Cerebral Vasculature

Question 1

How much of body weight is the brain?

How much of the cardiac output does the brain take?

How much oxygen consumption?

How much liver glucose?

Answer 1

2%

10-20%

20%

66%

Question 2

What is the major arterial supply to the brain?

What goes through the carotid canal and supplies the anterior side of the brain?

Brachiocephalic continues onto subclavian, what is the first branch of this?

Answer 2

Common carotid artery

Internal carotid artery

Vertebral artery

Question 3

Name the branches in the diagram

Answer 3

Question 4

How does blood leave the brain?

Answer 4

Venous drainage

Cerebral veins –> Venous sinuses in the dura mater –> Internal jugular vein

Question 5

Name the dural veous sinuses

Answer 5

Question 6

y

Question 7

What is the subdural space?

What is a subdural bleed?

Cause?

Answer 7

Space between the inner dura layer and the arachnoid layer

Bleed in this space and is venous, so is not high pressure as there is already a space so there might not be symptoms / symptom lag

Trauma, can be delayed clinical effects (venous, lower pressure)

Question 8

What is found in the subarachnoid space?

What is the cause of a subarachnoid bleed

Answer 8

All the CSF is found as well as vessels

Usually a burst/ruptured aneurism ; weakness in one of the basal vessel walls; congenital

Question 9

What is a intracerebral bleed?

Answer 9

Bleed in the brain tissue itself
Seen commonly in patients who are hypertensive

Question 10

What bleed is shown?

Answer 10

Subdural;
Dura is on the outside and a massive blood clot inside

Question 11

What bleed is shown?

Answer 11

Intracerebral bleed;
Probably due to poorly maintained hypertension

Question 12

What bleed is shown?

Answer 12

Extradural bleed;
Arterial bleed accumulated outside dura

Question 13

What bleed is shown?

Answer 13

Subarachnoid;
Covered in blood and goes everywhere as CSF is also there

Question 14

What is a stroke?

Answer 14

Cerebrovascular accident (CVA)

Definition: “rapidly developing focal disturbance of brain function of presumed vascular origin and of >24 hours duration”

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

Question 15

Transient ischaemic attack (TIA)?

Answer 15

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

Question 16

Infarction?

Answer 16

Degenerative changes which occur in tissue following occlusion of an artery

Question 17

Cerebral ischaemia?

Answer 17

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

Question 18

Thrombosis?

Answer 18

formation of a blood clot (thrombus)

Question 19

Embolism

Answer 19

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

Question 20

FAST for stroke? What does it stand for?

Answer 20

Face
Arms
Speed
Time

Question 21

What are the risk factors for stroke?

Answer 21

Age
Hypertension
Cardiac disease
Smoking
Diabetes mellitus

Question 22

What is the perfusion field of the posterior cerebral artery?

What is the perfusion field of the middle cerebral artery?

What is the perfusion field of the anterior cerebral artery?

Answer 22

Occipital lobe and inferior part of temporal lobe

Lateral surface of brain and most of the deep structures

Front and a strip of tissue to the parieto - occipital notch
Sagittal view - parietal lobe as well

Question 23

What symptoms do damage to the anterior cerebral artery lead to?

Answer 23

Paralysis of contralateral structures (leg > arm, face)

Disturbance of intellect, executive function and judgement (abulia)

Loss of appropriate social behaviour

Question 24

What symptoms do damage to the middle cerebral artery lead to?

Answer 24

“Classic stroke”

Contralateral hemiplegia – weakness rather than complete paralysis: arm > leg

Contralateral hemisensory deficits

Hemianopia: visual system

Aphasia (L sided lesion) - speech

Question 25

What symptoms do damage to the posterior cerebral artery lead to?

Answer 25

Visual deficits

-homonymous hemianopia

-visual agnosia

Question 26

What major risk factor for stroke is evident in this specimen?

Answer 26

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

Question 27

Which cerebral artery has been occluded in this specimen?

Answer 27

The marked area shows
evidence of infarction in the
perfusion field of the right
middle cerebral artery