Which of the following vessels supplies almost all of the Thalamus?

a. Superior cortical division of MCA
b. ACA
c. Inferior cortical division of MCA
d. Main stem of MCA
e. PCA

Which one of the following vessels supplies the leg area of primary motor and somatosensory cortex?

a. Superior cortical division of MCA
b. ACA
c. Inferior cortical division of MCA
d. Basilar Artery
e. PCA

Which one of the following vessels supplies Broca's area (essential for the production of language)?

a. Superior cortical division of MCA
b. ACA
c. Inferior cortical division of MCA
d. Superior Cerebellar Artery
e. PCA

Which one of the following vessels does NOT supply any part of the corticospinal tracts?

a.Cortical branches of MCA
b. Deep penetrating branches of MCA
c. Basilar artery
d. Anterior spinal artery
e. Posterior Inferior Cerebellar Artery

Part A. In which of the following regions do both hypertensive intracerebral hemorrhages and lacunar infarcts commonly occur?  Indicate ALL correct answers.

a. Basal ganglia
b. Primary Visual cortex
c. Thalamus
d. Pons
e. Wernicke's area

Part B. What feature is shared by the blood vessels that supply the areas you indicated in Part A?

a. All originate as branches of the carotid system
b. All originate as branches of the vertebral-basilar system
c. All are long slender branches of much larger vessels that penetrate deeply into the brain without anastomosing
d. All are short vessels that form multiple branches which anastomose with each other

A piece of thrombus has broken loose from a damaged mitral valve, and entered the carotid circulation. Which of the following areas might be affected if this embolus produces infarction of brain tissue? Indicate ALL correct answers.

a. Lateral parts of the frontal and parietal lobes
b. Lateral parts of the temporal lobe
c. Hypothalamus
d. Medial parts of the occipital lobe
e. Internal Capsule
f. Thalamus

After an ischemic stroke, the patient has a hoarse voice and difficulty swallowing, which you attribute to damage to nucleus ambiguus or the exiting 10th nerve. In addition, he has lost the ability to detect pain or hot and cold when these stimuli are applied to his right arm and leg or to the left side of his face. You attribute this pattern of pain and temperature loss to disruption of the spinothalamic tract (which crossed in the spinal cord), and the descending tract of 5 (which is composed of uncrossed primary sensory axons of the 5th nerve). Indicate ALL of the statements about this patient that are correct.

a. The stroke was produced by a reduction of blood flow in the carotid circulation.
b. The stroke was produced by a reduction of blood flow in the vertebral-basilar circulation.
c. The stroke affects neuroanatomic structures located in medial parts of the brainstem.
d. The stroke affects neuroanatomic structures located in dorsolateral parts of the brainstem.
e. The infarcted tissue is located in the pons
f. The infarcted tissue is located in the medulla
g. The infarcted tissue producing his signs/symptoms is all located on the left side of the nervous system
h. There must be infarcted tissue on both sides of the nervous system to account for his signs/symptoms.

A woman came to the emergency room after a brief episode during which her right hand suddenly became weak, and her right index finger and thumb "felt strange and tingled." Further testing reveals that her left internal carotid artery was largely occluded by atherosclerotic plaque, increasing the doctors' suspicion that the episode was a TIA. Indicate ALL of the following that are true concerning the brain tissue that was temporarily ischemic.

a. It is located on the left side of the patient's brain
b. It is located on the right side of the patient's brain
c. It is in the territory of deep penetrating branches of PCA
d. It is in the territory of deep penetrating branches of MCA
e. It is supplied by cortical branches of ACA
f. It is supplied by superior (suprasylvian) cortical branches of MCA
g. It is supplied by inferior (infrasylvian) cortical branches of MCA

In several sentences, explain why the circle of Willis does NOT protect the brain against SUDDEN blockage of the internal carotid artery.

Which of the following vessels supplies almost all of the Thalamus?

Your Answer	Correct Answer: e
a. Superior cortical division of MCA	a. Superior cortical division of MCA
b. ACA	b. ACA
c. Inferior cortical division of MCA	c. Inferior cortical division of MCA
d. Main stem of MCA	d. Main stem of MCA
e. PCA	e. PCA

Which one of the following vessels supplies the leg area of primary motor and somatosensory cortex?

Your Answer	Correct Answer: b
a. Superior cortical division of MCA	a. Superior cortical division of MCA
b. ACA	b. ACA
c. Inferior cortical division of MCA	c. Inferior cortical division of MCA
d. Basilar Artery	d. Basilar Artery
e. PCA	e. PCA

Which one of the following vessels supplies Broca's area (essential for the production of language)?

Your Answer	Correct Answer: a
a. Superior cortical division of MCA	a. Superior cortical division of MCA
b. ACA	b. ACA
c. Inferior cortical division of MCA	c. Inferior cortical division of MCA
d. Superior Cerebellar Artery	d. Superior Cerebellar Artery
e. PCA	e. PCA

Which one of the following vessels does NOT supply any part of the corticospinal tracts?

Your Answer	Correct Answer: e
a. Cortical branches of MCA	a. Cortical branches of MCA
b. Deep penetrating branches of MCA	b. Deep penetrating branches of MCA
c. Basilar artery	c. Basilar artery
d. Anterior spinal artery	d. Anterior spinal artery
e. Posterior Inferior Cerebellar	e. Posterior Inferior Cerebellar

Part A. In which of the following regions do both hypertensive intracerebral hemorrhages and lacunar infarcts commonly occur?
Indicate ALL correct answers.

Your Answer	Correct Answer: a, c, d
a. Basal ganglia	a. Basal ganglia
b. Primary Visual cortex	b. Primary Visual cortex
c. Thalamus	c. Thalamus
d. Pons	d. Pons
e. Wernicke's area (essential for language comprehension)	e. Wernicke's area (essential for language comprehension)

Part B. What feature is shared by the blood vessels that supply the areas you indicated in Part A?

Part B
Your Answer	Correct Answer: c
a. All originate as branches of the carotid system	a. All originate as branches of the carotid system
b. All originate as branches of the vertebral-basilar system	b. All originate as branches of the vertebral-basilar system
c. All are long slender branches of much larger vessels that penetrate deeply into the brain without anastomosing	c. All are long slender branches of much larger vessels that penetrate deeply into the brain without anastomosing
d. All are short vessels that form multiple branches which anastomose with each other	d. All are short vessels that form multiple branches which anastomose with each other

A piece of thrombus has broken loose from a damaged mitral valve, and entered the carotid circulation. Which of the following areas might be affected if this embolus produces infarction of brain tissue? Indicate ALL correct answers.

Your Answer	Correct Answer: a, b and e
a. Lateral parts of the frontal and parietal lobes	a. Lateral parts of the frontal and parietal lobes
b. Lateral parts of the temporal lobe	b. Lateral parts of the temporal lobe
c. Hypothalamus	c. Hypothalamus
d. Medial parts of the occipital lobe	d. Medial parts of the occipital lobe
e. Internal Capsule	e. Internal Capsule
f. Thalamus	f. Thalamus

Indicate ALL of the statements about this patient that are correct.

Your Answer	Correct Answer: b, d, f and g
a. The stroke was produced by a reduction of blood flow in the carotid circulation.	a. The stroke was produced by a reduction of blood flow in the carotid circulation.
b. The stroke was produced by a reduction of blood flow in the vertebral-basilar circulation.	b. The stroke was produced by a reduction of blood flow in the vertebral-basilar circulation.
c. The stroke affects neuroanatomic structures located in medial parts of the brainstem	c. The stroke affects neuroanatomic structures located in medial parts of the brainstem
d.The stroke affects neuroanatomic structures located in dorsolateral parts of the brainstem.	d.The stroke affects neuroanatomic structures located in dorsolateral parts of the brainstem.
e. The infarcted tissue is located in the pons	e. The infarcted tissue is located in the pons
f. The infarcted tissue is located in the medulla.	f. The infarcted tissue is located in the medulla.
g. The infarcted tissue producing his signs/symptoms is all located on the left side of the nervous system..	g. The infarcted tissue producing his signs/symptoms is all located on the left side of the nervous system.
h. There must be infarcted tissue on both sides of the nervous system to account for his signs/symptoms.	h. There must be infarcted tissue on both sides of the nervous system to account for his signs/symptoms.

Indicate ALL of the following that are true concerning the brain tissue that was temporarily ischemic.

Your Answer	Correct Answer: a and f
a. It is located on the left side of the patient's brain	a. It is located on the left side of the patient's brain
b. It is located on the right side of the patient's brain	b. It is located on the right side of the patient's brain >
c. It is in the territory of deep penetrating branches of PCA	c. It is in the territory of deep penetrating branches of PCA
d. It is in the territory of deep penetrating branches of MCA	d. It is in the territory of deep penetrating branches of MCA
e. It is supplied by cortical branches of ACA	e. It is supplied by cortical branches of ACA
f. It is supplied by superior (suprasylvian) cortical branches of MCA	f. It is supplied by superior (suprasylvian) cortical branches of MCA
g. It is supplied by inferior (infrasylvian) cortical branches of MCA	g. It is supplied by inferior (infrasylvian) cortical branches of MCA

In several sentences, explain why the circle of Willis does NOT protect the brain against SUDDEN blockage of the internal carotid artery.

Your Answer

We Were Looking For:

The circle of Willis is often incomplete, or the connections between the major arteries are made by such slender communicating vessels that they simply cannot carry enough blood to supply the large amount of brain tissue that would be rendered ischemic by sudden carotid occlusion. If, on the other hand, carotid occlusion has occurred slowly and progressively, it is possible that these tiny arteries will expand in diameter so that they can carry much more blood from the opposite carotid or from the posterior cerebrals, perhaps enough to protect the brain. Furthermore, other anastomoses may also develop - for example between the internal and external carotid via the ophthalmic artery - that provide additional ways for large amounts of blood to reach the jeopardized carotid territory.

End of Self Test
Module 3