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IMS: Neuroanatomy > CVA, TBI, and Coma > Flashcards

CVA, TBI, and Coma Flashcards

1
Q

Cerebral Blood Flow

A
  • CNS with high energy use
    • requires continuous oxygen and glucose
    • almost exclusively aerobic
    • no significant energy reserves
  • Grey matter more vascularized than white
    • White more susceptible to hypoxic-ischemic damage
  • Regional blood flow controlled by
    • systemic BP
    • innervation of vessels
    • response to metabolites
  • Autoregulation maintains constant flow over wide range of systemic BP
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2
Q

Ischemia

vs

Hypoxia

A

Ischemia = lack of blood

  • ↓ cerebral blood flow
  • ↑ fat/protein breakdown
  • see neuronal necrosis and infarcts
  • recovery maybe possible

Hypoxia = lack of oxygen

  • ↑ cerebral blood flow
  • see synaptic alterations
  • recovery possible
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3
Q

Factors Affecting

Cerebral Blood Flow

A
  1. Atherosclerosis
    • Plaques develop on vessel walls ⟾ ↓ blood flow
  2. Hypertension
    • Acute HTN
      • see HA, nausea, and AMS due to ↑ ICP
      • intracerebral hemorrhage possible
      • BBB with focal leaks
    • Chronic HTN
      • exacerbates atherosclerotic changes
      • extends into smaller vessels
  3. Inflammatory diseases
    • cranial/cerebral inflammation
    • systemic diseases
  4. Aneurysms
  5. AVMs
    • high chance of bleeding
    • subarachnoid or intracerebral
    • see seizures and headaches
  6. Cerebral amyloidosis
  7. Hematological disorders
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4
Q

Aneurysms

A
  1. Saccular
    • occurs at bifurcations
    • common at Circle of Willis
    • 40-70% rupture before death
  2. Fusiform
    • commonly occurs in basilar artery
    • see elongation and tortuosity
    • see with advanced atherosclerosis
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5
Q

Stroke

A

Abrubt onset of focal or global neurological symptoms caused by ischemia or hemorrhage.

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6
Q

TIA

A

Typical duration of 10 minutes.

Neurological deficits lasting less than 24 hours.

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7
Q

Vascular Infarcts

A

Strokes can be caused by infarcts in vessels.

  • Embolic vs thrombotic
    • ex. lacunar infarct​
  • Watershed infarcts occurs between vessels
  • Focal ischemia can occur with vessel occulsion
    • usually see contralateral loss of motor and sensation
  • Infarcts of vertebrobasilar system affects brainstem
    • crossed signs
      • decreased sensation to one side of face and contralateral body
    • cranial nerve problems
      • gaze, pupil movement
  • Hemispheric involvement indicated by seizures, hemineglect, and aphasia
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8
Q

Hemorrhage

A
  • Can be due to head injury or be spontaneous
  • Spontaneous hemorrhages can be intracerebral or in subarachnoid space
    • result of HTN, amyloidosis, AVMs, aneurysms, anticoagulation, tumors
  • Some associated with venous system
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9
Q

Stroke Treatment

A
  • Tissue plasminogen activator
  • Heparin
  • Intra-arterial thrombolysis
  • Correction of hyperglycemia
  • Carotid stents
  • Hemicraniectomy
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10
Q

Traumatic Brain Injury

(TBI)

A
  • High incidence and cost of treatment
  • Worse with war
  • Mortality decreased due to better acute care
  • No therapy for long-term degenerative changes
    • psychiatric problems
    • depression
    • substance abuse
    • PTSD
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11
Q

Behavioral Problems

with TBI

A
  • Sensory deficits
  • Headaches
  • Fatigue
  • Cognitive deficits
  • Emotional disorders
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12
Q

Glasgow Outcome Scale

(GOS)

A

Index of functional outcome of survivors.

Scale of 1-5

  • 1 = dead
  • 2 = persistent vegetative state
  • 3 = severe disability
  • 4 = moderate disability
  • 5 = good recovery with mild residual effects
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13
Q

Types of Head Injuries

A
  • Focal
    • contusions
    • hematomas
    • hemorrhage
    • tissue tears
    • Behavioral deficits caused by cortex and brain stem
  • Diffuse
    • concussion
    • Diffuse axonal injury (DAI)
    • Behavioral deficits caused by white matter, brainstem, thalamus
  • Gliosis and inflammation
  • Axonal injury, neuronal and oligodendrocyte death
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14
Q

Glasgow Coma Scale

A

15-point scale

Assess eye opening, motor response, verbal response.

  • Minimal ⟾ GCS 15, no LOC
  • Mild ⟾ GCS 14 or GCS 15 with amnesia, brief LOC, or impaired alertness
  • Moderate ⟾ GCS 9-13 or LOC >5 min or focal neuro deficit
  • Severe ⟾ GCS 5-8
  • Critical ⟾ GCS 3-4
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15
Q

TBI

Management

A
  • Surgical
    • evacuation of hematomas
  • Fluids
    • maintain BP
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16
Q

Permanent vs Transient

Ischemia

A
  • Permanent ischemia
    • brain appears dusky brown with blood still present
    • stains for neuropil
    • RBCs lyse and stains pale
  • Transient ischemia
    • brain pale
    • grey-white matter interface blurry
    • brightly stained RBCs
17
Q

Giant Cell Arteritis

A
  1. Internal lamina fragmented
  2. Intima proliferated, reducing lumen diameter
  3. Media exhibits calcification

IMS: Neuroanatomy (23 decks)

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