Circulation of the Brain
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Questions and Answers

What is the primary vessel of the anterior circulation?

  • Brachiocephalic artery
  • Internal carotid artery (correct)
  • Aorta
  • Vertebral artery

    • Which artery supplies the medial surface of the cerebral hemisphere?

  • Middle cerebral artery
  • Vertebral artery
  • Basilar artery
  • Anterior cerebral artery (correct)

    • From which artery does the left common carotid arise?

  • Subclavian artery
  • Aorta (correct)
  • Internal carotid artery
  • Brachiocephalic artery

    • Which structure marks the convergence of anterior and posterior circulations?

    <p>Circle of Willis</p> Signup and view all the answers

    What are the common sites for cerebrovascular accidents (CVAs)?

    <p>Bifurcation of the common carotid</p> Signup and view all the answers

    What is the primary cause of amaurosis fugax?

    <p>Disruption of blood flow to the retina causing temporary loss of vision in one eye that is associated with carotid stenosis</p> Signup and view all the answers

    What is a key advantage of using general anesthesia during carotid endarterectomy (CEA)?

    <p>Enhanced patient tolerance and motionless surgical field</p> Signup and view all the answers

    What condition is characterized by miosis, ptosis, and anhidrosis?

    <p>Horner syndrome</p> Signup and view all the answers

    During carotid endarterectomy, once the carotid artery is clamped, cerebral perfusion relies on which flow?

    <p>Collateral flow from the circle of Willis</p> Signup and view all the answers

    Which of the following agents is considered a good option for induction in general anesthesia for CEA?

    <p>Propofol or etomidate</p> Signup and view all the answers

    Which of the following statements regarding the management of hypotension during carotid clamping is correct?

    <p>Neo is preferred for treating hypotension to maintain cerebral perfusion pressure.</p> Signup and view all the answers

    What is the recommended goal for blood pressure during carotid clamping?

    <p>10-20% above baseline</p> Signup and view all the answers

    Which volatile anesthetic is noted to provide the best protection against cerebral ischemia?

    <p>Isoflurane</p> Signup and view all the answers

    What is the appropriate action if local anesthetic infiltration at the surgical site does not effectively treat bradycardia?

    <p>Administer atropine.</p> Signup and view all the answers

    What is the main risk associated with the use of a shunt during carotid artery surgery?

    <p>Embolization.</p> Signup and view all the answers

    What is the primary purpose of monitoring activated clotting time (ACT) in surgical procedures involving heparin?

    <p>To monitor bleeding risk because PT and PTT are not clinically useful at high levels of heparin, which are often used during surgery</p> Signup and view all the answers

    What complication is commonly observed after carotid endarterectomy and associated with strokes?

    <p>Postoperative hypertension. Goal SBP&lt;180</p> Signup and view all the answers

    What potential disadvantage is associated with using regional anesthesia for carotid endarterectomy?

    <p>Increased risk of phrenic nerve dysfunction.</p> Signup and view all the answers

    What is the main cause of carotid artery disease?

    <p>Atherosclerosis</p> Signup and view all the answers

    Which of the following symptoms is NOT associated with a transient ischemic attack (TIA)?

    <p>Severe headache</p> Signup and view all the answers

    What is the duration range for symptoms during a transient ischemic attack (TIA)?

    <p>5 minutes to 24 hours</p> Signup and view all the answers

    Which symptom differentiates a stroke from a TIA?

    <p>Neurological deficits lasting more than 24 hours</p> Signup and view all the answers

    What is the primary risk associated with carotid endarterectomy?

    <p>Higher risk of perioperative myocardial infarction</p> Signup and view all the answers

    In what scenario is carotid artery angioplasty and stenting preferred over carotid endarterectomy?

    <p>Severe obesity with a high BMI</p> Signup and view all the answers

    Which of the following is considered a symptom of symptomatic carotid artery disease?

    <p>Symptoms with ischemia and may result in TIA or stroke</p> Signup and view all the answers

    What vascular structure follows after the Basilar artery in the posterior circulation?

    <p>Posterior cerebral arteries</p> Signup and view all the answers

    Which of the following treatments is NOT a part of medical management for carotid disease?

    <p>Endarterectomy</p> Signup and view all the answers

    Which factor is least likely to influence cerebral injury from carotid artery disease?

    <p>Blood type</p> Signup and view all the answers

    What is a significant risk factor for increased stroke risk in patients over 70 undergoing CAS?

    <p>Age-related vascular changes</p> Signup and view all the answers

    Which of the following medications should be optimized preoperatively for patients undergoing carotid surgery?

    <p>Beta blockers</p> Signup and view all the answers

    What defines a complete stroke compared to an incomplete stroke?

    <p>Entire area of the brain is affected in complete stroke</p> Signup and view all the answers

    Of the two types of strokes, which is the most common?

    <p>Ischemic stroke 80%</p> Signup and view all the answers

    Study Notes

    Anterior Circulation

    • Anterior circulation supplies most of the brain's blood flow
    • Internal carotid artery is the primary vessel
    • Pathway: aorta → internal carotid → Circle of Willis → cerebral hemispheres
    • Internal carotid arteries pass through the skull's foramen lacerum
    • Bifurcate into anterior and middle cerebral arteries
    • Anterior cerebral artery (ACA) supplies the medial surface of the brain
    • Middle cerebral artery (MCA) supplies the lateral surface
    • Striate arteries are common sites for cerebrovascular accidents (CVAs)
    • Common carotid artery branches into the left and right common carotid arteries
    • Left common carotid arises from the aorta
    • Right common carotid arises from the brachiocephalic artery
    • The external carotid artery supplies blood to the structures external to the brain

    Posterior Circulation

    • Posterior circulation supplies the brainstem, cerebellum, and posterior fossa structures
    • Vertebral arteries arise from the subclavian artery
    • Enter the skull through the foramen magnum
    • Branches of the vertebral and basilar arteries supply the brainstem, cerebellum, vestibular apparatus, cochlear nuclei, and parts of temporal and occipital lobes
    • Posterior circulation pathways: aorta → subclavian → vertebral → basilar → posterior fossa structures
    • Anterior and posterior circulations converge at the Circle of Willis

    Circle of Willis

    • Anterior and posterior circulations converge at the Circle of Willis
    • A circulatory anastomosis
    • Helps equalize blood flow and maintain blood supply to the brain

    Carotid Disease

    • Atherosclerosis is the most common cause of carotid disease
    • Fatty deposits accumulate in the subintimal layer of the arteries
    • Plaque buildup causes narrowing and decreased blood flow
    • Plaques can rupture and cause thrombi/emboli and stroke
    • Two types of stroke: ischemic and hemorrhagic
    • Ischemic stroke (80%) is most common, caused by embolism, thrombus, or vasospasm
    • Hemorrhagic stroke (20%) is caused by a ruptured vessel

    Carotid Risk Factors

    • Older age, male sex, family history, high blood pressure (HTN), smoking, diabetes, obesity, and high cholesterol.

    Carotid Artery Disease Symptoms

    • Usually asymptomatic (plaques present, but adequate blood flow maintained)
    • Symptomatic disease, plaques may cause ischemia symptoms, transient ischemic attack (TIA), or stroke

    Transient Ischemic Attack (TIA)

    • Sudden temporary loss of blood flow to an area of the brain
    • Usually lasts 5 minutes to 24 hours
    • Symptoms similar to stroke, but resolve completely within 24 hours
    • Can be a warning sign for a future stroke

    Stroke

    • Neurological deficits persisting for more than 24 hours
    • Complete or incomplete evolution
    • Complete = entire area affected
    • Incomplete = additional brain area remains at risk

    Carotid Disease Treatments

    • Medical Treatment: Medications (antiplatelets, anticoagulants, statins) to control risk factors
    • Surgical Treatment: Endarterectomy (surgical removal of plaque), Angioplasty and Stenting (inserting a stent to widen the artery)

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    Related Documents

    Lesson 14 Carotid Artery Disease and Strokes PDF

    Description

    This quiz covers the concepts of anterior and posterior circulation in the human brain, detailing major vessels and their functions. It explores the pathways and supplies of blood flow to different regions, focusing on arteries involved in cerebrovascular incidents. Test your understanding of how blood circulates through the brain’s important structures.

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