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Pathophysiology 2 > Circulation of the brain > Flashcards

Circulation of the brain Flashcards

1
Q

Brain blood supply

A

2 vertebral arteries
2 internal carotid artieries

ensures continuous supply of nutrients
removal of waste

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2
Q

internal carotid

A

in front of neck and divides to form middle and anterior cerebral arteries

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3
Q

ACA

A

2 anterior cerebral arteries join via the anterior communication artery forming the front section of circle of willis

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4
Q

Vertebral

A

2 vertabral arteries pass uo through the formaina in transverse process of Cx vertabrae and join infront of the brainstem at the basilar artery

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5
Q

Upper brain stem

A

basilar artery divides into 2 posterior cerebral arteries that connect to back of circle of willis by 2 small posterior communicating arteries

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6
Q

Circle of willis

A

occlusion of one internal carotid artery may not result in stroke because brain is protected from bilateral carotid occlusion through basilar supply

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7
Q

Middle cerebral artery

A 
Most of the outer surface
Sensorimotor cortex
Basal ganglia
Internal capsule
Broca’s area (on left)
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8
Q

Anterior cerebral artery

A

Frontal lobe

Medial part of sensorimotor cortex

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9
Q

Posterior cerebral artery

A

Occipital lobe
Medial aspect of temporal lobe
Thalamus

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10
Q

Basilar artery

A

All of the brainstem
Cerebellum
Nuclei of cranial nerves

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11
Q

Disruption to blood supply

A

loss of consciousness within seconds

irreversible damage in minutes

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12
Q

Autoregulation

A

mean arterial bp of 60-150mmHg

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13
Q

BP

A

constriction or dilation of arterioles in brain

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14
Q

increase in CO2

A

dilation of arterioles in brain

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15
Q

decrease in O2

A

constriction of arterioles in brain

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16
Q

Causes of Autoregulation faliure

A 
CNS disease:
Trauma
Acute stroke
Tumours
Inflammation
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17
Q

Stroke/CVA

A

brain attack
A stroke, also known as a cerebrovascular accident (CVA), is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a haemorrhage (leakage of blood).

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18
Q

Classification

A

Haemorrhagic stroke

Ischaemia stroke

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19
Q

Haemorrhagic stroke

A

bleeding from a cerebral artery

20
Q

Subarachniod haemorrhage

A

bleeding into subarachnoid space
due to rupture of congenital anerysm or traume
sudden intense headache, vomiting, neck stiffness and loss of consciousness
10% die within two hours
40% die within two weeks

21
Q

Aneurysm

A

saccular
fusiform
ruptured

treated by surgical clipping

22
Q

Intracerebral haemorhage

A 
bleeding in deeper part of brain
longstanding hypertension
arterial wall weaken
micro-aneurysm develop 
rupture and bleed
sever headache and vomitting
23
Q

Ischaemic stroke

A

80% strokes due to occulsion
atherom of cerecral artery
emboli from atheromatous plaque in hear/neck vessel

Most common vessel: MCA > PCA > ACA

brainstem stroke less common but more serious

24
Q

Embolic stroke

A

completed stroke -sudden onset
transiet ischaemic attack
repeated small emboli no infraction occurs
piece of plaque can break free and clock blood supply to the brain

25
Q

artrial fibrilation

A

Atrial fibrillation is irregular heartbeat,blood clots are more likely to form in your heart, increasing stroke risk

26
Q

thrombotic stroke

A 
completed stroke-overnight
develops over several days
transient ischaemic attack
sudden to full recovery
20% risk of full CVA with 4 weeks
27
Q

Bamford classification

A

TACS – Total anterior circulation stroke
PACS – Partial anterior circulation stroke
POCS– Posterior circulation stroke
LACS – Lacunar stroke(deep penetrating arteries)
(TAC)S=stroke
(TAC)I=infarct
(TAC)H=haemorrhage

28
Q

Tramatic brain injury

A

injury to the brain caused by external physical force,
altered state of consciousness
impairment of cognitive or physical abilities
disturbances of behaviour or emotional functioning

temporary or permanent

29
Q

Mechanism of injury

A

Penetrating injury-risk of infection

Compression - inner cerebral traume

Deceleration- outer cerebral injury discrete cognitive deficit

Diffuse axonal injury– poor communication between brain structures, reduces processing speed, global impairment

30
Q

Extradural haemorrhage

A

bleeding into extradural space

cause by severe trauma

31
Q

sunadural haemorrhage

A

bleeding in subdural space
usually cause by severe trauma
maybe be delayed symptons

headache
drowsiness 
stupor
hemiparesis
coma
32
Q

Secondary damage of TBI

A 
raised ICP
infection
ischaemic changes
vasospasm
complication of systemic dysfunction
33
Q

Transient ischaemic attack TIA

A

A TIA is a sign that part of the brain is not getting enough blood, and there is a risk of a more serious stroke in future

34
Q

Hemiplegia

A

paralysis at one side of the body

35
Q

Clinical features of stroke

MOTOR

A

Alterations in tone
Low tone - flaccidity
High tone – spasticity

Ataxia
Weakness 
Asymmetry
Loss of normal movement patterns
Loss of postural adjustments
loss of balance 	
Compensations
36
Q

Pattern of spasticity

A 
Flexor pattern in upper limb
Shoulder elevation & retraction
Internal rotation & adduction
Elbow flexion & pronation
Wrist flexion
Finger flexion
Extensor pattern in lower limb
Hip retraction
Hip extension
Knee extension
Ankle plantarflexion & inversion
37
Q

Clinical features of stroke

SENSORY

A

impaired cutaneous sensation
stereognosis
proprioceptive impairment

visual problems
Visual field loss
Homonymous Hemianopia

38
Q

Clinical features of stroke

SPEECH

A

Expressive dysphasia
Damage to Brocas area
Usually associated with Rt hemiplegia
Loose ability to produce speech

Receptive dysphasia
Damage to Wernikes area in temporal lobe
Lose ability to understand speech

global aphasia

39
Q

Clinical features of stroke

COGNITIVE

A

Perceptual Problems

Astereognosis
Visual Agnosia
Auditory Agnosia
Depth perception
Apraxia
Anosagnosia 
Inattention/neglect
40
Q

Agnosia

A

Inability to recognise objects

41
Q

Neglet

A

more common with left hemiplegia
patients fails to attend to stimuli from the left side
poor prognosis if persists
results in many functional problems

42
Q

Clinical features of stroke

A 
Disorders of emotion 
Dysphagia
Delay / absent swallow reflex
Incontinence 
Secondary musculoskeletal problems
Balance / Gait problems
Functional difficulties
Social problems
43
Q

Physiotherapy treatment

A

prevent complications,
minimise impairments and to maximise function

Assessment
Identification of problems
Clinical reasoning
Goal setting
Objective outcomes
Choice of Rx method
Interdisciplinary input
44
Q

Factors affecting recovery

A 
Extent and nature of lesion
Integrity of collateral circulation
Pre-morbid status
Age
Capacity of Nervous System to re-organise
Environment
Motivation and Attitude of patient
Patient participation
Patient Experience
Co-exisiting conditions
Nutrition/Hydration
Medication
45
Q

Medical management

A 
Treat as medical emergency
MRI/CT scan
Ischaemic stroke (80%)– aspirin, anticoagulants - thrombolysis
SAH – surgery or endoplastic procedures
SDH/EDH/ICH – treat hypertension
TIA – aspirin, prevention work
Other tests – Blood tests, angiography, echocardiology
Other medication – osmotic agents
Surgery – carotid endarterectomy
46
Q

National Stroke startergy

A

Treat Stroke as a medical emergency
Effective assessment and treatment of vascular risk factors
TIAs assessed and scanned within 24hrs
Suspected stroke transferred to specialist stroke unit with MDT treatment and assessment
Range of services available locally to support long-term needs
Opportunity to return to work

Pathophysiology 2 (18 decks)

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