Blood Supply of the Brain and Spinal Cord Flashcards
Name some of the major arteries of the brain.
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)
How is the internal carotid artery segmented?
Into 7 segments Cervical Petrous Lacerum Cavernous Clinoid Ophthalmic Communicating
What are the branches of the internal carotid artery?
Ophthalmic artery (supplies whole orbit) Posterior communicating artery Anterior choroidal artery (supplies internal capsule, thalamus and optic chiasma)
Tell me about the middle cerebral artery.
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
Tell me about anterior cerebral artery.
Smaller branch of ICA
Supplies medal surface and adjacent convexity (frontal and parietal lobes)
Joined by anterior communicating artery
Tell me about the vertebral artery.
Arises from subclavian arteries Tortuous course Largest branch - Posterior cerebellar artery (PICA) Other branches - spinal arteries
Tell me about the basilar artery.
Overlies the pons
Supplies most of the brainstem
Superior and anterior inferior cerebellar arteries
Bifurcates into 2 PCA’s
Tell me about the PCA.
Bifurcation of BA
Goes around midbrain
Supplies the midbrain, thalamus, temporal and occipital lobes
Define a stroke.
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)
Define a TIA.
Transient Ischaemic Attack Sudden onset Focal disturbance of brain function (ocass. global) Presumed to be of vascular origin Resolves completely within 24 hours
How can intracerebral haemorrhage be classified?
Primary - no structure lesion
Secondary - e.g. tumour
How can cerebral infarcts be caused?
Large vessel atheroma/embolism Cardiac embolism Small vessel disease/lacunae Non atheromatous arterial disease (arteritis) Blood disorders
Other known aetiologies
Cryptogenic (no cause id)
How can intracerebral haemorrhages be caused?
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
What are the symptoms of a frontal lobe stroke?
Motor area (pre-motor and motor cortex) Broca's area (expressive dysphagia) Prefrontal cortex (personality/behaviour)
What are the symptoms of parietal lobe stroke?
Primary sensory cortex
Non dominant lesions - visuospatial issues
Optic radiation (superior)
- Inferior quadrantanopia/hemianopia
What are the symptoms of temporal lobe stroke?
Central representation - Auditory/vestibular function - Taste and smell Wernicke's area (receptive dysphagia (incomprehensible) Memory circuits Optic radiation (inferior) Superior quadrantanopia
What are the symptoms of occipital lobe stroke?
Visual cortex
What are the symptoms of cerebellum/brainstem?
Motor + sensory tracts
Cranial nerve nuclei
Cerebellum - balance coordination
What are the different strokes according to the OCSP?
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%)
Tell me about a TACS. (Aetiology, Clinical presentation and relevance)
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
Tell me about a PACS. (Aetiology, Clinical presentation and relevance)
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
Tell me about LACS. (Aetiology, Clinical presentation and relevance)
Lacunar stroke
Aetiology
Single perforating artery
Basilar ganglia/pons
Clinical presentation Pure motor Pure sensory Sensorimotor Ataxic hemiparesis
Relevance
Silent
Underdiagnosed
Tell me about a POCS. (Clinical presentation and relevance)
Posterior circulation stroke
Clinical presentation
Brainstem
Cerebellar or
Occipital involvement
Relevance
Complex presentation
Thrombosis
What are some relevant history when diagnosing a stroke?
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
