2 - Stroke Related Neuroanatomy-Neurophysiology Flashcards
What anatomical direction is this?
Axial
What anatomical direction is this?
Coronal
What anatomical direction is this?
Sagittal
What anatomical direction are these?
A = Superior/Dorsal
B = Posterior/Caudal
C = Inferior/Ventral
D = Anterior/Rostral
Name the Layers of the Brain.
A = Scalp
B = Cranium
C = Dura Mater
D = Arachnoid
E = Subarchnoid Space
F = Pia Mater
G = Cerebral Cortex
Name the 4 Major Lobes of the Brain.
Frontal
Parietal
Temporal
Occipital
What Is “Controlled” By These Specific Areas Of The Brain?
A = Motor Control
B = Cognition, planning, + problem solving
C = Speech
D = Smell
E = Hearing
F = Facial recognition
What Is “Controlled” By These Specific Areas Of The Brain?
A = Touch + pressure
B = Taste
C = Body awareness
D = Language
E = Reading
F = Vision
G = Cerebellum
What are these neruo sulci?
A = Precentral
B = Superior frontal
C = Inferior Frontal
D = Lateral frontal (Sylvian Fissure)
E = Superior temporal
What are these neruo sulci?
A = Central (Rolandic)
B = Postcentral
C = Intraparietal
D = Lateral occipital
E = Lunate
F = Interior temporal
What is the homunculus?
An metaphorical representation of the way motor + sensory information is organized neurologically
What is the motor area of the brain called?
Precentral Gyrus
What is the sensory area of the brain?
Postcentral Gyrus
Which of Brodmann’s Areas are important to SLPs?
(4)
44 + 45 (Broca’s)
22 + 40 (Wernicke’s)
41 + 42 (Auditory Association)
39 (Angular Gyrus)
What happens when Brodmann’s Areas 44 + 45 are injured?
(2)
Broca’s Aphasia
Apraxia of Speech
What happens when Brodmann’s Areas 22 + 40 are injured?
Wernicke’s Aphasia
What happens when Brodmann’s Areas 41 + 42 are injured?
Processing issues in Wernicke’s Aphasia
What happens when Brodmann’s Area 39 is injured?
(2)
Acalculia
Agraphia
Label the following neruo landmarks.
A = Anterior cingulate cortex
B = Ventromedial prefrontal cortex
C = Orbitofrontal prefrontal cortex
D = Dorsolateral prefrontal cortex
What is the ACC?
Anterior cingulate cortex
What does the ACC do?
(4)
Reward anticipation
Decision making
Empathy
Emotions
What happens when there is damage to the ACC?
(2)
Apathy
Poor motivation
What is the VMPC?
Ventromedial prefrontal cortex
What does the VMPC do?
Processing of risk + fear
What happens when there is damage to the VMPC?
(2)
Poor inhibition
Poor decision making
What is the OFPC?
Orbitofrontal prefrontal cortex
What does the OFPC do?
(2)
Empathy
Civil + appropriate social behavior
What happens when there is damage to the OFPC?
(5)
Impaired emotional reactivity + processing
Personality change
Poor impulse control
Increased aggression
Mood issues
What is the DLPC?
Dorsolateral prefrontal cortex
What does the DLPC do?
Organizing behavior to solve complex problems
(new learning, searching memory)
What happens when there is damage to the DLPC?
(5)
Poor organization strategies
Poor word list generation
Poor word fluency
Poor sorting behavior
Poor concreteness
What is the Insula Cortex?
What does it play a large role in?
Patch of cortex behind the frontal, parietal, and temporal lobes
Expressive speech + motor output
What is the Arculate Fasciculus?
What is it important for?
Association fibers connecting the temporal lobe (Wernicke’s) to the frontal lobe (Broca’s)
Language processing
What is the Basal Ganglia?
What does it do?
Area within the diencephalon (top of brain stem) that receives input from multiple sites in cortex
Refines muscle movements
What can happen if the Basal Ganglia is damaged?
(3)
Problems with movement + sensation
Loss of voluntary movement
Change in appearance of involuntary movements
What is the Thalamus?
What is it believed to do? (2)
Two egg shaped nuclei located in the diencephalon (top of brain stem) next to basal ganglia
Major relay center for descending motor information and ascending sensory information
Regulates overall electrical energy in cortex
What does the Thalamus play an important role in?
(3)
Maintaining consciousness, alertness, + attention
What does the Internal Capsule contain? (2)
What supplies blood to this area?
Both ascending + descending axons
Fibers coming to and from the cerebral cortex
Lenticulostriate arteries
Label the following arteries.
A = Anterior cerebral artery
B = Posterior cerebral artery
C = Internal carotid artery
D = Basilar artery
E = Vertebral artery
Label the following arteries.
A = Circle of Willis
B = (Right) Middle Cerebral Artery
C = Basilar Artery
D = (External) Carotid Arteries
E = Vertebral Arteries
Label the following arteries.
A = Anterior Cerebral Artery
B = (Left) Middle Cerbral Artery
C = Posterior Cerebral Artery
D = Internal Carotid Arteries
What major arteries suppy the following areas?
A = Anterior cerebral artery
B = Middle cerebral artery
C = Posterior cerebral artery
What major arteries supply the following areas.
A = Anterior cerebral artery
B = Middle cerebral artery
C = Posterior cerebral artery
Label the following arteries.
A = Anterior cerbral artery (ACA)
B = Lenticulostriate arteries
C = MCA inferior division
D = MCA superior division
What are the following areas called?
What are they?
Watershed areas
Border zones between the territories between two major arteries in the brain
Fill in the following chart.
A = Silent CNS Infarction
B = Ischemic Stroke
C = TIA
D = Ischemic Stroke
What is a CNS Infarction?
(2)
Brain, spinal cord, or retinal cell death due to ischemia.
Can also be cause by hemorrhage
What is an Intracerebral Hemorrhage?
Focal collection of blood within the brain
What is a Subarchnoid Hemorrhage?
Bleeding within the subarchnoid space
What is the difference between Ischemia + Infarction?
Ischemia = Physiological tissue changes
Infarction = Tissue death
Do similiar neuro injuries always result in the same loss of function?
No
What area of the brain will result in Expressive Language deficits?
Anterior damage
What area of the brain will result in Receptive Language deficits?
Posterior damage
What is an Ischemic Stroke?
One cause by blockage
What is an Hemorrhagic Stroke?
One cause by bleeding
What is a Thrombosis Ischemia?
How fast do these occur?
What is an added risk?
Stroke caused by a build up of plaque or a blood clot
Slower since the build up of the clot is gradual
An area of the blockage can break off and cause an embolic stroke
What is a Embolism (Ischemia)?
(2)
Stroke cause when a piece of plaque or a blood clot breaks off
This piece travels to a vessel that is too small for it to pass and it causes a blockage
What is Hypoperfusion (Ischemia)?
What will it cause?
What specific areas may also be affected?
Damage that occurs when blood flow is decreased to all parts of body, but is not fully stopped
Brain damage
Watershed areas
What is an Intracerebral Hemorrhage?
Bleeding within the brain
What is an Extracerebral Hemorrhage?
Bleeding occuring within the meninges
What kind of stroke is this?
Ischemic
How common are Ischemic Strokes?
Intracerbral Hemorrhage?
Subarchnoid Hemorrhage?
87%
10%
3%
What kind of strokes are the following?
A = Ischemic
B - Hemorrhage
Where do Infarctions tend to occur?
Closest to the clot
Where do Ischemias tend to occur?
Further from the clot where it might receive a secondary blood supply from a nearby artery
What is the Physiological response to an Ischemic Stroke?
(5)
Edema
Transneural degeneration
Denervation hypersensitivity
Diaschisis
Collateral sprouting
What is Edema?
Tissue swelling
What is Transneural Degeneration?
Neuron death due to disruption of input/output of nearby neurons
What is Denervation Hypersensitivity?
Extreme sensitivity due to interruptions of neural supply/activity
What is Diaschisis?
Distal loss of function due to connection in damaged area
What is Collateral Sprouting?
When neurons adjacent to damaged area take over some of the lost function
Are stroke a singular event?
(2)
No - they often reoccur
They can last over several days
What is an Ischaemic Core?
The brain tissue near a blockage that is destined to die
What is a Penumbra?
The brain area near a blockage that is salageable
What do clots normally form around?
Atherosclerotic plaques
What is a clot called?
Thrombus
What is a traveling particle in the blood stream called?
Embolus
What are treatment options of Ischemic Strokes?
(3)
Carotid Endarterectomy
Carotid Stenting
Tissue Plasminogen Activator (tPA - medication)
What is a Carotid Endarterectomy?
A surgical removal of the plaque causing a blockage
What is a Carotid Stent?
What are the risks?
A device inserted at the plaque build up that expands the vessel
Part of the clot breaks off or the vessel wall is weakened
What is Tissue Plasminogen Activator (tPA )?
When is it a treatment option?
A clot dissolving medication
Within 2-4 hours of an ischemic stroke
What is the most common Extracerebral Hemorrhagic Stroke?
Subarachoid (3%)
How often do Intracerbral Strokes occur?
7-9%
What are the major risk factors for Hemorrhagic Stroke?
(4)
AA ethnicity
Hypertension (HTN)
High blood pressure
LDL (bad) cholesterol + triglyerides inversely related to ICH (good)
What are some risk factors NOT associate with Hemorrhagic Stroke?
(7)
Sex
Smoking
Alcohol intake
BMI
Waist-to-hip ratio
Waist circumference
Diabetes
What is the BIGGEST risk factor for Hemorrhagic Stroke?
Blood pressure
Can infraction occur with a hemorrhagic stroke?
Yes due to pressure on the tissue
Where are Intracerebral Hemorrhages most likely to occur?
(5)
Central lobes
Basal ganglia
Thalamus
Pons
Cerebellum
What is an Aneursym?
A swelling of a blood vessel
What is an Anterior Venus Malformation (AVM)?
What does this increase the risk of?
A congenital condition where arteries and veins grow together into a web
Risk of vessel rupture
What are some medical treatments for Hemorrhagic Stroke?
(2)
Microsurgical clipping
Cerebral Stenting
What is Microsurgical Clipping?
How is it inserted?
Small metal clip is place at the neck of the aneurysm to stop blood flow
Inserted via craniotomy (opening the skull)
What is Cerebral Stenting?
Why does it work?
Coils of platinum wire are passed through a catheter to fill the aneurysm
The coils fill the aneursym and cause blood to clot obliterating the aneursym
What are TIA’s also referred to as?
Mild Strokes
(May need to clarify with patient)
What is CSF Leakage?
How is it treated?
Too much cerebral spinal fluid is produce putting excessive pressure on the brain
Extra fluid is removed via a shunt
