CEREBRAL VASCULATURE

Question 1

Describe the path of venous drainage in the brain

Answer 1

Cerebral veins –> Venous sinuses in dura –> internal jugular vein

Question 2

How do extradural haemorrhages occur and why are there immediate clinical effects

Answer 2

Trauma which can rupture an artery causing high pressure bleed so intracranial pressure rises acutely e.g. trauma to pterion

Question 3

How do subdural haemorrhages occur and how do they present?

Answer 3

Trauma which causes venous leakage of low pressure. Thus can have delayed clinical effects and delayed onset

Question 4

How do subarachnoid haemorrhages occur and how do they present?

Answer 4

Ruptured aneurysm - more relevant at base of brain with circle of willis

Question 5

How do intracerebral haemorrhages occur and how do they present?

Answer 5

They occur spontaneously and are usually seen in individuals with chronic hypertensive

Question 6

What is a stroke?

Answer 6

Cerebrovascular accident (CVA)

Rapidly developing focal disturbance of brain function of presumed vascular origin and of > 24 hours duration

Thrombo-embolic (85%) or haemorrhage (15%)

Question 7

What is a transient ischaemic attack (TIA)?

Answer 7

Rapidly developing focal disturbance of brain function of presumed vascular origin that resolves within 24 hours

“mini stroke’

Sign of a possible stroke in future

Question 8

What is an infarction?

Answer 8

Degenerative changes which occur in tissue following occlusion of an artery

Question 9

What is cerebral ischaemia?

Answer 9

Lack of sufficient blood supply to nervous tissue resulting in permanent damage if blood flow is not restored quickly

Question 10

What is a thromboembolic stroke?

Answer 10

Where a thrombus (blood clot) has formed in a larger vessel and is carried to smaller vessels supplying brain and plugs it

Question 11

How can atherosclerotic debris cause a stroke?

Answer 11

Build-up of fatty deposits in vessels e.g. internal carotid could break away and go to brain to block blood supply

Question 12

Why must you check for no bubbles before giving IV injections?

Answer 12

Air can cause a blockage thus leading to stroke

Question 13

List the risk factors for stroke

Answer 13

Age
Hypertension
Cardiac disease
Smoking
Diabetes mellitus (affects vasculature)

Question 14

What are the 3 cerebral arteries?

Answer 14

Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery

Question 15

What are anterior cerebral artery stroke symptoms?

Answer 15

Paralysis of contralateral structures - leg > arm/face (parietal)

Disturbance of intellect, executive function and judgment (frontal)

Loss of appropriate social behaviour (frontal)

Question 16

What are middle cerebral artery stroke symptoms?

Answer 16

Contralateral hemiplegia - arm > leg (deep motor structure)

Contralateral hemisensory deficits

Hemianopia

Aphasia - lack of normal speech

Question 17

What are posterior cerebral artery stroke symptoms?

Answer 17

Visual deficits:

• homonymous hemianopia
• visual agnosia (loss of recognition)
• prosopagnosia (cannot recognise faces of ppl u have known)