SCRN Exam Review Exam Questions with Verified
Solutions.
Posterior Cerebral Artery (PCA) - ANS Arises from basilar. Supplies Occipital Lobe ,
Midbrain, Thalamus, Pineal Gland, Choroid Plexus, and Corpus Callosum
Symptoms of PCA Stroke - ANS -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) - ANS Feeds anterior inferior parts of the
cerebellum
Symptoms of AICA Stroke - ANS 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) - ANS Feeds cerebellum, superior section of
the medulla,. Choroid plexus and fourth ventricle
Symptoms of PICA Stroke - ANS Wallenburg Syndrome (lateral Medullary Syndrome):
Loss of pain and temperature sensation in the contralateral trunk and ipsilateral face
Basilar Artery - ANS 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 - ANS 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) - ANS Feeds the media portion of the frontal and parietal
lobes as well as the corpus callosum
Symptoms of ACA Stroke - ANS Contralateral motor/sensory deficits impacting legs >
arms
Middle Cerebral Artery (MCA) - ANS Feeds majority of the frontal, parietal, and
temporal lobes, basal ganglia, internal capsule. It is divided M1 - M4
Symptoms of MCA Stroke - ANS -Aphasia if dominant hemisphere
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,-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 - ANS Venous channels enter into venous sinuses located in
the Dura matter.
Superior Sagittal Sinus - ANS Travels posteriorly between the cerebral hemispheres
towards the occiput
Straight Sinus - ANS Travels along the tentorium, draining blood from the superior
cerebellar veins.
Transverse Sinus - ANS Travels along the base of the occiput laterally and forwardly
Sigmoid Sinus - ANS Begins beneath the temporal bone and travels to the jugular
foramen where it becomes the internal jugular veins
Stroke Pathophysiology - ANS Arterial blood flow to the brain tissue fails to meet
metabolic demands resulting in cell damage or death. ISCHEMIA FIRST THEN
INFARCT.
Penumbra - ANS Zone surrounding the core infarct, damaged by ischemia but not yet
infarcted
---- functionally silent yet metabolically active
Hypoxia leading to Necrotic Pathway - ANS Cell energy failure
Hypoxia leading to Apoptotic Pathway - ANS Programmed cell death in the penumbral
zone
ICH Stroke Pathophysiology - ANS Occurs when a cerebral blood vessel opens
abnormally and spills blood into brain tissue.
Classification of ICH Brain Injury - ANS 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 - ANS Aneurysm from s in the cerebral vasculature and
ruptures, resulting in blood spilling in the subarachnoid space
Saccular Aneurysm - ANS narrow neck, widened dome -- Most Common
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, Fusiform Aneurysm - ANS Outpouching of the vessel without a distinct neck --- Less
common
Early Brain Injury - ANS Hours and first several days after aneurysm rupture cerebral
edema forms, injury results from decreased cerebral blood flow
Cerebral Vasospasm (Delayed Cerebral Injury) - ANS Large Vessel Spasm generally
begins on day 4 continues up to 21 days
Brain Requirements - ANS 20% of the body's Oxygen
15% of the body's Cardiac Output
Cerebral Blood Flow - ANS 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 - ANS Embolic: develop elsewhere and travel to blood vessel in
the brain
Small Vessel Occlusion - ANS Thrombotic: caused by a clot that develops in the vessel
of the brain
Cerebral Cortex - ANS Grey matter on the outermost section of the cerebrum and
cerebellum
Divided into four lobes
- Frontal
- Parietal
- Occipital
- Temporal
Frontal Lobe - ANS motor, behavioral expression. Motor/sensory maps
Parietal Lobe - ANS Sensation, optic radiations carrying sensory input from the eyes,
language centers *typically left side of brain*
Language Centers - ANS Broca's: Production/Expressive
Wernicke's: Comprehension/Receptive
Occipital Lobe - ANS Vision and interpretation of visual sensory signals
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