Brain Vasculature and Cerebrovascular Accident
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Questions and Answers

Which condition involves the bulging of a weakened arterial wall, potentially leading to rupture and hemorrhage?

  • Atherosclerosis
  • Stenosis
  • Aneurysm (correct)
  • Dissection

A patient presents with symptoms of reduced blood flow in the carotid artery. What arterial condition is most likely contributing to these symptoms?

  • Venous Insufficiency
  • Atherosclerosis (correct)
  • Lymphatic Obstruction
  • Arterial Dissection

Which of the following arterial conditions involves the tearing of the arterial wall, potentially leading to the formation of a false lumen?

  • Vasospasm
  • Arteriosclerosis
  • Aneurysm
  • Dissection (correct)

A 60-year-old patient with a history of hypertension and smoking is diagnosed with an arterial condition. Which of the following is most likely to be the primary underlying factor contributing to this condition?

<p>Atherosclerosis (D)</p> Signup and view all the answers

A physician orders diagnostic imaging to evaluate a patient suspected of having a cerebral vascular accident (CVA). Which of the following arterial conditions would this imaging be MOST helpful in identifying?

<p>Aneurysm (A)</p> Signup and view all the answers

Which of the following arteries is NOT part of the vertebrobasilar system within the Circle of Willis?

<p>Anterior Cerebral Artery (ACA) (B)</p> Signup and view all the answers

A patient presents with a sudden loss of balance and coordination. Which artery is MOST likely affected based on these symptoms?

<p>Superior Cerebellar Artery (SCA) (C)</p> Signup and view all the answers

Aneurysms are MOST commonly found in which location within the cerebral vasculature?

<p>Bifurcations of major vessels within the Circle of Willis (C)</p> Signup and view all the answers

Which artery would MOST likely be affected given the lack of collateral perfusion?

<p>Basilar artery (A)</p> Signup and view all the answers

A patient is diagnosed with arteriovenous malformation. Which best describes this condition?

<p>Abnormal connection between arteries and veins. (D)</p> Signup and view all the answers

Atherosclerosis is MOST likely to develop at which point in the cerebral vasculature system?

<p>Bifurcations of major vessels (D)</p> Signup and view all the answers

Following a traumatic brain injury, a patient exhibits signs of ischemia in the occipital lobe. Which artery is MOST likely compromised?

<p>Posterior Cerebral Artery (C)</p> Signup and view all the answers

Upon reviewing an angiogram, a radiologist identifies a blockage in the M1 segment of the middle cerebral artery. Which region of the brain is MOST immediately at risk of infarction?

<p>Lateral aspect of the cerebral hemisphere (B)</p> Signup and view all the answers

Which of the following arteries provides blood supply to the inner ear?

<p>Anterior Inferior Cerebellar Artery (A)</p> Signup and view all the answers

A patient presents with vision problems after a stroke. Which artery is MOST likely involved?

<p>Ophthalmic Artery (B)</p> Signup and view all the answers

Which condition increases the risk of both hemorrhagic and occlusive strokes?

<p>Atherosclerosis (A), Arteriovenous Malformation (AVM) (B)</p> Signup and view all the answers

A patient exhibits a sudden, severe headache, and a CT scan reveals diffuse subarachnoid hemorrhage and hydrocephalus. An angiogram identifies a saccular berry aneurysm in the anterior communicating artery. What is the most likely underlying cause of the aneurysm?

<p>Arteriosclerotic plaques weakening the vessel wall (C)</p> Signup and view all the answers

Occlusion of the lenticulostriate arteries, which branch off the proximal M1 segment of the MCA, would primarily affect which structure?

<p>Posterior limb of the internal capsule (D)</p> Signup and view all the answers

Which vascular structure supplies the basal ganglia, limbic structures, and anterior limb of the internal capsule?

<p>Recurrent Artery of Heubner (D)</p> Signup and view all the answers

A patient experiences cardiac arrest leading to a lack of oxygenated blood to the brain. This condition is best described as:

<p>Global Cerebral Ischemia (D)</p> Signup and view all the answers

What is the primary difference between ischemia and infarction in the context of cerebrovascular accidents?

<p>Ischemia is a temporary reduction in blood flow, while infarction is the death of brain tissue. (C)</p> Signup and view all the answers

Which arteries provide blood supply to the thalamus and posterior limb of the internal capsule?

<p>Thalamoperforator and Thalamogeniculate arteries (A)</p> Signup and view all the answers

What pathological mechanism underlies lacunar infarctions?

<p>Thrombosis of small, penetrating arteries. (B)</p> Signup and view all the answers

A patient presents with a constellation of symptoms, suggesting a CVA. Which of the following symptoms most strongly suggests a hemorrhagic stroke rather than an occlusive stroke?

<p>Explosive headache with nuchal rigidity. (B)</p> Signup and view all the answers

Which condition involves bleeding into the wall of a blood vessel?

<p>Dissection (B)</p> Signup and view all the answers

Occlusion of lenticulostriate branches off the M1 segment of the middle cerebral artery (MCA) would most likely result in which of the following?

<p>Pure hemiparesis due to damage to the posterior limb of the internal capsule. (D)</p> Signup and view all the answers

A patient presents with right-sided weakness, slurred speech, and an extension plantar response (Babinski's sign). The right facial weakness spares the forehead. Which vascular event is the most likely explanation?

<p>Occlusion of lenticulostriate branches off the left M1 segment of middle cerebral artery (MCA). (D)</p> Signup and view all the answers

A patient exhibits weakness in the left leg and mild weakness in the left arm, accompanied by a positive Babinski's sign on the left side. Mild dysarthria is also noted. Which cerebral artery is most likely affected by an infarct?

<p>Left anterior cerebral artery (ACA). (A)</p> Signup and view all the answers

A patient presents with blurry vision and a right visual field defect, but no somatosensory or motor deficits. Which cerebral artery is most likely affected by an infarct?

<p>Left posterior cerebral artery (PCA). (B)</p> Signup and view all the answers

Watershed infarcts are most likely to occur due to hypo-perfusion in the border zones between major cerebral arteries. Which of the following clinical presentations would be most suggestive of a watershed infarct between the ACA and MCA?

<p>Proximal limb weakness. (D)</p> Signup and view all the answers

Which of the following best explains why the internal capsule is particularly vulnerable to the effects of hemorrhage or infarction?

<p>It is supplied by end arteries with no significant anastomosis or collateral perfusion. (C)</p> Signup and view all the answers

If a patient presents with pure hemiparesis (weakness on one side of the body) without any sensory loss, which of the following locations is most likely the site of a small lacunar infarct?

<p>Posterior limb of the internal capsule. (B)</p> Signup and view all the answers

A patient presents with pure hemisensory loss (sensory loss on one side of the body) without any motor deficits. Which of the following locations is most likely the site of a small lacunar infarct?

<p>Ventral posterior nucleus of the thalamus. (A)</p> Signup and view all the answers

What is the most likely diagnosis for a patient exhibiting progressive dementia, cranial nerve palsies, dysarthria, dysphagia, a positive gag reflex, and emotional imbalance, stemming from a series of small lacunar infarcts?

<p>État lacunaire. (B)</p> Signup and view all the answers

Which of the following is the primary mechanism by which astrocytes contribute to the blood-brain barrier (BBB)?

<p>Inducing endothelial tight junctions in brain capillaries. (D)</p> Signup and view all the answers

Which of the following describes the role of pericytes in maintaining the blood-brain barrier (BBB)?

<p>Regulating cerebral blood flow and BBB integrity. (C)</p> Signup and view all the answers

The exchange of substances across the blood-brain barrier (BBB) is highly regulated. Which of the following mechanisms allows for the transport of lipid-soluble molecules across the BBB?

<p>Simple diffusion. (C)</p> Signup and view all the answers

The cerebral vein of Galen drains into which of the following?

<p>Straight sinus. (D)</p> Signup and view all the answers

What is the significance of the 'empty delta sign' in the context of cerebral venous drainage?

<p>It suggests thrombosis of the superior sagittal sinus. (C)</p> Signup and view all the answers

The inferior anastomotic vein of Labbé primarily drains into which of the following sinuses?

<p>Transverse sinus. (D)</p> Signup and view all the answers

Flashcards

Cerebrovascular Accident (CVA)

Brain blood vessel problems. Can cause stroke-like symptoms

Aneurysm

Weakened artery wall bulges, risking rupture and bleeding

Atherosclerosis

Plaque buildup narrows/blocks arteries, reducing blood flow

Arterial Dissection

Tear in artery wall layers, obstructing blood flow

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Arterial vasculature

Blood vessels that carry oxygenated blood away from the heart to the body

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Dissection (Vascular)

Bleeding into the wall of a blood vessel.

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Arteriovenous Malformation (AVM)

An abnormal tangle of blood vessels connecting arteries and veins, disrupting normal blood flow and oxygen circulation.

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Infarction

Area of dead tissue due to lack of blood supply.

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Ischemia

Lack of blood flow to a brain region.

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Hypoxia

Lack of oxygenated blood in a brain region.

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Cerebral Infarction

Death of brain tissue due to circulatory failure.

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Occlusive Stroke

Blockage of a blood vessel by a thrombus or embolus.

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Hemorrhagic Stroke

Rupture of a blood vessel in the brain.

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Infarction and Ischemia

Tissue death (infarction) or damage (ischemia) due to insufficient blood supply.

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Circle of Willis

Network of interconnected arteries at the base of the brain that provides collateral circulation.

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Basilar Artery

Vertebral arteries merge to form this, supplying the brainstem and cerebellum.

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Anterior Cerebral Artery (ACA)

Supplies the anterior portion of the brain. It's a branch of the internal carotid artery.

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Middle Cerebral Artery (MCA)

Supplies the lateral surface of the brain. It's a branch of the internal carotid artery.

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Posterior Cerebral Artery (PCA)

Supplies the posterior portion of the brain, including the occipital lobe.

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Posterior Communicating Artery

Connects the anterior and posterior cerebral circulation within the Circle of Willis.

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Hemorrhage in Brain

Bleeding within the brain; end arteries mean no alternative blood supply.

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Lacunar Infarcts

Small areas of dead tissue due to interruption of blood flow, often in the internal capsule or thalamus.

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État Lacunaire

A condition with progressive dementia, cranial nerve issues, and emotional changes.

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Hemiparesis/Hemiplegia

Weakness on one side of the body, the face may be affected while sparing the forehead.

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Babinski's Sign

Sign of upper motor neuron lesion with toes extending upwards upon stimulation of the sole of the foot.

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ACA Infarct Symptoms

Weakness in the leg and arm due to ACA infarct.

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PCA Infarct Symptoms

Visual field deficits due to PCA infarct.

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Watershed Infarct

Infarction at the borders of arterial territories due to hypoperfusion.

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Venous System of Brain

Drains blood from the brain into the internal jugular vein

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Superior Sagittal Sinus

Sinus that is located at the top of the brain, drains into the transverse sinus

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Blood-Brain Barrier (BBB)

Maintains tight junctions, regulating what passes from blood to brain.

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Cerebrospinal Fluid (CSF) Functions

Acts as a shock absorber and helps remove waste products from the brain.

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Study Notes

  • The lecture covers the arterial and venous vasculature of the brain, examples of CVA (Cerebrovascular Accident), and the blood-brain barrier

Arterial Vasculature

  • The arterial supply to the brain comes from the vertebral and basilar arteries, and the internal carotid arteries
    • The vertebral and basilar arteries supply the cerebellar, cerebral, spinal, and pontine regions
    • The internal carotid arteries primarily supply the cerebral regions
  • The vertebral arteries merge to form the basilar artery
  • Cerebral arteries make up parts of the Circle of Willis

Circle of Willis

  • An anastomosis of vessels
  • Consists of the vertebral and basilar artery system, and the internal carotid artery system
  • Vertebrobasilar System consists of:
    • Posterior cerebral artery (PCA)
    • Superior cerebellar artery (SCA)
    • Anterior inferior cerebellar artery (AICA)
    • Posterior inferior cerebellar artery (PICA)
    • Anterior and posterior spinal arteries
  • Internal Carotid Artery Consists of
  • Posterior communicating artery
  • Middle cerebral artery (MCA)
  • Anterior communicating artery
  • Anterior cerebral artery (ACA)
  • Ophthalmic artery
  • Internal Carotid System
    • Includes :
    • Internal carotid artery
    • Ophthalmic artery
    • Posterior communicating artery
    • Anterior communicating artery
    • Anterior cerebral artery (A1, A2 segments)
    • Middle cerebral artery (M₁ proximal branch, M₂ segments)
    • Lenticulostriate arteries
    • Anterior choroidal arteries which supply the basal ganglia, hippocampus, and posterior limb of the internal capsule
  • Vertebro-basilar System
    • Includes Vertebral artery, Basilar artery, Spinal artery, Posterior inferior cerebellar artery, Anterior inferior cerebellar artery, Superior cerebellar artery and Posterior cerebral artery (P1, P2 segments)
  • The anterior choroidal artery, thalamoperforator, thalamogeniculate and posterior choroidal artery supply blood to the thalamus and the posterior limb of the internal capsule
  • Occlusion of end vessel causes focal ischemia
    • Hypo-perfusion causes border zone infarct
    • Proximal limb weakness can be (ACA / MCA)
    • Aphasia can be (PCA / MCA)

Venous Vasculature

  • Veins eventually drain into the internal jugular vein
  • Veins that participate in venous drainage include
  • Inferior sagittal sinus, superior anastomotic vein of Trolard, inferior anastomotic vein of Lobe, and torcula or confluence of sinuses
  • Superficial veins include superior sagittal sinus and cavernous sinus
  • Deep veins include Great vein of Galen
  • Superior Sagittal, Inferior Sagittal and Straight Sinuses
  • Cerebral Veins
  • Superior petrosal sinus, inferior petrosal sinus
  • Superior anastomotic vein of Trolard, inferior anastomotic vein of Labbe and Superficial middle cerebral vein
  • Cerebral vein of Galen and Basil vein of Rosenthal

Blood Brain Barrier (BBB)

  • Formed by endothelial cells with tight junctions, induced by astrocytes
  • Pericytes support the BBB
  • Metabolic barrier (MAO)
  • Functions of the CSF
    • Shock absorber
    • Removal of metabolites
    • pH buffer
  • Blood and CSF exchange
    • Lipid soluble diffusion
    • Receptor mediated transport
    • Ion channel diffusion

Pathology

  • Examples of CVA
    • Aneurysm
    • Atherosclerosis
    • Dissection
    • Arterio-Venous Malformation
    • Infarction
  • Atherosclerosis often occurs at bifurcations in major vessels and the Circle of Willis, and can cause plaque deposition on the vessel wall
    • Within the Circle of Willis, there is anastomosis providing collateral supply, but the basilar artery lacks collateral perfusion
  • Aneurysms are "baloonings"
    • Berry aneurysms occur at the base of the brain, in particular at the Circle of Willis
    • Micro-aneurysms are intra-cerebral
  • Dissections involve bleeding within the vessel
    • Internal carotid
  • Arteriovenous malformation is intra-cerebral
  • Atherosclerosis
    • causes occlusive stroke, infarction and hemorrhage
  • Aneurysm and dissection
    • cause hemorrhage and infarction (death of tissue)
  • Ischemia is lack of blood flow to brain
  • Hypoxia is lack of oxygenated blood in brain
  • Infarction leads to death of brain

Cerebrovascular Accident or CVA

  • It is a risk with many complications, including:
  • Occlusive stroke is either thrombolytic or embolytic from a closure of vessels
  • Hemorrhagic stroke is from rupture of blood vessels

Global Cerebral Ischemia

  • Diffuse hypoxic and/or ischemic encephalopathy
    • Causes cardiac arrest
    • Shock
    • Hypo-perfusion

Focal Cerebral Ischemia

  • Caused by the following:
    • Embolism
    • Thrombus
    • Vasculitis
  • Lacunar infarction in Intra-cerebral Hemorrhage Note: penetrating arteries to thalamus, basal ganglia and internal capsule are END arteries so no collateral perfusion
  • Small lacunes cause
    • Posterior limb: Pure hemi-paresis no sensory loss, descending motor
    • Ventral posterior nucleus of the thalamus, pure Hemisensory loss, ascending sensory
    • Etat lacunaire: progressive dementia, cranial nerve palsies, dysarthria, dysphagia, (+) gag reflex, emotional imbalance

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Description

This lecture explores the arterial and venous vasculature of the brain, including the vertebral, basilar, and internal carotid arteries. It also covers the Circle of Willis and examples of Cerebrovascular Accidents (CVA). Key concepts such as the blood-brain barrier are discussed.

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