Circulation Of The Brain ( Stroke + Traumatic Brain Injury)

Question 1

Structure of the cerebral circulation?

Answer 1

Internal carotids pass in front of the neck and divide to form anterior and middle cerebral arteries
Two anterior cerebral arteries join by the anterior communicating artery

Question 2

Structure of the posterior cerebral circulation?

Answer 2

2 vertebral arteries passing up through foramina in transverse processes of C vertebra and join in front of the brainstem= basilar artery
Upper brainstem, basillar artery divides into two posterior cerebral arteries

Question 3

What parts of the brain does the middle cerebral artery supply?

Answer 3

Most of the outer surface
Sensorimotor cortex 
Basal ganglia 
Internal capsule 
Broca's area

Question 4

What parts of the brain does the anterior cerebral artery supply?

Answer 4

Frontal lobe

Medial part of the sensorimotor cortex

Question 5

What parts of the brain does the posterior cerebral artery supply?

Answer 5

Occipital lobe
Medial half of temporal lobe
Thalamus

Question 6

What parts of the brain does the basillar artery supply?

Answer 6

All of brainstem
Cerebellum
Nuclei of cranial nerve

Question 7

What is auto regulation?

Answer 7

Occurs between mean arterial BP of 60-150mmHg

Question 8

What causes auto regulation to fail?

Answer 8

Disease of the CNS: 
Trauma 
Acute stroke
Tumours 
Infections

Question 9

The two types of strokes?

Answer 9

Haemorrhage

Ischaemia

Question 10

4 types of haemorrhagic strokes?

Answer 10

Subarachnoid
Intracerebral
Subdural
Extradural

Question 11

What is a subarachnoid haemorrhage?

Answer 11

Bleeding in the subarachnoid space due to rupture of congenital aneurysm, anteriovenous malformation or trauma
Association with sudden intense headaches, vomiting, neck stiffness and unconscious
10% die in 2 hours, 40% in 2 weeks

Question 12

What is Intracerebral haemorrhage?

Answer 12

Bleeding in deep parts of the brain
Associated with hypertension
Anterior wall weakness- micro aneurysm- rupture and bleeds.
Severe headaches and vomiting

Question 13

Subdural haemorrhage?

Answer 13

Bleeding into subdural space
Maybe an integral between trauma and symptoms
Bleeding or little veins
Headaches- drowsiness- stupour- hemiparesis-coma

Question 14

Extradural haemorrhage?

Answer 14

Bleeding into extramural space

Caused by severe trauma, tearing of meningeal artery

Question 15

Characteristics of ischaemic stroke?

Answer 15

80% of strokes due to occlusion (blockage and closing of blood vessels)
Atheroma of cerebral artery
Emboli from a thermatous heart
Most common vessel: MCA/PCA/ACA
Brainstem strokes less common and more serious

Question 16

Characteristic of an embolic stroke?

Answer 16

Complete stroke (sudden) 
Transient ischaemic attack + repeated small emboli and no infarction occurs

Question 17

Characteristics of thrombotic stroke?

Answer 17

Completed stroke ( develops overnight)
Developing stroke
Transient ischaemic attack

Question 18

What is a traumatic brain injury?

Answer 18

Injury to the brain from external physical factors:

• altered state of consciousness
• impairment of cognition and physical abilities
• disturbance of behaviour and emotional functioning

Question 19

What is the Glasgow coma scale?

Answer 19

Eye opening, verbal response and motor response

3 dead and 8 unconscious

Question 20

Stats of TBI?

Answer 20

250/300 out of 100,000
2:1 M:F
16-25
RTA> falls> attacks

Question 21

What are the 4 mechanisms of injury?

Answer 21

• Penetrating
• Compression
• Deceleration
• Diffuse axonal injury

Question 22

Secondary damage of TBI?

Answer 22

Raised ICP- distortion of brain
Infection
Ischaemic changes 
Vasospasm- spasm of blood vessels 
Complications of system dysfunction

Question 23

What is the brainstem supplied from?

Answer 23

2 vertebral arteries

2 internal carotid arteries