affecting CN's X and XII as well as the Pyramidal Tracts, and Medial Lemniscus resulting in Ipsilateral TOngue Paresis, Contralateral Limb Weakness, and Decreased Virbation / Joint Position.
  32. Wallenberg's Syndrome ...
    Caused by infarction in the territory of the PICA affecting CN Vsp, CN VIII, Solitary Nucleus, Nucleus Ambiguus, Spnithalamics Tract, Sympathetics, and Inferior Cerebellar Peduncle resulting in Nausea / Emesis, Impaired Pain and Temperature Sensation, Impaired Gag Ipsilaterally, Horner's Syndrome, Impaired Taste, and Hoarseness.
  33. The Lacunar Syndromes include ...
    Pure Motor: Internal Capsule (pl), Brachium Pontis, Corona Radiata

    Pure Sensory: Posterolateral Thalamus

    Dysarthria-Clumsy Hand: Internal Capsule, Basis Bontis, or Cerebral Peduncle

    Ataxia / HemiparesisL Basis Pontis or Internal Capsule
  34. Red Neurons6-24 hours after ischemic stroke
  35. Reactiveastrocytosis about 12 hours after stroke
  36. Reactive astrocytosis in the cerebellum where it is called Bermann's Gliosis about 12 hours after stroke
  37. PMN’s invade the ischemic region in 2-3 days and will remain for months
  38. 2days after ischemia, there is vascular proliferation which lacks a proper BBB

    That is why this is the peak time for hemorrhage
  39. Old MCA infarction
  40. Wallerian Degeneration from old infarction
  41. Lacunar Infarction in the pons
  42. Lipohyalinosis which is proliferation of the lamina media
  43. Arterial Dissection with blood inside the elastic wall 

    RF's: Trauma, Marfan’s, EDS, Fibromuscular, Dysplasia
  44. Lymphocyteswithin the blood vessel wall typical for a vasculitis
  45. Sinovenous Thrombosis of the Superior Sagital Sinus

    RF's: Dehydration, Hypercoagulable States, Anemia, Infection
  46. Cortical Hemorrhage

    RF's: Amyloid, Coagulopathy, AVMs, HTN
  47. CongoRed stain demonstrating biorefringense typical of amyloid angiopathy
  48. Hypertensive hemorrhages common in the Putamen (65%), Thalamus, Cerebellum, and Pons
  49. Aneurysm at the Circle of Willis
  50. Aneurysm - note the irregular section which lacks a basal lamina (dark line)
  51. Subarachnoid Hemorrhage

    Most commonly from a ruptured aneurysm after which trauma is the most common cause

    Evaluate with a headt CT followed by LP then angio
  52. Epidural Hematoma

    Caused by tearing of the meningeal arteries (e.g. the middle meningeal artery under pterion)
  53. Subdural Hematoma

    Caused by tearing of bridging veins and may be seen after traume, low pressure, coagulopathy
  54. What are common causes of intracerebral hemorrhage?
    • Amyloid
    • Angiopathy
    • Angioinvasive Fungal
    • Infection
    • Aneurysm
    • Coagulation Disorders
    • Cocaine
    • Hypertension
    • Neoplasms
    • Hemorrhagic transformation of an ischemic stroke
    • Trauma
    • Vascular Malformation
    • Anticoagulation / Warfarin
  55. What are the two major types of stroke and their relative percentages?
    Ischemic

    Hemorrhagic
  56. What are the major types of ischemic stroke?
    • Embolic
    • Thrombotic
    • Watershed
  57. What are the characteristic signs, symptoms, and causes of an Embolic Stroke?
    Sudden and maximal symptoms at onet

    Emboli may arise from the Heart of Proximal Vessels
  58. What are the characteristic signs, symptoms, and causes of a Thrombotic Stroke?
    May be either abrupt in onset or evolve over time

    May be due to progressive occlussion of large or small arteries
  59. What are the characteristic signs, symptoms, and causes of a Watershed Infarction?
    Major cause is systemic hypoperfusion

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