SCRN EXAM REVIEW2023 QUESTIONS AND ANSWERS

Posterior Cerebral Artery (PCA) - Answer- Arises from basilar. Supplies Occipital Lobe , Midbrain, Thalamus, Pineal Gland, Choroid Plexus, and Corpus Callosum Symptoms of PCA Stroke - Answer- -Contralateral Visual Field Homonymous hemianopia -Visual Agnosia (unable to interpret/recognize visual information) - Weber's Syndrome (3rd nerve palsy + contralateral hemiplegia) -Parinaud's Syndrome (Impaired upwards gaze, convergence-retraction nystagmus, primary conjugate downward gaze) Anterior Inferior Cerebellar Artery (AICA) - Answer- Feeds anterior inferior parts of the cerebellum Symptoms of AICA Stroke - Answer- Lateral Pontine Syndrome: vertigo, vomiting, nystagmus, falling towards the side of the lesion, ipsilateral loss of sensation to the face, ipsilateral facial paralysis, ipsilateral hearing loss Posterior Inferior Cerebellar Artery (PICA) - Answer- Feeds cerebellum, superior section of the medulla,. Choroid plexus and fourth ventricle Symptoms of PICA Stroke - Answer- Wallenburg Syndrome (lateral Medullary Syndrome): Loss of pain and temperature sensation in the contralateral trunk and ipsilateral face Basilar Artery - Answer- An artery, formed by the fusion of the vertebral arteries, that supplies blood to the brainstem (medulla and pons) and to the posterior cerebral arteries. Symptoms of Basilar Artery Stoke - Answer- Coma, quadriparesis, ataxia, dysarthria, CN dysfunction and visual deficits, Locked in Syndrome, Intranuclear Opthalmoplegia, gaze paresis, Millard Gulber Syndrome CN VI VII damage (diplopia facial weakness, loss of corneal reflex), Nausea, vomiting, diplopia, gaze palsy, dysarthria,. vertigo, tinnitus, hemiparesis, and quadriplegia. Anterior Cerebral Artery (ACA) - Answer- Feeds the media portion of the frontal and parietal lobes as well as the corpus callosum Symptoms of ACA Stroke - Answer- Contralateral motor/sensory deficits impacting legs > arms Middle Cerebral Artery (MCA) - Answer- Feeds majority of the frontal, parietal, and temporal lobes, basal ganglia, internal capsule. It is divided M1 - M4 Symptoms of MCA Stroke - Answer- -Aphasia if dominant hemisphere -Neglect if non-dominant hemisphere -Contralateral motor/sensory loss of face/arm/leg with Arms > Legs -Anosognosia: neglect or lack of self awareness Venous Vascular Anatomy - Answer- Venous channels enter into venous sinuses located in the Dura matter. Superior Sagittal Sinus - Answer- Travels posteriorly between the cerebral hemispheres towards the occiput Straight Sinus - Answer- Travels along the tentorium, draining blood from the superior cerebellar veins. Transverse Sinus - Answer- Travels along the base of the occiput laterally and forwardly Sigmoid Sinus - Answer- Begins beneath the temporal bone and travels to the jugular foramen where it becomes the internal jugular veins Stroke Pathophysiology - Answer- Arterial blood flow to the brain tissue fails to meet metabolic demands resulting in cell damage or death. ISCHEMIA FIRST THEN INFARCT. Penumbra - Answer- Zone surrounding the core infarct, damaged by ischemia but not yet infarcted ---- functionally silent yet metabolically active Hypoxia leading to Necrotic Pathway - Answer- Cell energy failure Hypoxia leading to Apoptotic Pathway - Answer- Programmed cell death in the penumbral zone ICH Stroke Pathophysiology - Answer- Occurs when a cerebral blood vessel opens abnormally and spills blood into brain tissue. Classification of ICH Brain Injury - Answer- Primary Brain Injury: Direct result of the hematoma Secondary Brain Injury: Hours or days after ICH, mass effect causes mechanical disruption and damage to cell membranes SAH Stroke Pathophysiology - Answer- Aneurysm from s in the cerebral vasculature and ruptures, resulting in blood spilling in the subarachnoid space Saccular Aneurysm - Answer- narrow neck, widened dome -- Most Common Fusiform Aneurysm - Answer- Outpouching of the vessel without a distinct neck --- Less common Early Brain Injury - Answer- Hours and first several days after aneurysm rupture cerebral edema forms, injury results from decreased cerebral blood flow Cerebral Vasospasm (Delayed Cerebral Injury) - Answer- Large Vessel Spasm generally begins on day 4 continues up to 21 days Brain Requirements - Answer- 20% of the body's Oxygen 15% of the body's Cardiac Output Cerebral Blood Flow - Answer- Normal: 50 - 55 mL/100g/min Oligemia: 30 - 40 mL/100g/min Moderate Ischemia (the penumbra): 20 - 30 mL/100 g/min Severe ischemia and Cell Death: 0 - 10 mL/100 g/min Large Vessel occlusion - Answer- Embolic: develop elsewhere and travel to blood vessel in the brain Small Vessel Occlusion - Answer- Thrombotic: caused by a clot that develops in the vessel of the brain Cerebral Cortex - Answer- Grey matter on the outermost section of the cerebrum and cerebellum Divided into four lobes - Frontal - Parietal - Occipital - Temporal Frontal Lobe - Answer- motor, behavioral expression. Motor/sensory maps Parietal Lobe - Answer- Sensation, optic radiations carrying sensory input from the eyes, language centers *typically left side of brain* Language Centers - Answer- Broca's: Production/Expressive Wernicke's: Comprehension/Receptive Occipital Lobe - Answer- Vision and interpretation of visual sensory signals Dysarthria - Answer- Slurred speech, reflecting poor motor control of the muscles associated with speech and language Temporal Lobe - Answer- Coding visual memory and processing auditory and visual sensory input and language comprehension Basal Ganglia - Answer- a group of nuclei serving as the coordinating center for several nerve tract including coordinating muscle movement Globus Pallidus - Answer- A key component of the basal ganglia instrumental in control of voluntary muscle movement Limbic System - Answer- a group of nuclei and cortical structures that encode memory and regulate autonomic nervous system and endocrine function in response to emotional situations Hypothalamus - Answer- Coordinates autonomic nervous system with endocrine function, control of body temperature, circadian rhythm, and body water/osmolality Amygdala - Answer- Plays a crucial role in the management of stress, rage, and anxiety. Center for memory and emotions. Cingulate Gyrus - Answer- develop emotions and encode memory Hippocampus - Answer- Contains centers for memory and learning, regulation of corticosteroid production, and spatial relations Diencephalon - Answer- Between the brain stem and cerebellum Thalamus - Answer- The brain's sensory switchboard, located on top of the brainstem; it directs messages to the sensory receiving areas in the cortex and transmits replies to the cerebellum and medulla Pineal Gland - Answer- produces serotonin and melatonin - contributes to circadian rhythms Pituitary Gland - Answer- Two Lobes Anterior: produces hormones Posterior: releases hormones Cerebellum - Answer- Movement coordination and maintaining balance and position sense. *Cannot initiate movement however is responsible for the unconscious coordination of movement. Brainstem - Answer- Most basic neurologic functions and reflexes Midbrain - Answer- Coordinates eye movement and reflexes associated with hearing and vision CNI: Olfactory: above the midbrain CNII: (s) Optic: Transmits visual cues (visual field deficits) CNIII: (M) Oculomotor: innervates 4 of the 6 muscles that move the eye, medially, upwards, outwards, downwards, pupillary constriction dilation and accommodation CNIV: (M) Trochlear: moves the eye downward and inward Pons - Answer- Acts as a message center between cerebellum and cerebrum CNV: (M/S) Trigeminal: pain temp and light touch from the face, scalp, gag CNVI: (M) Abducens: Lateral gaze CNVII: (M/S): Facial: innervates facial muscles CNVIII: (S) Vestibulocochlear: cochlear- hearing, Vestibular- balance Medulla - Answer- The base of the brainstem; controls heartbeat and breathing CNIX : (M/S) Glossopharengeal: movement of pharynx and larynx, swallowing, taste on posterior tongue CNX: (M/S) Vagus: parasympathetic input to the neck thorax, and abdomen, sensor imput from external ear CNXI: (M) Accessory: motor impulses to pharynx and shoulders CNXII: (M) Hypoglossal: allows for control of the tongue muscles resulting in normal speech and swallow Somatosensory Tracts - Answer- Pathways of neuronal communication 2 pathways System 1: Fine touch proprioception and vibration System 2: Carries pain and temperature sensation from the periphery of the CNS Lock-In Syndrome - Answer- Occlusion of the vertibrobasilar artery resulting in pontine damage - quadriplegic and cannot speak but cogn