CNS ANAT (351 cards) PDF

1. WHICH 1. WHICH OF OF THE THE FOLLOWING FOLLOWING VESSELS VESSELS IS IS EVALUATED EVALUATED USING USING THE...

1. WHICH 1. WHICH OF OF THE THE FOLLOWING FOLLOWING VESSELS VESSELS IS IS EVALUATED EVALUATED USING USING THE THE A. distal A. distal ICA ICA SUBMANDIBULAR TCD SUBMANDIBULAR TCD WINDOW? WINDOW? e THE THE DISTAL DISTAL ICA ICA CAN CAN A. distal A. distal ICA ICA ¢ BE BE EVALUATED EVALUATED USING USING THE THE SUBMANDIBULAR SUBMANDIBULAR APPROACH APPROACH B. MCA B. MCA C. ACA C. ACA Here is the tabular chart based on the provided information about the submandibular window: D. VERTEBRAL D. VERTEBRAL ARTERIES ARTERIES Intracranial Average Depth Probe Time Averaged Maximum Artery Setting Angulation Velocity Direction of Flow Distal ICA 60 - 80 mm Medial 30 cm/s + 9an/s Away (Can be bi- directional) Parameter Description Patient Position Supine with neck extended Probe Placement Under the jawline (mandible) toward the right or left side and angled cephalad Purpose Used to evaluate the distal CA and siphon, if not evaluated in other views Normal Flow Direction Away from the probe Aspect Details Patient Position Supine with neck extended Probe Placement Under the jawline (mandible) toward the right or left side and angled cephalad Evaluation Use Used to evaluate the distal ICA and siphon, if not evaluated in other view Normal Flow Direction Normal flow moves away from the probe Intracranial Artery Distal ICA Average Depth Setting 60 - 80mm Probe Angulation Medial Time Averaged Maximum 30cm/s t 9em/s Velocity Direction of Flow Away (can be bi-directional) 2. 13. 2. 13. which which branch branch of of the the circle circle of of the the willis willis supplies supplies the the corpus corpus callosum callosum A. ACA A. ACA and the and cavum septum the cavum septum pellucidum pellucidum with arterial blood? with arterial blood? e the the corupus corupus callosum callosum and and the the cavurn cavurn septum septum pellucidium pellucidium are are A. ACA A. ACA e located located aling aling the the midline midline in in the the anterior anterior brain brain B. PCA B. PCA ¢ both both structures structures are are fed by the fed by the anterior anterior cerebral cerebral artery artery C.MCA C. MCA D. BASILAR D. BASILAR ARTERY ARTERY Anterior Cerebral Artery (ACA) Aspect Details Origin The ICA (Internal Carotid Artery) terminates when it splits into the MCA (Middle Cerebral Artery) and ACA. Supply Areas Supplies the frontal and parietal lobes and the corpus callosum. Segments Al Segment: Located between the ICA and the anterior communicating artery origin - A2 Segment: Located distal to the anterior communicating artery origin. Symptoms of ACA - Loss of coordination. Disease Incontinence. Severe leg or in Facial drooping or asymmetry. L 3. 14. 3. 14. the the _________________is is described described as as the segment of the segment of the the vessel vessel located located B. P1 B. P1 SEGEMENT SEGEMENT OF OF THE THE PCA PCA btwn the btwn the distal distal basilar basilar artery artery and and the the orgin orgin of of the the posterior posterior communicator communicator artery artery e¢ THE THE P1 P1 SEGMENT SEGMENT IS IS LOCATED LOCATED BTWN BTWN THE THE DISTAL DISTAL BASILAR BASILAR ARTERY ARTERY A. M1 A. M1 segment segment ofof the the MCA MCA ◦° and and the the origin origin of of the the posterior posterior communicator communicator artery artery B. P1 B. P1 SEGEMENT SEGEMENT OF OF THE THE PCA PCA ◦© the the P2 P2 segment segment is is located located distal distal to to C. P2 C. P2 SEGEMENT SEGEMENT OF OF THE THE PCA PCA ▪= the origin of the origin of the the posterior posterior communicatory communicatory artery artery D. M3 D. M3 SEGMENT SEGMENT OF OF THE THE MCAMCA Segment Location P1 Segment of the Located between the distal basilar artery and the origin of the posterior communicator PCA artery P2 Segment of the Located distal to the origin of the posterior communicator artery PCA Posterior cerebral artery PRE-COMMUNICATING INTERPEDUNCULAR POST- COMMUNICATING AMBIENT CISTERN QUADRIGEMINAL QUADRIGEMINAL CISTERN | | OCCIPITAL CORTICAL ———+ LOBE SULCI ie i\ ff TERMINAL 4 \ A \ ‘ BRANCHES 3 Tuberothalamic — ~ Middle Superior Intenor ferns: rans inferolateraVihalamogeniauate farms Latera! postenor choradal Superior cerebellar ortenes artery Basilar artery 4. 25. 4. 25. the the carotid carotid siphon siphon :: B. supplies B. supplies blood blood to the opthalmic to the opthalmic artery artery A. usually A. usually forms forms a a complete complete circle circle around around the the distal distal ECA ECA before before joining the circle joining the circle ICA SIPHON ICA SIPHON AREA: AREA: of willis of willis e distal distal ICA ICA coruses coruses anteriorly anteriorly then then medially medially B. supplies B. supplies blood blood toto the the opthalmic opthalmic artery artery ▪= then posteriorly forming then posteriorly forming an an "s" "s" reduces reduces flow flow C. is C. is an an area area of of flow flow separation separation due due to the increae to the increae in in vessel vessel diameter diameter at at the the bulb bulb ▪= increases increases reistance reistance to to flow flow D. causes D. causes an an area area of of decreased decreased resistance resistance to to flow flow in in the the distal distal ICA ICA ▪= causes causes turbulence turbulence and and has has increased increased risk risk for for flow reducing flow reducing lesions such lesions such as as ateroma ateroma and and thrombus thrombus Concept Details Ophthalmic Artery The ICA (Internal Carotid Artery) supplies blood to the ophthalmic artery. Supply ICA Siphon Area The distal ICA courses anteriorly then medially, then posteriorly forming an “S* shape. which reduces flow. Flow Effects in ICA ~ increases resistance to flow Siphon ~ Causes turbulence Increases the risk of flow-reducing lesions, such as atheroma and thrombus. 5. Which 5. Which of of the the following following statements statements is is true true regarding regarding the the vertebral vertebral arteries? arteries? D. the D. the right right vertebral vertebral artery artery is is normally normally smaller smaller than than the left the left A. A. the right and the right and left left vertebral vertebral arteries arteries empty empty their their blood blood into into the the right right and and left left Instructor Feedback The right vertebral artery is normally smailer than the left vertebral artery. basilar arteries basilar arteries - Itoriginates from the right subclavian actery, B. the B. the right right vertebral artery is vertebral artery is the the first first baranch baranch of of the the aortic aortic arch arch The right and left vertebral arteries merge distally to foem a single basilar artery C. vertebral C. vertebral artery artery flow flow is is normally normally bipahsic bipahsic due due to to turbulence at theri turbulence at theri junction junction Normal Doppter 2 low resistance, waveform, with the with the basilar basilar artery artery Vortebrat Artery Wavelorm assessed for tlow direction, velocity, and resistance D. the D. right vertebral the right vertebral artery artery is is normally normally smaller smaller than than the left the left Waveforms Normally demonstrates a low to medium velocity, law resistance waveform Variations in flow velocity between the right and Jeft side are normal, the left side is usuaily dominant - Stenosis usuaslly occurs in the proximal artery, and this segment is not normally evaluated on a duplex exam Loss of diastolic flow indicates a distal occlusion Early systolic deceleration is a sign of subclavian artery stenosis. ; \ } Right Left Vertebral Art. Vertebral Art. 6. 52. 6. 52. which of the which of the following following vessels is most vessels is most commonly commonly assessed assessed for the for the C. common C. common carotid carotid artery artery presence of presence of aa bruit? bruit? ¢ The The CCA CCA is is the the artery artery that that is is most most commonly commonly assessed assessed for a bruit for a bruit A. common femoral A. common artery femoral artery B. PTA/DPA B. PTA/DPA Artery Assessment Clinical Significance C. common C. common carotid carotid artery artery Common Carotid Most commonly Detection of bruits can indicate turbulent blood flow due to D. aorta D. aorta Artery (CCA) assessed for a bruit arterial stenosis, commonly used in screening for carotid artery disease, 7.. The The ACA ACA and and its its branches branches feed feed whch of the whch of the following following lobes lobes of of the the brain? brain? d. parietal d. parietal and and frontal frontal ~ A. occipital and A. occipital and frontal frontal Artery Supplied Areas b. occipital b. occipital and and parietal parietal ACA (Anterior Cerebral Feeds the parietal and frontal lobes. c. frontal c. only frontal only Artery) d. parietal d. parietal and and frontal frontal MCA (Middle Cerebral Supplies large portions of the loteral surfaces of the frontal, parietal, and Artery) temporal lobes, Vertebral and Basilar Arteries = Supply the brainstem, cerebellum, and posterior cerebral cortex, PCA (Posterior Cerebral Criginate from the basilar artery to supply the medial temporal and occipital Arteries) lobes. Aspect Details Origin Terminal branch of the internal carotid artery (ICA) Course Proximal (A1) segment from ICA to ACoA; Distal (A2) segment from ACoA along corpus callosum, Branches Al Segment: Medial lenticulostriate arteries, ACoA; A2 Segment: Orbitofrontal artery, artery, Ci ginal artery, artery, other cortical branches Clinical Symptoms of ACA disease include loss of dinati severe leg ip i hemiplegia in leg, facial drooping or Medial view Lateral view a) Posterior cerebral artery ® Middle cerebral artery GEEKYMEDICS.COM Anterior cerebral artery 8. 61. 8. 61. when when evaluating evaluating the the cartoid cartoid siphon siphon from from the submandibular window the submandibular window ,, C. 60-80 C. 60-80 mm mm the sample the sample depth depth should should be be set set to to value value btwn btwn e the the carotid carotid siphon siphon is is A. 30-50 A. 30-50 mm mm ▪= evaulated evaulated when the sample when the sample depth depth is is placed placed at at an an B. 40-60 B. 40-60 mm mm C. 60-80 C. 60-80 mm mm approximate depth approximate depth of of 70 70 mm mm_(btwn (btwn 6060 and and 80 80 mm) mm) D. 80-110 D. 80-110 mm mm Submandibular Window Details Patient Position Patient is supine with neck extended Probe Placement Probe placed under the jawline (mandible) toward the right or left side and angled cephalad Usage Used to evaluate the distal ICA and siphon, if not evaluated in other view Normal Flow Normal flow moves away from the probe Aspect Details Patient Position Supine with neck extended Probe Placement Under the javdine (mandible) toward the right or left side and angled cephalad Evaluation Use Used to evaluate the distal ICA and siphon, if not evaluated in other view ‘Normal Flow Direction Normal flow moves away from the probe Intracranial Artery Distal ICA Average Depth Setting 60 - 80mm Probe Angulation Medial Time Averaged Maximum 3cm/s + Yem/s Velocity Direction of Flow Away (can be bi-directional) Intracranial Average Depth Probe Time Averaged Maximum Artery Setting Angulation Velocity Direction of Flow Siphon 6) - 80 mm Slight Lateral 4t cm/s 4 11 cm/s Away (can be bi directional) Ophthalmic 4) - 60mm Medial 21 cm/s + Sams Toward 9. 69. 9. 69. which which vein vein is is best best evaluated evaluated for for compressibility compressi lity by by asking asking the the pt pt to to D. subclavian vein peform a peform a quick quick ,, deep deep sniff? sniff? A. great A. great saphenous saphenous vein vein Aspect Details B. axiallary B. axiallary vein vein Vein Subclavian Vein C. distal C. distal IVC IVC Manual Compression Limited due to its position beneath the clavicle D. subclavian D. subclavian veinvein Compression Test If the patient performs a quick deep sniff, the normal subclavian vein should demonstrate compression Physiological Basis The quick deep sniff causes a rapid decrease in intrathoracic pressure, increasing venous for Sniff Test feturn and collapsing the subclavian vein due to increased outflow into the innominate vein This table summarizes the key points about the subclavian vein, its anatomical challenges for manual compression, and the physiological response observed during a quick deep sniff test. Aspect Details Patient Position (UV and Supine with the head turned slightly away from the affected side Subctavian Veins) Patient Position (Other Arm Supéne or with the head of the bed elevated Veins) Affected Arm Position Dependent position and externally rotated Veins to Evaluate Internal jugular, subclavian, axillary, brachial, basilic, cephalic: deep forearm veins (radial and ulnar) may also be included Assessment Technique (UV and Assessed for cornpressibility by asking the patient to sniff quickly Subclavian) Flow Characteristics Deep veins of the shoulder and upper arms should normally demonstrate spontaneous and phasic flow Cardiac Pulsatility Normally found in the internal jugular vein (UV) and subclavian veins This table summarizes the protocol for evaluating upper extremity veins for deep vein thrombosis (DVT) using 2D and Doppler ultrasound. tL Aspect Details Anatornical The subclavian vein is a major vein that runs under the clavicle (cofarbone) and receives Location blood from the external jugular vein and the axillary vein. It eventually drains into the brachiocephalic (innominate) vein, intrathoracic Sniffing creates @ rapid decrease in intrathoracic peessure due to the contraction of the Pressure Change diaphragm and the upper airway muscles, leading to an increase in the negative pressure within the thoracic cavity. Venous Return The decrease in intrathoracic pressure duting a sniff increases the pressure gradient between Mechanism the peripheral veins and the central veins (venae cavae). enhancing venous return to the heart, Effect on The subclavian vein is particularly ible to changes in ic pressure due to its Subclavian Vein —_ proximity to the thoracic cavity and its relatively large diameter. The negative pressure increases the venous return from the subclavian vein into the brachiocephatic vein, Collapse The rapid increase in venous return can cause 3 temporary collapse of the subclavian vein as Mechanism the blood 6 rapidly drawn into the larger, more capacious brachiocephalic vein, This collapse is Facilitated by the high compliance of the venous walls, which can easty collapse under pressure. Clinical This phenomenon is used clinically to assess the patency and function of the subclavian vein, Significance The absence of expected collapse during a sniff test might indicate an obstruction or thrombosis in the subclavian vein or more central veins. ¢ Anatomical Anatomical Consideration: Consideration: The The subclavian subclavian vein’s anatomical position vein’s anatomical position under the under the clavicle clavicle and and its its drainage drainage into into the the brachiocephalic brachiocephalic vein vein make make itit highly responsive highly responsive toto intrathoracic intrathoracic pressure pressure changes. changes. e Physiological Physiological Mechanism: Mechanism: Sniffing Sniffing decreases decreases intrathoracic intrathoracic pressure, pressure, enhancing venous enhancing venous return, return, and and causing causing the the subclavian subclavian vein vein to to collapse collapse quickly due quickly due to to the the increased increased outflow. outflow. ¢ Clinical Clinical Use: Use: This This collapse collapse isis a a normal normal physiological physiological response response and and can can be be used diagnostically used diagnostically to identify venous to identify venous obstructions. obstructions. This detailed This detailed explanation explanation integrates integrates anatomical anatomical and and physiological physiological aspects aspects to to explain why explain why the the subclavian subclavian vein vein collapses collapses during during the the sniff sniff test 10.72. 10. the ICA 72. the ICA terminates into which terminates into which two two branches branches of of the circle of the circle of willis? willis? B. MCA B. MCA and and ACA ACA A. MCA A. MCA and and posterior posterior communicator communicator arteries arteries ◦° Bilateral Bilateral ICAs ICAs course course superiorly superiorly to to join the circle join the circle of of Willis Willis on on the the B. MCA B. MCA and and ACA ACA lateral aspect lateral aspect of of each each side side of of the the brain brain C. PCA C. PCA and and ACA ACA ◦° in in most most patients, patients, they terminate at they terminate at the the orgination orgination of of the the MCA MCA and and D. Vertebral D. and basilar Vertebral and basilar arteries arteries ACA ACA ◦© the the PCoA PCoA is is branch branch of of the the distal distal ICA ICA Here’s a Here’s a mnemonic mnemonic to help remember to help remember the the termination of the termination of the Internal Internal Carotid Carotid Artery (ICA) Artery (ICA) into into the the Middle Middle Cerebral Cerebral Artery Artery (MCA) (MCA) and and Anterior Anterior Cerebral Cerebral Artery (ACA): Artery (ACA): “Mighty Anterior "Mighty Anterior Connection" Connection" ¢ Mighty: Mighty: Refers Refers to to MCA MCA (Middle (Middle Cerebral Cerebral Artery). Artery). e Anterior: Refers to Anterior: Refers to ACA ACA (Anterior (Anterior Cerebral Cerebral Artery). Artery). ¢ Connection: Connection: Represents Represents the termination into the termination into the the circle circle of of Willis. Willis. This mnemonic This mnemonic should should helphelp recall recall that that the the ICA ICA terminates terminates into into both both the the MCA MCA and and ACA. Let ACA. Let me me know know ifif you you need need further further assistance! assistance! Segment Description Cervical ICA —_- Extracranial segment that originates at the carotid bifurcation and extends to the petrous portion of the temporal bone ~ Evaluated on extracranial Duplex examination Petrous ICA - Intracranial segment that courses along the petrous portion of the temporal bone Not able to evaluate using 2D imaging, requires Doppler evaluation Cavernous ~ Tortuous intracranial segment that extends from the petrous portion to the circle of Willis Distal end of the cavernous segment is called the supractinoid segment The ophthalmic artery is the first branch of the ICA and originates from the cavernous segment The ICA terminates when it splits into the MCA (Middle Cerebral Artery) and ACA (Anterior Cerebral Artery) 1. Internal carotid arteries (ICA) 2. Middle cerebral arteries (MCA) 3. Anterior cerebral arteries (ACA) 4. Anterior communicating artery 5. Posterior communicating artery 6. Posterior cerebral arteries(PCA) 7. Cerebellar arteries 8. Vertebral arteries 9. Basilar artery 11. 74. 11. 74. which of the which of the following following describes describes the the normal normal appearance appearance of of a a waveform waveform A. low resistance A. low resistance with spectral broadening with spectral broadening obtained in obtained in the the MCA? MCA? ◦© the the itracranial itracranial arteries arteries normally normally demonstrate demonstrate low low resistance resistance flow flow A. low A. low resistance resistance with with spectral spectral broadening broadening due to due to B. low B. low resistanc, resistanc, laminar laminar flow with clear flow with clear spectral spectral window window ◦° the the low low resistacne resistacne fo fo the the brain brain tiisues. tiisues. C. low C. low resistance resistance flow flow that that varies varies with with patient patient respiration respiration ◦© spectral spectral broadening broadening is is normal normal in in these these arteries arteries due due to to the the small small d. low d. low resistanc, resistanc, low low velocity velocity with with small small flow reversal component flow reversal component in in diastole diastole size of size of the the vessels vessels image Courtesy of CLEMSON UNIVERSITY ~ CV IMAGING LEADERSHIP CONCENTRATION Component Description