SCRN Exam Review 2023/ 151 Questions
With Correct Answers.
Posterior Cerebral Artery (PCA) - -Arises from basilar. Supplies Occipital Lobe ,
Midbrain, Thalamus, Pineal Gland, Choroid Plexus, and Corpus Callosum
-Symptoms of PCA Stroke - --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) - -Feeds anterior inferior parts of the
cerebellum
-Symptoms of AICA Stroke - -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) - -Feeds cerebellum, superior section of
the medulla,. Choroid plexus and fourth ventricle
-Symptoms of PICA Stroke - -Wallenburg Syndrome (lateral Medullary Syndrome):
Loss of pain and temperature sensation in the contralateral trunk and ipsilateral face
-Basilar Artery - -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 - -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) - -Feeds the media portion of the frontal and parietal
lobes as well as the corpus callosum
-Symptoms of ACA Stroke - -Contralateral motor/sensory deficits impacting legs >
arms
-Middle Cerebral Artery (MCA) - -Feeds majority of the frontal, parietal, and temporal
lobes, basal ganglia, internal capsule. It is divided M1 - M4
-Symptoms of MCA Stroke - --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 - -Venous channels enter into venous sinuses located in the
Dura matter.
-Superior Sagittal Sinus - -Travels posteriorly between the cerebral hemispheres
towards the occiput
-Straight Sinus - -Travels along the tentorium, draining blood from the superior
cerebellar veins.
-Transverse Sinus - -Travels along the base of the occiput laterally and forwardly
-Sigmoid Sinus - -Begins beneath the temporal bone and travels to the jugular foramen
where it becomes the internal jugular veins
-Stroke Pathophysiology - -Arterial blood flow to the brain tissue fails to meet
metabolic demands resulting in cell damage or death. ISCHEMIA FIRST THEN
INFARCT.
-Penumbra - -Zone surrounding the core infarct, damaged by ischemia but not yet
infarcted
---- functionally silent yet metabolically active
-Hypoxia leading to Necrotic Pathway - -Cell energy failure
-Hypoxia leading to Apoptotic Pathway - -Programmed cell death in the penumbral
zone
-ICH Stroke Pathophysiology - -Occurs when a cerebral blood vessel opens abnormally
and spills blood into brain tissue.
-Classification of ICH Brain Injury - -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 - -Aneurysm from s in the cerebral vasculature and
ruptures, resulting in blood spilling in the subarachnoid space
-Saccular Aneurysm - -narrow neck, widened dome -- Most Common
-Fusiform Aneurysm - -Outpouching of the vessel without a distinct neck --- Less
common
, -Early Brain Injury - -Hours and first several days after aneurysm rupture cerebral
edema forms, injury results from decreased cerebral blood flow
-Cerebral Vasospasm (Delayed Cerebral Injury) - -Large Vessel Spasm generally begins
on day 4 continues up to 21 days
-Brain Requirements - -20% of the body's Oxygen
15% of the body's Cardiac Output
-Cerebral Blood Flow - -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 - -Embolic: develop elsewhere and travel to blood vessel in the
brain
-Small Vessel Occlusion - -Thrombotic: caused by a clot that develops in the vessel of
the brain
-Cerebral Cortex - -Grey matter on the outermost section of the cerebrum and
cerebellum
Divided into four lobes
- Frontal
- Parietal
- Occipital
- Temporal
-Frontal Lobe - -motor, behavioral expression. Motor/sensory maps
-Parietal Lobe - -Sensation, optic radiations carrying sensory input from the eyes,
language centers *typically left side of brain*
-Language Centers - -Broca's: Production/Expressive
Wernicke's: Comprehension/Receptive
-Occipital Lobe - -Vision and interpretation of visual sensory signals
-Dysarthria - -Slurred speech, reflecting poor motor control of the muscles associated
with speech and language
With Correct Answers.
Posterior Cerebral Artery (PCA) - -Arises from basilar. Supplies Occipital Lobe ,
Midbrain, Thalamus, Pineal Gland, Choroid Plexus, and Corpus Callosum
-Symptoms of PCA Stroke - --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) - -Feeds anterior inferior parts of the
cerebellum
-Symptoms of AICA Stroke - -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) - -Feeds cerebellum, superior section of
the medulla,. Choroid plexus and fourth ventricle
-Symptoms of PICA Stroke - -Wallenburg Syndrome (lateral Medullary Syndrome):
Loss of pain and temperature sensation in the contralateral trunk and ipsilateral face
-Basilar Artery - -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 - -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) - -Feeds the media portion of the frontal and parietal
lobes as well as the corpus callosum
-Symptoms of ACA Stroke - -Contralateral motor/sensory deficits impacting legs >
arms
-Middle Cerebral Artery (MCA) - -Feeds majority of the frontal, parietal, and temporal
lobes, basal ganglia, internal capsule. It is divided M1 - M4
-Symptoms of MCA Stroke - --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 - -Venous channels enter into venous sinuses located in the
Dura matter.
-Superior Sagittal Sinus - -Travels posteriorly between the cerebral hemispheres
towards the occiput
-Straight Sinus - -Travels along the tentorium, draining blood from the superior
cerebellar veins.
-Transverse Sinus - -Travels along the base of the occiput laterally and forwardly
-Sigmoid Sinus - -Begins beneath the temporal bone and travels to the jugular foramen
where it becomes the internal jugular veins
-Stroke Pathophysiology - -Arterial blood flow to the brain tissue fails to meet
metabolic demands resulting in cell damage or death. ISCHEMIA FIRST THEN
INFARCT.
-Penumbra - -Zone surrounding the core infarct, damaged by ischemia but not yet
infarcted
---- functionally silent yet metabolically active
-Hypoxia leading to Necrotic Pathway - -Cell energy failure
-Hypoxia leading to Apoptotic Pathway - -Programmed cell death in the penumbral
zone
-ICH Stroke Pathophysiology - -Occurs when a cerebral blood vessel opens abnormally
and spills blood into brain tissue.
-Classification of ICH Brain Injury - -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 - -Aneurysm from s in the cerebral vasculature and
ruptures, resulting in blood spilling in the subarachnoid space
-Saccular Aneurysm - -narrow neck, widened dome -- Most Common
-Fusiform Aneurysm - -Outpouching of the vessel without a distinct neck --- Less
common
, -Early Brain Injury - -Hours and first several days after aneurysm rupture cerebral
edema forms, injury results from decreased cerebral blood flow
-Cerebral Vasospasm (Delayed Cerebral Injury) - -Large Vessel Spasm generally begins
on day 4 continues up to 21 days
-Brain Requirements - -20% of the body's Oxygen
15% of the body's Cardiac Output
-Cerebral Blood Flow - -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 - -Embolic: develop elsewhere and travel to blood vessel in the
brain
-Small Vessel Occlusion - -Thrombotic: caused by a clot that develops in the vessel of
the brain
-Cerebral Cortex - -Grey matter on the outermost section of the cerebrum and
cerebellum
Divided into four lobes
- Frontal
- Parietal
- Occipital
- Temporal
-Frontal Lobe - -motor, behavioral expression. Motor/sensory maps
-Parietal Lobe - -Sensation, optic radiations carrying sensory input from the eyes,
language centers *typically left side of brain*
-Language Centers - -Broca's: Production/Expressive
Wernicke's: Comprehension/Receptive
-Occipital Lobe - -Vision and interpretation of visual sensory signals
-Dysarthria - -Slurred speech, reflecting poor motor control of the muscles associated
with speech and language
