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arteries of stroke
-lateral striate arteries -arise from MCA -supply internal capsule, caudate, putamen, globus pallidus
most common site of berry aneurysms
anterior communicating artery
The vertebral artery arises from _______ and gives off ________ and ________.
-subclavian artery -anterior spinal artery -PICA
The basilar artery gives rise to...
-paramedian pontine arteries -AICA -superior cerebellar artery -PCA -labyrinthine artery (15% of people)
major blood supply to the midbrain
supplies thalamus, LGN and MGN, occipital lobe; occlusion results in CL hemianopia with macular sparing
blood supply of internal capsule
lateral striate arteries, anterior choroidal artery
hypothalamus and thalamus
posterior communicating artery
CN III palsy
posterior communicating artery
anterior choroidal artery
-NOT part of circle of Willis -arises from internal carotid -supplies LGN, GP, posterior limb of internal capsule
leg-foot area of motor and sensory cortices
bitemporal lower quadrantopia
anterior communicating artery
The medial striate arteries arise from ________ and supply ________.
-ACA -anterior putamen and caudate nucleus and anteroinferior internal capsule
middle cerebral artery
-Broca's and Wernicke's areas -face and arm areas of motor and sensory cortices -FEF
dorsolateral quadrant of medulla
-supplied by PICA -contains nucleus ambiguus (CN IX, X, XI) and inferior cerebellum
caudal lateral pontine tegmentum, including CN VII, the spinal trigeminal tract of CN V, and the inferior surface of the cerebellum
superior cerebellar artery
dorsolateral tegmentum of rostral pons, SCP, superior cerebellum and cerebellar nuclei, cochlear nuclei
risk factors for berry aneurysms
-APKD -Ehlers-Danlos -Marfan's -advanced age -HTN -smoking -race (blacks)
Charcot-Bouchard microaneurysms
-chronic HTN -affects small vessels in basal ganglia, thalamus
Wallenberg's syndrome
-PICA infarct -nystagmus -ipsil ataxia -N/V -Horner's
watershed zones
-upper arm/upper leg weakness -defects in higher-order visual processing
stroke of anterior circle
-general sensory and motor dysfct -aphasia
stroke of posterior circle
-CN deficits (vertigo, visual deficits) -coma -cerebellar deficits
fall toward side of lesion
cerebellar hemispheric lesion
eyes look AWAY from side of lesion
PPRF (paramedian pontine reticular formation)
eyes look TOWARD lesion
rupture of middle meningeal artery, often secondary to fracture of temporal bone
epidural hematoma
lucid interval
epidural hematoma
rupture of bridging veins
subdural hematoma
biconvex disk that can cross falx and tentorium (NOT suture lines)
epidural hematoma
elderly, alcoholics, blunt trauma, shaken baby
subdural hematoma
bloody or xanthochromic spinal tap
subarachnoid hemorrhage
risk of vasospasm 2-3 days afterward
subarachnoid hemorrhage
-caused by HTN, amyloid angiopathy, DM, tumor -usu in basal ganglia, internal capsule
parenchymal hemorrhage
exits midbrain from interpeduncular fossa
CN III in addition to moving the eye and elevating the eyelid, sends preganglionic parasym fibers to ciliary ganglion, which projects to sphincter pupillae (miosis) and ciliary muscle (accomodation)
exits from dorsal aspect of brain stem
conditions assoc with CN III impairment
-transtentorial (uncal) herniation - sphincter pupillae muscles are affected first (dilated pupil), then somatic efferent fibers (external strabismus) -aneurysms of carotid and posterior communicating arteries - compress CN III within cavernous sinus or interpeduncular cistern -diabetes oculomotor palsy - damages central fibers and spares sphincter pupillae fibers
exits from cerebellopontine angle
exits skull through jugular foramen
LMN lesion of CN VII
Bell's palsy face area of motor ctx projects to facial nucleus of pons
superior salivatory nucleus of caudal pons
contains pregang parasym neurons that project to lacrimal, submandibular, sublingual glands
lacrimal pathway of CN VII
sup salivatory nuc --> intermediate and greater petrosal nerves --> pterygopalatine ganglion --> lacrimal gland
submandibular pathway of CN VII
sup salivatory nuc --> intermediate nerve and chorda tympani --> submandibular ganglion --> glands
nucleus Solitarius
visceral Sensory taste, baroreceptors, gut distention CN VII, IX, X
nucleus aMbiguus
Motor innervation of pharynx, larynx and upper esophagus (swallowing, palate elevation) CN IX, X, XI
dorsal motor nucleus
parasym fibers to heart, lungs, upper GI
superior orbital fissure
CN III, IV, V1, VI, ophthalmic vein
foramen rotundum
foramen ovale
foramen spinosum
middle meningeal artery
foramen magnum
spinal roots of CN XI, brain stem, vertebral arteries
muscles that close the jaw
masseter, temporalis, medial pterygoid
foci of necrosis surrounded by palisading (tumor)
glioblastoma multiforme
small round blue cell tumors
Lymphoma Ewing sarcoma ALL Retinoblastoma Rhabdomyosarcoma Neuroblastoma Neuroepithelioma Medulloblastoma
3 tumors with psammoma bodies
-meningioma -papillary carcinoma of the thyroid -papillary serous cystadenocarcinoma of the ovaries
all muscles with "glossus" except _____ are innervated by the hypoglossal nerve
palatoglossus (vagus)
all muscles with "palat" except _____ are innervated by the vagus nerve
tensor veli palatini (CN V3)
-usually low grade but occasionally anaplastic -resemble astrocytomas in most respects but grow more slowly and are more sensitive to chemo -calcification in 90% of cases
Homer-Wright pseudorosettes, neurosecretory granules
neuroblastoma -kids<5 -presents as abd mass (adrenal medulla) -Hutchinson neuroblastoma: skull and orbital mets that produce exophthalmos; mets to LN, liver, lung, bone
pseudobulbar palsy
-dysphagia -dysarthria ("donald duck" -hyperactive gag reflexes -spontaneous crying or laughter -causes: bilateral CVA involving internal capsule, motor neuron dz, MS
-acute onset -recurrent attacks of vertigo -N/V -diminished hearing, tinnitus -endolymphatic hydrops
Meneire disease

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