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PPE - Neurology > Blood Supply of the Brain and Spinal Cord > Flashcards

Blood Supply of the Brain and Spinal Cord Flashcards

1
Q

Name some of the major arteries of the brain.

A

Anterior circulation

  • Internal Carotid Artery (ICA)
  • Middle Cerebral artery (MCA)
  • Anterior Cerebral Artery (ACA)
  • Posterior Communicating Artery

Posterior circulation

  • Basilar artery (BA)
  • Vertebral Artery (VA)
  • Posterior Cerebral Artery (PCA)
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2
Q

How is the internal carotid artery segmented?

A 
Into 7 segments
Cervical
Petrous
Lacerum
Cavernous
Clinoid
Ophthalmic
Communicating
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3
Q

What are the branches of the internal carotid artery?

A 
Ophthalmic artery (supplies whole orbit)
Posterior communicating artery
Anterior choroidal artery (supplies internal capsule, thalamus and optic chiasma)
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4
Q

Tell me about the middle cerebral artery.

A

Direct continuation of ICA

Supplies 2/3 of brain convexity

Lateral aspect of frontal/parietal/occipital lobes
Lateral striate arteries supply basal ganglia

Most strokes occur in MCA territory

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5
Q

Tell me about anterior cerebral artery.

A

Smaller branch of ICA
Supplies medal surface and adjacent convexity (frontal and parietal lobes)

Joined by anterior communicating artery

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6
Q

Tell me about the vertebral artery.

A 
Arises from subclavian arteries
Tortuous course
Largest branch
- Posterior cerebellar artery (PICA)
Other branches - spinal arteries
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7
Q

Tell me about the basilar artery.

A

Overlies the pons
Supplies most of the brainstem
Superior and anterior inferior cerebellar arteries
Bifurcates into 2 PCA’s

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8
Q

Tell me about the PCA.

A

Bifurcation of BA

Goes around midbrain
Supplies the midbrain, thalamus, temporal and occipital lobes

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9
Q

Define a stroke.

A

Clinical syndrome of abrupt loss of focal brain function lasting > 24 hours (or causing death) that is due to either spontaneous haemorrhage into brain substance or inadequate blood supply to a part of the brain (thrombosis, embolism)

Includes SAH (Subarachnoid haemorrhage)

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10
Q

Define a TIA.

A 
Transient Ischaemic Attack
Sudden onset
Focal disturbance of brain function (ocass. global)
Presumed to be of vascular origin
Resolves completely within 24 hours
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11
Q

How can intracerebral haemorrhage be classified?

A

Primary - no structure lesion

Secondary - e.g. tumour

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12
Q

How can cerebral infarcts be caused?

A 
Large vessel atheroma/embolism
Cardiac embolism
Small vessel disease/lacunae
Non atheromatous arterial disease (arteritis)
Blood disorders

Other known aetiologies
Cryptogenic (no cause id)

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13
Q

How can intracerebral haemorrhages be caused?

A

Hypertensive - microaneurysms/lipohyalinosis (40%)
AVM’s (arteriovenous malformation) or aneurysms (15%)
Amyloid angiopathy (10%)
Haemostatic anticoagulant, thrombolytic, thrombocytopenia (10%)
Other - cocaine, amphetamines, tumour, venous
thrombosis

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14
Q

What are the symptoms of a frontal lobe stroke?

A 
Motor area (pre-motor and motor cortex)
Broca's area (expressive dysphagia)
Prefrontal cortex (personality/behaviour)
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15
Q

What are the symptoms of parietal lobe stroke?

A

Primary sensory cortex
Non dominant lesions - visuospatial issues
Optic radiation (superior)
- Inferior quadrantanopia/hemianopia

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16
Q

What are the symptoms of temporal lobe stroke?

A 
Central representation
- Auditory/vestibular function
- Taste and smell
Wernicke's area (receptive dysphagia (incomprehensible)
Memory circuits
Optic radiation (inferior)
Superior quadrantanopia
17
Q

What are the symptoms of occipital lobe stroke?

A

Visual cortex

18
Q

What are the symptoms of cerebellum/brainstem?

A

Motor + sensory tracts
Cranial nerve nuclei
Cerebellum - balance coordination

19
Q

What are the different strokes according to the OCSP?

A

Oxfordshire Classification of Stroke Project

TACS - Total anterior circulation stroke (20%)
PACS - Partial anterior circulation stroke (35%)
LACS - Lacunar stroke (20%)
POCS - Posterior circulation stroke (25%)

20
Q

Tell me about a TACS. (Aetiology, Clinical presentation and relevance)

A

Total anterior circulations stroke

Aetiology
Proximal occlusion (ICA or proximal MCA)
Large volume infarct
Superficial and deep territories

Clinical presentation
Contralateral hemiparesis (+/- hemianaesthesia)
Contralateral hemianopia
Higher cerebral dysfunction (cortical signs: dysphagia, dyspraxia (fine coordination)

Relevance
High mortality

21
Q

Tell me about a PACS. (Aetiology, Clinical presentation and relevance)

A

Partial anterior circulation stroke

Aetiology
Occlusion of MCA branch
Restricted infarct

Clinical presentation
2 or 3 of a TACS symptoms
OR restricted motor deficit (face OR arm OR leg only)
OR isolated cortical signs

Relevance
High early recurrence rate

22
Q

Tell me about LACS. (Aetiology, Clinical presentation and relevance)

A

Lacunar stroke

Aetiology
Single perforating artery
Basilar ganglia/pons

Clinical presentation
Pure motor
Pure sensory
Sensorimotor
Ataxic hemiparesis

Relevance
Silent
Underdiagnosed

23
Q

Tell me about a POCS. (Clinical presentation and relevance)

A

Posterior circulation stroke

Clinical presentation
Brainstem
Cerebellar or
Occipital involvement

Relevance
Complex presentation
Thrombosis

24
Q

What are some relevant history when diagnosing a stroke?

A

Symptom onset
When exactly??
Speed of onset
Progression of symptoms

Neurological symptoms (localisation and characterisation)
Body part affected
Modalities involved
Positive vs negative symptoms important
Stroke is always negative - they lose functions

Other symptoms
Suggesting bleeding: headache, seizure
Suggesting raised ICP: headache, vomiting, drowsiness
Suggesting aetiology: Cardiac symptoms

Atypical presentations
Delirium, confusion, collapse, incontinence

25
Q

What are some vascular risk factors of stroke?

A

Non-Modifiable
Age, gender, genetic, family history, previous stroke/TIA

Lifestyle
Smoking, sedentary lifestyle, Heavy alcohol intake, diet

Medical
Hypertension, hypercholesterolemia, diabetes, arrhythmia

26
Q

What are some differential diagnosis of stroke?

A 
Hypoglycaemia (other metabolic disturbances)
Migrainous aura
Epilepsy
SOL (secondary vs primary tumour, others)
Demyelination
Labyrinthine disorders
Others
- Retinal Bleeds, or infarcts (not defined as a stroke)
- Peripheral neuropathy
- Myopathies
- Delirium
- Hyperventilation (usually transient)
- Functional or Psychological
27
Q

What are some of the neurological deficits of a stroke?

A

Unilateral hemiparesis/monoparesis
Unilateral facial palsy (upper vs motor MNL)
Unilateral sensory deficit (+ modalities)

Dominant cortical (dysphagia, dysgraphia, dyslexia)
Nondominant cortical (visuospatial disorder, neglect)
Hemianopia/quadrantanopia (both eyes involved)

Cranial nerve signs
Cerebellar signs

28
Q

What are some initial investigations when a stroke is suspected?

A 
BM stat (blood glucose measurement)
Haematological: FBC, INR
Biochemical: U+E, LFT, TFT, glucose, lipid
ECG
Radiological: CXR where indicated
29
Q

What imaging is used in a suspected stroke?

A

Urgent when thrombolysis is an option

Indications

  • Look for the bleeding (ICH, SDH, SAH, bleed into tumour)
  • Screen for stroke mimics (tumours, other rarities)
  • May visualise infarct

Most early CT scans (

30
Q

What extra do you do in a younger or cryptogenic stroke?

A 
Full coagulation profile
Thrombophilia screen
- Protein C/S ATIII, FV Leiden, P20210A
Antiphospholipid antibodies
- Anticardiolipin, lupus anticoagulant
Autoimmune screen
Fasting plasma homocysteine
Blood cultures
TFT, Syphilis serology, HIV serology
31
Q

What is the treatment of an acute stroke?

A

Intravenous thrombolysis (alteplase)
- Only if ischaemic, and given within 4.5 hours of onset
Early aspirin therapy (where not thrombolysed)
Management in the Acute Stroke Unit
Specialist rehabilitation therapists
Routine carer involvement
Education and training programs

32
Q

How can stroke be prevented?

A 
Antithrombotic meds
Medical risk factor treatment
- Treat hypertension
- Treat hypercholesterolemia
- Carotid surgery (if significant carotid stenosis)
- Treat diabetes
Lifestyle changes
Medication compliance

PPE - Neurology (19 decks)

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