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BRS YR2 > Cerebral Vasculature > Flashcards

Cerebral Vasculature Flashcards

1
Q

How much Cardiac Output does the brain use?

A

10-20%

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2
Q

How much O2 does the brain consume?

A

20%

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3
Q

How much liver glucose does the brain use?

A

66%

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4
Q

Why is the brain vulnerable when blood supply is impaired?

A

Due to it’s high metabolic demands

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5
Q

Which arteries supply the brain?

A
  • Internal carotid (entry through the carotid canal), branch of the common carotid artery
  • vertebral artery (foramen magnum)
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6
Q

Arteries in the brain?

A

The Circle of Willis
In ascending order:
(2 x vertebral > basilar artery > posterior cerebral > posterior communicating > middle cerebral (internal carotid) > anterior cerebral > anterior communicating)

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7
Q

Where does atherosclerotic build-up occur most often in the cerebral arteries/circle of willis?

A

Where it divides.

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8
Q

What happens if there is an effective blockage of the cerebral arteries in the Circle of Willis?

A

Theoretical chance of compensatory flow from the other side.
Realistically compensation between the posterior and anterior cerebral arteries is weak because the posterior communicating arteries are very thin.

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9
Q

Venous drainage of the brain?

A

Drains mainly through venous sinuses in the dura mater (through the cerebral veins) > internal jugular vein

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10
Q

Order of venous drainage through the sinuses?

A

superior (+inferior) sagittal sinus + straight sinus > confluence of sinuses > sigmoid sinus (lateral drainage)

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11
Q

What are the different types of intracranial haemorrhage

A
  • extradural
  • subdural
  • subarachnoid
  • intracerebral
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12
Q

Where do sinuses form?

A

In between the meningeal (inner) and periosteal (outer) layers of the dura mater

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13
Q

What causes a extradural cranial haemorrhage?

A
  • trauma
  • high pressure arterial bleed
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14
Q

What causes a subdural cranial haemorrhage?

A
  • trauma
  • low pressure, venous bleed
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15
Q

What causes a subarachnoid cranial haemorrhage?

A

Ruptured aneurysms (normally congenital)
- blood vessel weakness
- may burst in hypertensive patients

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16
Q

What causes an intracerebral cranial haemorrhage?

A

hypertension, spontaneous

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17
Q

Which dural haemorrhage often has immediate clinical effects?

A

Extradural

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18
Q

Which dural haemmorhage often has delayed clinical effects?

A

Subdural

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19
Q

Where is a fragile point in the head?

A

Pterion

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20
Q

Why is the Pterion so vulnerable?

A

Protects the artery supplying the dura (if ruptured causes an extradural bleed)

21
Q

Where do Extradural bleeds occur?

A

Between the dura and the skull, builds up pressure (arterial)

22
Q

How do extradural bleeds present?

A
  • Acute onset
  • surgical emergency
  • high intracranial pressure
23
Q

Where do subdural bleeds occur?

A
  • Between the dura and the arachnoid.
  • small amount of space
24
Q

How do subdural bleeds present?

A
  • Delayed onset of symptoms
  • venous, lower pressure bleed
25
Q

Where do subarachnoid haemorrhages most commonly occur?

A
  • Base of the brain, near the circle of willis
26
Q

Stroke Definition

A

(CVA)
cerebrovascular accident
rapidly developing disturbance of brain function of a presumed vascular origin for >24 hours

27
Q

What does a rapid onset stroke indicate?

A
  • Likely vascular origin
  • exclusion of differentials must occur
28
Q

What is a thrombo-embolic stroke and how common is it?

A
  • Stroke due to blockages
  • 85% of strokes
29
Q

What is a haemorrhage stroke and how common is it?

A
  • Stroke due to brain bleed
  • 15% of strokes
30
Q

What is a Transient Ischaemic Attack (TIA)?

A
  • rapidly developing focal disturbance of brain function of a presumed vascular origin that completely resolves in 24 hours
  • no residual deficits
31
Q

TIA time span?

A

normally can be from 30 seconds - 1 minute

32
Q

What does a TIA indicate?

A
  • Subsequent stroke further down the line
  • cause of TIA may worsen
33
Q

What is an infarction?

A

Degenerative changes that occur in the tissue due to occlusion of an artery (tissue death)

34
Q

What is cerebral Ischaemia?

A

Lack of sufficient blood supply to nervous tissue which leads to permanent damage if blood supply is not restored quickly.

35
Q

How is Ischaemia different from hypoxia?

A

Ischaemia is a lack of everything, not just O2

36
Q

Thrombosis definition

A
  • Formation of a blood clot (thrombus)
  • can be a form of embolism
37
Q

Embolism definition

A

Plugging of a small vessel by material carried from a larger vessel

38
Q

Examples of embolism

A
  • thrombi from the heart
  • atherosclerotic debris from the internal carotid
  • fat
  • air (IV injections)
39
Q

How are strokes a public health issue?

A
  • 3rd most common cause of death (100,000 deaths/year)
  • 50% of survivors are permanently disabled
  • 70% show an obvious neurological deficit
40
Q

Risk Factors of Stroke

A
  • Age
  • Hypertension
  • Cardiac Disease
  • Smoking
  • Diabetes Mellitus (effects on vasculature)
41
Q

Where does the Anterior Cerebral artery perfuse?

A
  • midline structures (about 1cm strip)
  • all the way back to the parietal-occipital fissure
42
Q

Where does the Middle Cerebral artery perfuse?

A
  • most of lateral surface of the brain
  • most of the subcortical (deep) structures in the brain
43
Q

Where does the Posterior Cerebral artery perfuse?

A
  • mostly the occipital lobe
  • inferior part of the temporal lobe
44
Q

Symptoms of stroke of the Anterior Cerebral Artery

A
  • paralysis of contralateral structures
    (most likely the leg than arm or face)
  • front lobe damage
  • disturbance of intellect, executive function and judgement (abulia)
  • possible loss of appropriate social behaviour.
45
Q

Symptoms of a Middle Cerebral Artery stroke?

A

‘Classic Stroke’

  • (deep motor structures): contralateral hemiplegia (arm>leg)
  • (sensory cortex): contralateral hemisensory deficits.
  • (runs from eye to occipital) Hemianopia
  • Aphasia, lack of normal speech (Left-sided lesion)
46
Q

Symptoms of a Posterior Cerebral Artery stroke

A 
- The occipital region of the brain 
Visual Deficits: 
- Homonymous hemianopia 
- Visual Agnosia
- Prosop Agnosia (unable to recognise faces)
47
Q

Indication of Infarction

A

Loss of clear differentiation between white and grey matter.

48
Q

What is an atheroma?

A
  • Fatty deposits in blood vessels that cause atherosclerosis
  • seen as yellow discolouration in the walls of the vessels

BRS YR2 (67 decks)

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