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Year 3 Neuro > Cerebral Vasculature > Flashcards

Cerebral Vasculature Flashcards

1
Q

Why is the brain so vulnerable?

A

Very vulnerable if blood supply is impaired because it is so metabolically active

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2
Q

What three arteries supply the brain?

A

Common carotid
Internal carotid
Vertebral artery

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3
Q

What is the benefit of the arrangement of the circle of willis?

A

If you have a blockage in one of the internal carotids e.g. atherosclerotic build up

Chance of compensatory flow from the other side

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4
Q

How does blood exit the cranial cavity?

A

Cerebral vains

Venous sinuses in the dura mater

Internal jugular vein

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5
Q

What are the layers of the brain?

A

Dura mater
(Inner meningeal layer and Outer periosteal layer)
Arachnoid mater
Pia mater

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6
Q

Is there any extradural space?

A

No space between the skull and the dura mater

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7
Q

What are the 4 types of haemorrhage?

A

Extradural
Subdural
Subarachnoid
Intracerebral

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8
Q

What are main features of extradural haemorrhage?

A

trauma, immediate clinical effects (arterial, high pressure)
Can strip dura away from the skull
Raised ICP
Some pts might have a lucid interval

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9
Q

What does a fracture to the pterion result in?

A

Main artery supplying the dura (middle meningeal artery) is behind the pterion
Rupture of this artery causes a extradural haemorrhage

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10
Q

What are main features of subdural haemorrhage?

A

trauma, can be delayed clinical effects (venous, lower pressure)
which is why patients are often kept overnight after a head injury

high impact injuries

Cresenteric collection on CT

If large enough can cause midline shift or herniation

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11
Q

What are main features of subarachnoid haemorrhage?

A 
Ruptured aneurysms (congenital) 
Weaknesses in the blood vessel walls that burst and cause subarachnoid bleeds
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12
Q

What are main features of subarachnoid haemorrhage?

A

Spontaneous hypertensive

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13
Q

What is a CVA?

A

Cerebrovascualr accident (stroke)

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14
Q

What is the definition of a CVA?

A

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

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15
Q

What are the two types of stroke?

A

Thrombo-embolic (85%)

  • Ischaemic, blockage stops blood flow
  • AF is common cause of emboli formation

Haemorrhagic (15%)

  • Vessel bursts
  • Intracerebral or Subarachnoid
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16
Q

What is a TIA?

A

Transient ischaemic attack

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17
Q

What is the definition of a TIA?

A

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

can last seconds/minutes

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18
Q

What is an infarct?

A

Degenerative changes which occur in tissue following occlusion of an artery

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19
Q

What is cerebral ischaemia?

A

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

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20
Q

What does thrombosis mean?

A

formation of a blood clot (thrombus) causing a blockage

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21
Q

What does embolism mean?

A

plugging of small vessel by material carried from larger vessel e.g. thrombi from the heart or atherosclerotic debris from the internal carotid

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22
Q

What are the risk factors for stroke?

A 
Age
Hypertension
Cardiac disease
Smoking
Diabetes mellitus

Haemorrhagic

  • Anti-coag
  • AV malformation
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23
Q

What are the three main cerebral arteries?

A

Anterior
Middle
Posterior

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24
Q

Which cerebral has the biggest perfusion field?

A

Middle cerebral artery

It also supplies many of the subcortical, deep structures of the brain

25
Q

What does the anterior cerebral artery supply?

A

Midline structures

Perfuses all the way back to the parietal-occipital fissure

26
Q

What does the posterior cerebral artery supply?

A

Inferior part of the temporal lobe

Occipital lobe

27
Q

What are the anterior cerebral artery symptoms?

A

Paralysis of contralateral structures (leg > arm, face)

Disturbance of intellect, executive function and judgement (abulia)

Loss of appropriate social behaviour

28
Q

What are the middle cerebral artery symptoms?

A

Classic stroke”

Contralateral hemiplegia: arm > leg

Contralateral hemisensory deficits

Hemianopia (loss of one side of the visual field)

Aphasia (L sided lesion)

29
Q

What are the posterior cerebral artery symptoms?

A

Visual deficits

homonymous hemianopia

visual agnosia

30
Q

How would atherosclerosis look on a specimen?

A

yellow discolouration in the walls of the vessels is a build-up of atheroma, fatty deposits that cause atherosclerosis or “hardening of the arteries”

31
Q

How does fresh blood present on a CT scan?

A

White lesions

32
Q

How does blood that has become a haematoma present (after time has passed)?

A

Black lesions

33
Q

What are some RFs for subdural haematoma?

A

Old age

Alcoholism

34
Q

What are symptoms of raised ICP?

A 
Throbbing Headache worse when coughing, sneezing and in the morning 
Blurred vision (Papillodema)
Feeling less alert than usual
Vomiting
Changes in behaviour
Weakness 
Fatigue
Irritability
35
Q

What is the treatment for a subdural haematoma < 10mm in size, non-expansile without significant dysfunction?

A 
Observation + follow up imaging
Prophylactic anti-epileptics for 7 days
e.g. phenytoin 
Correct coagulopathy
Raise head of bed
36
Q

What is the treatment for a subdural haematoma < 10mm in size or expansile or with significant dysfunction?

A 
Surgery first line
- Burr-hole craniotomy
- Trauma craniotomy
- Hemicraniotomy
In addition to above
37
Q

What investigations are done for a head injury?

A

Head CT within 1 hour if any of the following present:

GCS < 13 initially
GCS < 15 at 2 hrs after injury
Suspected skull fracture
Post-trauma seizure
Focal neurological deficit
<1 episodes of vomiting

CT within 8 hours if no but on anti-coag OR loss of consciousness/amnesia + RFs

  • > 65 yrs
  • history of bleeding disorder
  • trauma
  • > 30 mins retrograde amnesia of events preceding injury
38
Q

What can cause raised ICP?

A 
Severe head injury
Stroke
Brain abscess
Meningtis/Encephalitis
Hydrocephalus 
AV malformation/fistula
Venous sinus thrombosis
39
Q

What is idiopathic IH?

A

Intracranial hypertension in women in their 20s/30s

Associated with:
Overweight
Endocrine problems
Abs, steroids, COCP
Anaemia or polycythaemia
CKD
Lupus
40
Q

What investigations are done for raised ICP?

A

CT or MRI

Lumbar puncture

41
Q

What is the medical treatment of idiopathic IH?

A 
Weight loss
Stop medications
Diuretics
Steroids for headaches and reduce risk of vision loss
Regular LPs
42
Q

What is the surgical treatment of idiopathic IH?

A

Shunt

Optic nerve sheath fenestration

43
Q

When do you monitor ICP?

A

Pts with head injury:

+GCS 3-8 and abnormal CT scan

OR

Normal CT but 2 of the following
40+ yrs
Motor posturing
SBP <90mmHg

44
Q

What is the gold standard for monitoring ICP?

A

Intraventricular fluid filled catheter transducer systems

45
Q

What is the treatment for raised ICP?

A

CSF drainage
Head of bed elevation
Analgesia
Diuretics

46
Q

What are causes of spontaneous SAH?

A

Intracranial aneurysm
Arteriovenous malformation
Pituitary apoplexy
Arterial dissection

47
Q

What are some conditions associated with berry aneurysms?

A

adult polycystic kidney disease, Ehlers-Danlos syndrome and coarctation of the aorta

48
Q

What are the classic presenting features of a SAH?

A

Headache: sudden-onset (‘thunderclap’ or ‘baseball bat’), severe and occipital
N+V
Meningism
Coma
Seizures
Sudden death
ECG changes including ST elevation may be seen

49
Q

How do you diagnose SAH?

A

CT head - bright

LP - min 12 hours post symptoms onset, xanthochromia seen

50
Q

What is the management of SAH?

A

Neurosurgery referral ASAP after confirmation
Treatment depends on cause

Intracranial aneurysms - Coil, some require craniotomy + clipping

Hydrocephalus - External ventricular drain

51
Q

What symptoms are more likely in haemorrhagic strokes?

A

Decreased level of consciousness
Headache
N+V
Seizures

52
Q

What is the FAST campaign?

A

Face - ‘Has their face fallen on one side? Can they smile?’
Arms - ‘Can they raise both arms and keep them there?’
Speech - ‘Is their speech slurred?’
Ttime - ‘Time to call 999 if you see any single one of these signs.’

53
Q

What investigations are done for suspected stroke?

A

CT
MRI
Urgently

54
Q

How do you manage ischaemic strokes?

A

Thrombolysis if

  • pt presents within 4.5 hours of symptom onset
  • pt has not had prev intracranial haemorrhage or uncontrolled hypertension

Exclude haemorrhagic ASAP and start 300mg asprin

55
Q

What is treatment for a TIA?

A

Immediate antithrombotic therapy - Clopidogrel for secondary prevention OR Asprin 75mg

If pt has had TIA in the past 7 days or more than one:
arrange to be seen by stroke specialist urgently

Statin e.g. Atorvastatin

Consider anti-coag for AF e.g. LMWH

Carotid doppler

56
Q

What is the management of haemorrhagic strokes?

A 
Most pts not suitable for surgery
Supportive 
Stop anti-coagulants
Lower BP
Early mobilisation
57
Q

How do you assess storke?

A

ROSIER score >0 means stroke is likely

-1: Syncope and Seizure

+1: Asymmetric facial weakness, arm weakness, leg weakness, speech disturbance or visual field defect

58
Q

What are possible features of TIAs?

A 
unilateral weakness or sensory loss.
aphasia or dysarthria
ataxia, vertigo, or loss of balance
visual problems
sudden transient loss of vision in one eye (amaurosis fugax)
diplopia
homonymous hemianopia

Year 3 Neuro (17 decks)

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