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5 - Neuro > deck_3166997 > Flashcards

deck_3166997 Flashcards

1
Q

What are the main blood vessels that supply the brain?

A

Internal carotidsVertebral arteries

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2
Q

Give the branches of the internal carotid arteries

A

Anterior cerebralMiddle cerebral (continuation)OpthalmicPosterior communicating

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3
Q

What does the anterior cerebral artery supply?

A

Medial surfaces of frontal and parietal lobes

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4
Q

What does the middle cerebral artery supply?

A

Lateral surfaces of the cerebral cortex

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5
Q

Give the branches of the vertebral arteries

A

Join to form the basilar arteryPosterior cerebral arteries

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6
Q

What does the basilar artery supply?

A

Medulla Brainstem

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7
Q

What does the posterior cerebral artery supply?

A

Inferior surface of brainOccipital lobe

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8
Q

Where do the internal carotid arteries enter the skull?

A

Carotid canal

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9
Q

Where do the vertebral arteries enter the skull?

A

Foramen magnum

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10
Q

Why is the circle of willis important?

A

Provides collateral circulation if there is a blockage to one part of a blood vessel- usually inadequate after a sudden occlusion

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11
Q

Describe autoregulation

A

Cerebral blood vessels will constrict and dilate in response to changes in cerebral perfusion pressure so that it can maintain a sufficient perfusion.

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12
Q

Decreased CPP?

A

Vasodilation

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13
Q

Increased CPP?

A

Vasoconstriction

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14
Q

Define cerebral perfusion pressure

A

The net pressure gradient causing cerebral blood flow to the brainMean arterial pressure minus intracranial pressure

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15
Q

Define stroke

A

A clinical syndrome of abrupt loss of focal brain function lasting over 24 hours or causing death

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16
Q

What causes a stroke?

A
  1. Spontaneous haemorrhage into brain tissue2. Inadequate blood supply
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17
Q

What are the different types of stroke?

A

IschaemicHaemorrhagic

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18
Q

Describe ischaemic stroke

A

80-85% of strokesDue to blockage of blood supply- large vessel atheroma or embolism80% = atheroma20% = AF

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19
Q

Describe haemorrhagic stroke

A

15% of strokesRupture of cerebral blood vessels Primary = no structural lesionSecondary - structural lesion is present

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20
Q

What are the main causes of haemorrhagic stroke?

A

Hypertensive causes (40%)- microaneurysmsLarge aneurysms (15%)Anticoagulant/thrombolytic causesDrugs e.g. cocaine, amphetaminesTumour

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21
Q

Define a TIA

A

Sudden onset focal disturbance of brain function which resolves completely within 24 hours Most within 20 mins to 2 hours

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22
Q

Give some symptoms that occur if the site of the stroke is in the frontal lobe

A
  • Speech impairment- personality changes- Movement impairment (motor control area)
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23
Q

Give some symptoms that occur if the site of the stroke is in the Parietal lobe

A

Eye sight problems- superior optic radiation- inferior homonymous hemianopia

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24
Q

Give some symptoms that occur if the site of the stroke is in the occipital lobe

A

Homonymous hemianopia

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25
Q

Give some symptoms that occur if the site of the stroke is in the cerebellum

A

Cerebellum contains: cardiac and respiratory control centresMotor and sensory tractsCranial nerve nuclei- Can have damage associated with all of these

26
Q

Give some symptoms that occur if the site of the stroke is in the temporal lobe

A

Taste and smell changesWernickes area Inferior optic radiation- superior homonymous hemianopia Auditory and vestibular function

27
Q

What happens when you get damage to wernicke’s area?

A

Receptive aphasia- Pt is unable to understand language in the written or spoken form- Will be able to speak with normal syntax and intonation but the words will not make any sense

28
Q

What are the different classifications of strokes?

A

Total anterior circulation strokePartial anterior circulation strokeLacunar strokePosterior circulation stroke

29
Q

Give the cause and presentation of a total anterior circulation stroke

A

Proximal occlusion of internal carotid or prox middle cerebral artery. Causes: contralateral hemiparesiscontralateral hemianopiahigher cerebral dysfunction e.g. dysphasia and dyspraxia

30
Q

Give the cause and presentation of a partial anterior circulation stroke

A

Occlusion of a branch of the MCSASymptoms - Two of:- contralateral hemiparesis- contralateral hemianopia- higher cerebral dysfunctionIn face of arm or leg only Or have isolated cortical signs

31
Q

Give the cause and presentation of a lacunar stroke

A

Occlusion of a single perforating artery, affects deeps trcutires of the brain e.g, basal ganglia, pons, thalamusSymptoms:Pure motorPure sensorySensorimotorHemiparesis

32
Q

Give the cause and presentation of a posterior circulation stroke

A

Occlusion of a vessel found in the posterior circulation of the brainSymptoms:Affects brainstem, cerebellum of occipital lobe

33
Q

Give some risk factors for stroke

A

AgeGenderFamily historyPrevious stroke/TIASmokingSedentary lifestyleHeavy alcohol intakePoor dietHypertension HypercholesterolaemiaDiabetes mellitusArrhythmia - AF

34
Q

What are some differentials for stroke?

A

Hypoglycaemia and metabolic disturbancesMigraine auraEpilepsySpace occupying lesionDemyelination - MS

35
Q

What will a CT scan show in a stroke?

A

Will show haemorrhage instantlyCan visualise an infarct (rarer to see)

36
Q

What will an MRI scan show?

A

Will be able to visualise an infarct

37
Q

Why is raised ICP a problem?

A

Skull is a rigid structure with a fixed volumeVolume is determined by brain, CSF and bloodChange in vol of one must be accompanied by an equal an opposite change in the other two

38
Q

What is normal ICP?

A

0-10mmHg

39
Q

Where are the three main areas where compression and herniation can take place?

A

Cingulate gyrusUncusCerebellar tonsils

40
Q

Describe a cingulate gyrus hermiation

A

Brain is pushed away from lesion and herniates under the falx cerebri to the opposite hemisphere. This is a subflacine herniation.

41
Q

Describe a central herniation

A

Brain herniates down between the tentorium cerebelli

42
Q

Describe an uncal herniation

A

Brain herniates around the tentorium cerebelli, from one side

43
Q

Describe a tonsillar herniation

A

Brain is forced downwards and herniates through the cerebellar tonsils through the foramen magnum.

44
Q

Give some clinical signs of ICP

A

Loss of function (motor and sensory)Change in behaviourDrop in level of consciousnessChange in pupil reactionChanges in BP, pulse and breathing

45
Q

How does the brain get injured?

A

Direct injury due to the brain being shaken inside the skull Direct injury leads to oedema and haemorrhage due to rupture of arteries or veins. Extra or subdural haematoma, causing increase ICP

46
Q

What are the arteries that supply the spinal cord?

A

Anterior spinal artery Two paired posterior spinal arteries Anterior and posterior medullary arteries

47
Q

What areas do each of the spinal arteries supply?

A

Ant = anterior two thirdsPost = posterior third

48
Q

What gives rise to the anterior spinal artery?

A

Union of branches of the vertebral arteries- runs in the anterior median fissue

49
Q

What gives rise to the posterior spinal arteries?

A

Branch of:- vertebral artery- posteroinferior cerebellar artery

50
Q

Describe the ant and post medullary arteries

A

Branch from the aorta- main circulation to the spinal cord

51
Q

Describe the artery of adamkiewicz

A

Greater anterior segmental medullary artery- arises in lower thoracic or upper lumbar segment, usually on the left- reinforces circulation to the lower spinal cord - branches from the segemental spinal artery

52
Q

Describe spinal artery sydrome

A

Occlusion of the anterior spinal artery. Causing ischaemia and infarction.

53
Q

What symptoms arise as a result of anterior spinal artery syndrome?

A

Get spinal shock initially- flaccid weakness, areflexia and anaesthesia Followed by complete motor paralysis - corticospinal tractLoss of pain and temperature- ant and lat spinothalamic tractsGet UMN signs and muscle atrophy

54
Q

Give some causes of anterior spinal artery symdrome

A

Diseases of the aorta- aneurysm, trauma, dissection, atherosclerosisAortic surgeryVasculitisSCDHypotensionCardiac emboliDisc herniation which compresses vessels

55
Q

What are some signs that can be seen in brainstem infarctions?

A

Lateral medullary syndromeLocked-in syndrome

56
Q

Describe lateral medullary syndrome

A

Due to occlusion of posterior inferior cerebellar artery. Causes acute vertigo as well as cerebellar signs.

57
Q

Describe vascular dementia

A

Multiple large infarcts can lead to a generalised loss seen with advanced cerebrovascular disease. Each infarct causes a progression of the condition leading to dementia, pseudobulbar palsy and shuffling gait.

58
Q

What causes intracerebral haemmorrhages?

A

Degeneration of small deep penetrating arteries leading to a massive bleed. Usually due to chronic hypertension and occur at certain sites (basal gangli, pons, cerebellum, subcortical white matter)

59
Q

Describe a decorticate response

A

Severe head injury or after a large infarct- destroy connections between thalamus and cortex- isolates cortex from lower brain and spinal cord- arms are flexed, legs are extended - damage to corticospinal and rubrospinal tracts

60
Q

Describe a decerebrate response

A

Damage to lower parts of brain or brainstem- complete loss of descending inhibition on descending motor tracts - complete extension of lower limbs, upper limbs and headBrainstem damage

61
Q

What can be indicated by a progression from a decorticate to decerebrate response?

A

Indicates uncal or tonsillar brain herniation

5 - Neuro (17 decks)

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