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FNS: Lab

Neuro Lab Handout: Blood Supply

What is an ischemic stroke? blood clots that block an artery
What percentage of all strokes are ischemic? 80%
What is a hemorrhagic stroke? a break in the wall of an artery
What percentage of all strokes are hemorrhagic? 20%
Where does the blood supply to the brain come from (in the neck)? internal carotid and vertebral arteries
What are the terminal branches of the internal carotid arteries? anterior and middle cerebral aa
Where do the middle cerebral arteries run? laterally to the insular lobes
Which artery connects the anterior cerebral aa? anterior communicating artery
Where do the vertebral aa come from? subclavian aa
Where do the vertebral aa unite? What do they form? At the pons-medullary junction, basilar artery
What does the basilar artery divide into? Where? two posterior cerebral aa, pons-midbrain junction
Where do the posterior communicating aa arise from? proximal portions of the posterior cerebral aa
Where do the posterior communicating aa connect to? internal carotid aa
What all is in the Circle of Willis? Which aa? anterior communicating, anterior cerebrals, internal carotids, posterior communicating, and posterior cerebrals
Which of the two terminal branches of the internal carotid is thicker? MCA
Where do the lenticulostriate aa supply? striatum and posterior limb of internal capsule
Strokes involved with the posterior limb of the internal capsule involve which arteries? lenticulostriate
What are symptoms of a stroke involving the posterior limb of the internal capsule? contralateral weakness and UMN signs (corticobulbar, corticospinal tracts), and contralateral loss of discriminatory aspects of sensation (2 point localization, joint position)
After giving off lenticulostriate aa, where does the MCA go? Continues laterally to insula
Name the 5 key areas supplied by insular branches of the MCA. 1. lateral prefrontal c, 2. frontal eye fields on middle frontal gyrus, 3. primary motor c (precentral gyrus- only head/UE portions), 4. primary somatosensory c (postcentral gyrus- only head/UE), 5. posterior parietal c.
Which areas are supplied by insular branches of the MCA on the dominant hemisphere only? Broca’s motor speech area, and Wernicke’s speech area
Strokes involving this main artery are most common types MCA (can involved it or its branches)
What are the most common S+S of unilateral MCA stroke? [weakness, UMN signs, AND somatosensory deficits] on the contralateral arm and lower face
Strokes involving the posterior parietal cortex on the non-dominant hemisphere produce which S+S? contralateral neglect
Strokes involving the posterior parietal cortex on the dominant hemisphere produce which S+S? difficulty reading, writing, arithmetic and distinguishing right from left
What is Gerstmann Syndrome? trouble distinguishing right from left
What areas does the ACA supply (in general)? branches to the medial aspects of the frontal and parietal lobes (not occipital)
What are the key areas supplied by the ACA (specifically)? 1. medial prefrontal c, 2. primary motor c (on paracentral lobule), 3. primary somatosensory c (on paracentral lobule)
What are the primary motor and somatosensory cortices medial continuations of? precentral and postcentral gyri
Which portions of the homuncululi are represented on the paracentral lobule? lower limb and anogenital areas
What are the most common S+S of unilateral ACA stroke? weakness and other UMN signs involving contralateral leg; and somatosensory deficits of contralateral leg
What do the PCAs mainly supply? the inferior temporal lobe and most of occipital lobe- including primary visual cortex along calcarine sulcus
What is the most obvious sign of a unilateral stroke involving cortical branches of the PCA? contralateral homonomous hemianopsia
Where is Broca’s area? right above the most anterior part of the lateral sulcus (on the outer surface of the cortex)
Where is Wernicke’s area? right above the superior temporal sulcus, below the lateral sulcus (at the posterior portions of these sulci)
Which arteries (main) supply the brainstem and cerebellum? vertebral and basilar aa
Which artery supplies the medial medulla? anterior spinal artery
Where does the anterior spinal artery come from? branches of each vertebral artery
Strokes of the anterior spinal artery result in infarction of which tissues? hypoglossal nucleus and nerve, and corticospinal tract (in medullary pyramids)
T/F Usually a stroke of the anterior spinal arteries affects both sides False- it usually involves a branch on one side
What S+S would be observed with a stroke involving branches from the anterior spinal artery? 1. ipsilateral weakness/paralysis of tongue (CN XII), contralateral weakness/paralysis of body (corticospinal tract)
Where do the PICA come from? What does it stand for? vertebral aa- posterior inferior cerebellar arteries
What do the PICAs supply? lateral medulla and cerebellum
What S+S would result from a PICA stroke? 1. contralateral pain+temperature loss of body (LST) and 2. ipsilateral pain+temperature loss of face (spinal trigeminal nucleus/tract)
What is telling of the level of the lesion (stroke) in the brainstem? cranial nerve signs
What is telling of whether the lesion (stroke) is medial or lateral in the brainstem? signs related to tracts
What supplies the pons? branches of the basilar artery
Where does the medial pons receive its blood supply from? pontine branches of the basilar a
Where does the lateral CAUDAL pontine zone receive its blood supply from? AICA (anterior inferior cerebellar aa)
Where does the lateral ROSTRAL pontine zone receive its blood supply from? SCA (superior cerebellar aa)
Which branch of the basilar artery is usually the first branch? AICAs
Which branch of the basilar artery is usually the second to last? SCA
Which arteries surround the oculomotor nerve? Which is rostral, which is caudal? posterior cerebral is rostral, SCA is caudal
Strokes involving the caudal part of the medial pons typically involve which two structures? What are the associated S+S? 1. ipsilateral weakness/paralysis of LR muscle (CN VI) and 2. contralateral weakness/paralysis of body medullary pyramids
Where does the midbrain get its blood from? branches of the proximal part of PCA
Strokes involving the medial parts of the PCA typically involve which structures? What are associated S+S? 1., CN III (ipsilateral eye weakness/paralysis) and 2. cerebral peduncles (contralateral weakness/paralysis of body, face, tongue)
Which 3 arteries supply the SC? How far down do they go? anterior spinal a, and 2 posterior spinal aa- they run the length of the SC
When do the posterior spinal aa arise from the vertebral aa? (in the picture, they arise from PICA, shortly after it comes from vertebral) as they pass through the foramen magnum
How far down the spinal aa does blood go from the vertebral junction? only about C4- there are other spinal medullary aa further caudal that supply SC
Can you see the posterior medullary arteries on the specimens in lab? Where? no (would run with the dorsal roots)
Can you see the anterior medullary arteries on the specimens in lab? Where? if you’re lucky, at the cervical and lumbar enlargements (run with ventral roots)
Do most veins associated with the brain follow the arteries’ courses? How about the SC? no- some, but not most; SC do follow the aa
Where does venous blood flow from the brain go? adjacent dural venous sinuses
Where does venous blood flow from the SC go? parallel the arteries and eventually drain into epidural venous plexus
What is the other name for the epidural venous plexus? internal vertebral venous plexus of Batson
Study atlas pictures of functional areas
Created by: mbyess