Blood Supply to the Brain Flashcards
What proportion of body weight does the brain make up?
2%
How much cardiac output does the brain receive?
15%
How much total body oxygen does the brain use?
20%
How much total body glucose does the brain use?
25%
What is the average brain blood flow?
46mL/100g of brain per minute
What causes unconsciousness?
20 seconds of anoxia
> 5 minutes = permanent unconsciousness
By is blood flow regulated?
Auto-regulation
What is the normal rate of cerebral blood flow?
Normotensive cerebral blood flow = 50mL per 100g of brain tissue per minute when cerebral perfusion pressure is between 60-160mmHg
What increases cerebral blood flow?
Low oxygen
High cCO2
What are cerebral arteries like?
Thin walled, easily blocked/distorted/ruptured
What are cerebral veins like?
No valves, thin walled, no muscles or elasticity to help return
What is the main arterial supply to the brain?
Internal carotid - 80%
Vertebral arteries - 20%
What does a normal angiogram show?
Anterior communicating and posterior communicating are closed
What are some common variations of the circle of willis seen on an angiogram?
- one posterior communicating small and one large
- anterior communicating is large
What are the main posterior circulation branches?
- vertebral arteries
- basilar artery
- posterior cerebral artery
What do the vertebral arteries supply?
- spinal cord -> posterior and anterior spinal arteries
- dorsal medulla of brainstem -> PICA
What does the basilar artery supply?
Pons and cerebellum
What does the posterior cerebral artery supply?
- inferior and medial aspects of temporal and occipital cortex
- thalamus and posterior internal capsule
- midbrain
What is the superficial venous drainage?
- superficial cerebral veins cross subarachnoid space -> pierce dura via bridging veins to enter intracranial dural venous sinuses -> joins with CSF coming from arachnoid granulations in sinuses
What is the role of arachnoid granulation?
Allow CSF flow into venous blood of sinuses and prevent backflow into sub-arachnoid space
What are the major causes of stroke?
Atherosclerosis Hypertension Aneurysm Elderly Head injury - trauma Alcoholics Arteriovenous malformation
What causes an ischemic stroke?
Atherosclerosis or embolism
What causes a cerebral haemorrhage?
Trauma
Spontaneous haemorrhage stroke
What can a MCA stroke affect?
- dominant hemisphere
- striate arteries
- non-dominant hemisphere
What are the effects of an MCA stroke?
Dominant hemisphere -> global aphasia, sensorimotor loss of contralateral face, upper limb and trunk
Non dominant hemisphere -> neglect syndrome
What are the effects of an ACA stroke?
Contralateral sensorimotor loss below waist
Urinary continence
Personality defects
Split-brain syndrome
What are the effects of a PCA stroke?
- contralateral homonymous hemianopia
- reading and writing deficits
- impaired memory
What is a TIA?
Temporary loss of brain function
less than 30 mins
sudden onset but 24 hour resolves
warning sign of heart attack or stroke
What are symptoms of a TIA affecting the anterior circulation?
- motor weakness
- hemi-sensory loss
- dysarthria
- transient monocular blindness
What are the symptoms of a TIA affecting the posterior circulation?
- vertigo
- diplopia
- ataxia
- amnesia
What is a extra-axial bleed?
Outside of the brain tissue
Where can extra-axial bleeds occur?
Epidural hematoma
Subdural hematoma
Subarachnoid hematoma
What are the features of an epidural hematoma?
Traumatic
Blood between dura mater and skull
Rapid arterial bleeding or large venous sinuses
What are the features of a subdural hematoma?
Traumatic/ageing
blood between dura mater and arachnoid mater
rupture to bridging veins
What are the features of a subarachnoid hematoma?
Spontaneous between arachnoid and pia mater ruptured aneurysm or head injury arterial most frequent traumatic brain lesion
How does a epidural hematoma present?
With lucid period immediately after trauma followed by unconsciousness
Which vessels are affected in an epidural hematoma?
Middle meningeal artery (pterion)
Anterior ethmoidal artery (frontal)
What is the mechanism of an epidural hematoma?
- blood compresses intracranial structures -> CN III
- weakness of extremities on opposite side of lesion
- loss of visual field opposite to lesion
How do you diagnose an epidural hematoma?
CT or MRI
Convex lens
Do not cross suture lines
What are the types of subdural hematoma?
Acute - after high speed acceleration/deceleration
Subacute - cerebral contusions
Chronic - slower onset as venous bleed
What are the symptoms of subdural hematoma?
Irritability, seizures, headache, numbness, disorientation
How do you diagnose a subdural hematoma?
CT - crescent shaped with concave surface
can look epidural but cross suture lines
What are the symptoms of a subarachnoid hematoma?
Severe headache (thunderclap)
vomiting
confusion
lowered level of consciousness
How do you diagnose a subarachnoid hematoma?
- CT white diffuse over sulci on both sides
- lumbar puncture blood evidence
- bilirubin
What are the 3 types of cerebral aneurysm?
- saccular
- fusiform
- berry
Why are aneurysms dangerous?
May rupture