Cerebral vasculature Flashcards by Thulasi Ramachandran

What is the blood supply to the brain?

Vertebral artery
Internal carotid artery
Common carotid artery

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What is the venous drainage of the brain?

Cerebral veins -> venous sinuses in the dura mater -> internal jugular vein

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Which sinus does blood from the great cerebral vein drain into?

Straight sinus

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Features of extradural haemorrhage

Trauma

Immediate clinical effects

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Features of subdural haemorrhage

Trauma

Delayed clinical effects

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Features of subarachnoid haemorrhage

Ruptured aneurysms

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Features of intracerebral haemorrhage

Spontaneous hypertensive

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Stroke is also known as cardiovascular accident. What is the difference between a CVA and a transient ischaemic attack (TIA)?

TIA resolves within 24hrs, whereas a CVA will be more than 24hrs

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What are the risk factors for stroke? (5)

Age
Hypertension
Cardiac disease
Smoking
Diabetes Mellitus
(CHADS)

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Anterior cerebral artery symptoms

Paralysis of contralateral structures
—- leg > arm+face
Disturbance of intellect, executive function and judgement
Loss of appropriate social behaviour

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Middle cerebral artery symptoms

"Classic stroke"
Contralateral hemiplegia
----- arm > leg
Hemianopia
Contralateral hemisensory deficits
Aphasia if L sided lesion

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Posterior cerebral artery symptoms

Homonymous heminopia

Visual agnosia

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What are the pyramidal tracts?

Corticobulbar

Corticospinal

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Where do the pyramidal tracts travel?

Pass through the pyramids of the medulla

Motor cortex to spinal cord or cranial nerve in brainstem

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What do the pyramidal tracts control?

Voluntary movements of the body and face

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What are the extrapyramidal tracts?

Rubrospinal
Tectospinal
Reticulospinal
Vestibulospinal

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Where do the extrapyramidal tracts travel to?

Brainstem nuclei to spinal cord

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What do the extrapyramidal tracts control?

Involuntary movements for balance, posture and locomotion

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What innervates the axial musculature?

Anterior corticospinal tract

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What innervates limb control?

Lateral corticospinal tract

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What is the corticobulbar tract responsible for?

Voluntary movements of the face (and neck)

Function of the vestibulospinal tract

Stabilises head during body movements
Coordinates head movements with eye movements
Mediates postural adjustments

Function of reticulospinal tract

Changes in muscle tone associated with voluntary movement

Postural stability

Function of tectospinal tract

Orientation of head and neck during eye movements

Function of rubrospinal tract

Innervates lower motor neurons of flexors of the upper limb

Negative signs of upper motor neuron lesion

Loss of voluntary motor function Paresis - graded weakness of movement Paralysis

Positive signs of upper motor neuron lesion

``` Increased abnormal motor function due to loss of inhibitory descending inputs Spasticity Hyper-reflexia Clonus Babinski's sign ```

What is apraxia?

Disorder of skilled movement Commonly due to lesion of inferior parietal lobe or frontal lobe => motor areas Common causes include stroke and dementia

Signs of lower motor neuron lesion

``` Weakness Hypotonia Hyporeflexia Muscle atrophy Fasciculations Fibrillations ```

What are fasciculations?

damaged motor units produce spontaneous action potentials -> twitch

What are fibrillations?

spontaneous twitching of individual muscle fibres

What is motor neuron disease?

Progressive neurodegenerative disorder of the motor system

What is ALS?

Amyotropic Lateral Sclerosis

What is the function of the basal ganglia?

Decision to move Elaborating associated movements Moderating and coordinating movements Performing movements in order

What is the basal ganglia made up of?

``` Caudate nucleus Putamen External Globus Pallidus Nucleus accumbens Subthalamic nuclei Substania nigra Ventral pallidum ```

What is Parkinsons?

Degeneration of dopaminergic neurons that originate in the substantia nigra and project to the striatum

Signs of Parkinsons disease

``` Bradykinesia Akinesia Hypomimic face Rigidity (cog-wheel) Tremor at rest ```

What is Huntington's disease?

Degeneration of GABAergic neurons in the striatum. caudate and then in the putamen

Signs of Huntington's disease

``` Choreic movements Speech impairment Difficulty swallowing Unsteady gait Cognitive decline Dementia ```

What is ballism?

Sudden uncontrolled flinging of limbs and occurs contralaterally Usually from stoke affecting subthalamic nucleus

What does the vestibulocerebellum do?

Regulates gait, posture and equillibrium | Coordination of head movements with eye movements

A tumour at the vestibulocerebellum can lead to...

Gait ataxia and tendency to fall

What does the spinocerebellum do?

Coordinates speech Adjusts muscle tone Coordinates limb movements

Degenerative and atrophy (chronic alcoholism) of the spinocerebellum leads to...

Wide gait and stance

Degenerative and atrophy (chronic alcoholism) of the spinocerebellum leads to...

Wide gait and stance

What does the cerebrocerebellum do?

``` Coordinates skilled movements Cognitive function Attention Processing language Emotional control ```

Damage to the cerebrocerebellum leads to...

tremor and affects speech

What is Babinski's sign?

When the sole of the foot is stimulated with a blunt instrument, the big toe curls upwards Associated with upper motor neuron lesion

What is clonus?

Involuntary and rhythmic muscle contractions Loss of descending inhibitions Associated with upper motor neuron lesion

What is recruitment?

Smaller units are recruited first As more force is required, more units are required Allows fine control

What is rate coding?