Brain Pathology - Tom Butts

Question 1

What are some common sites of occlusion within the cerebrovascular system?

Answer 1

Proximal subclavian artery
First segment of vertebral artery (before enters transverse foramina)
Fourth segment of vertebral artery (intracranial)
Basilar artery
Carotid bifurcation
Siphon portion of internal carotid artery
ACA origin
MCA origin

Question 2

Describe the location of the different cerebellar arteries

Answer 2

Superior - just before the vertebral artery splits into the two posterior cerebral arteries
AICA - just after unification of vertebral to form the basillar
PICA - from vertebral arteries whilst separate.

Question 3

The vertebrobasilar system is associated with what functional part of the brain

Answer 3

Brainstem and cranial nerve funcation
Also contributes to PCA - occipital lobe.

Question 4

What regions of the brain are supplied by what cerebral artery?

Answer 4

Question 5

What brain regions are shown in this image?

Answer 5

Brocas anteriorly
Wernicks posteriorly

Question 6

What are some key functional regions of the brain that are shown in this image?

Answer 6

Premotor area
Supplementary motor area
Primary motor cortex
Somatosensory cortex
Visual cortex
Auditory cortex

Question 7

Give an overview of the function of the different cranial nerves.

Answer 7

CN1 - olfactory
CN2 - optic
3 - lens accomodation, miosis, eye movements
4 - superior oblique
5 - sensation of the face, motor to muscles of mastication
6 - lateral rectus
7 - muscles of facial expression, anterior 2/3 tongue taste, PANS to lacrimal and submandibular/lingual
8 - hearing and balance
9 - taste post 1/3 tongue, sens to tonsil, pharynx and middle ear, motor - stylopharyngesus and parotid gland
10 - PANS chest and abdo
11- sternocladiomastoid and trapexius
12- motor tp the tongue

Question 8

What are the key functions of the cerebellum?

Answer 8

Cognitive function
Proprioception and motor coordination
Vestibular function

Question 9

What are the two different types of stroke?
What is more common?

Answer 9

Ischemic stroke - 90%
Haemorrhagic stroke - 10%

Question 10

What is the prognosis of an haemorrhagic stroke?

Answer 10

Worse prognosis than ischemic
Microaneurysms in the brain parenchyma rupture, can cause pressure ad rupture or neighbouring vessels
Bloods extravasates into brain tissue, dependent on tissue turgor and BP.
Can raised raised ICP and herniation

Question 11

Where are the main areas of pathological bleeding in the meninges?

Answer 11

Epidural - between the skull and the dura mater
Subdural - between dura and arachnoid
Subarachnoid - between arachnoid and pia

Question 12

What blood vessel is an epidural haematoma often caused by?

Answer 12

The middle meningeal artery.

Question 13

What are the key features of a subdural haematoma on imaging?

Answer 13

Typically caused by soft tissue trauma causing venous bleed
Is a concave bleed
Looks like a banana

Question 14

What are the features of an epidural haematoma on imaging?

Answer 14

Typically caused by skull fracture that perforates the meningeal artery
Typically convex bleed
Looks like a pear

Question 15

How to tell the difference between a subdural and an epidural bleed on imaging?

Answer 15

Question 16

How does a subarachnoid haematoma present clinically?

Answer 16

From asymptomatic to fatal
If result of ruptured aneurysm are often accompanied by a thunderclap headache due to rise in ICP
Imaging shows blood in the subarachnoid space and cisterns.

Question 17

What are the different type of hernias that can occur in the brain?

Answer 17

Subfalcine - under the falx cerebri
Transtentorial/central - under the tentorium cerebelli (caused by large mass) push into brainstem
Uncal - push laterally into the brainstem, can impinge the cerebral peduncles (corticospinal/bulbar) +/- oculomotor nerve
Tonsillar - cerebellar out of foramen magnum