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Neuroscience Lecture 14 and 15 > Lecture 16: TBI, Vascularization and Stroke > Flashcards

Lecture 16: TBI, Vascularization and Stroke Flashcards

1
Q

What is traumatic brain injury?

A

Insult to brain caused by external physical force (not degenerative or congenital nature). May produce a diminished or altered state of consciousness. May result in an impairment in cognitive abilities or physical functioning

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2
Q

Prognosis for Brain Injury

A

younger, shorter coma, shorter post traumatic amnesia (anterograde), small brain injury, location based (damage in CNS or not), cause of injury (fall v. gun)

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3
Q

Fun fact about TBI

A

Males 15-24 at higher risk followed by elderly, infants. Motor vehicles biggest cause followed by falls and violence/sports injuries

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4
Q

Skull intact, no penetration of skull

A

Closed head injury TBI

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5
Q

Penetration of skull with direct injury

A

Open head injury TBI

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6
Q

What is most common type of TBI?

A

Focal injury (local, damage to specific area). Direct impact of short duration related to deceleration/acceleration ex) coup-contra-coup (usually seen with diffuse axon injury)

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7
Q

Coup-contra-coup

A

Brain hurled against skull then ricochets in oppo. direction (frontal and temporal most often damaged (under focal injury)

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8
Q

Contusion

A

Bruises

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9
Q

Diffuse axonal injury

A

Stretch injury to membrane of axon, leading to axon breakage (Diffuse injury)

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10
Q

Secondary damage is increased intracranial pressure, swelling hemorrhage, oxygen deprivation

A

Diffuse injury (TBI)

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11
Q

Damage is diffuse and impact several areas, occur from hypoxia, damage in blood vessels

A

Diffuse Injury (TBI)

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12
Q

Hematoma

A

localized collection of blood, usually clotted in tissue or organ (epidural, subdural, intracerebral)

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13
Q

Epidural hematoma

A

above dura (between brain and skull)

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14
Q

Subdural hematoma

A

Below dura

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15
Q

Intracerebral hematoma

A

Inside brain

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16
Q

Coma

A

state person makes no purposeful response to environment and rom which she can’t be aroused (may last hours or days) followed by semi coma (confusion)

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17
Q

Glasgow Coma Scale

A

way to record conscious state of person. 15 is awake (us), and 3 is death, deep coma (tests eye, verbal, motor)

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18
Q

State of inconsistent, erratic responsiveness generally unable to communicate with outside world

A

Minimally conscious state

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19
Q

TBI cognitive impairment consists of…

A

diminished mental processing speed, difficulty with divided attention, difficulty with executive functions

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20
Q

Where is damage if you have dysarthria?

A

Right or left. It is slurred speech, mechanical issue, damage to motor cortex/cranial nerves/corticobulbar

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21
Q

Where is damage if you have aphasia?

A

Generally damage to LEFT hemisphere (Broca’s, Wernicke’s, global) Deficit in language

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22
Q

Anterograde Amnesia

A

More common esp. after injury and comma (can be period or days) can’t remember moment of injury and things after.

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23
Q

Where is damage if you have spasticity, atypical reflexes?

A

upper motor neuron/hyper reflexia

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24
Q

Where is damage if you have poor balance and equilibrium?

A

Cerebellum

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25
Q

Where is damage if you have abnormal postures?

A

Descending motor, basal ganglia

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26
Q

Where is damage if you have difficulty swallowing?

A

Cranial Nerves

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27
Q

Where is damage if you have tremors?

A

Resting tremor (basal ganglia), intention tremors (cerebellum)

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28
Q

Where is damage if you have Athetosis?

A

Basal Ganglia (involuntary writhing movements)

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29
Q

Damage to ventral and medial prefrontal association cortices?

A

Personality/Emotion: poor judgment, irritability, apathy, altered sex drive, decreased goal directed, impaired social skills, emotional lability, limited self awareness

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30
Q

Where is damage if you have apraxia?

A

Damage in left hemisphere (left PTO)

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31
Q

Where is damage if you have unilateral neglect?

A

Damage to right PTO

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32
Q

Where is damage if you have visual spatial, poor body awareness?

A

Damage to right PTO

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33
Q

Where is damage if you have constructional apraxia?

A

Right PTO

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34
Q

What are the two paired arteries from aorta that supply blood to brain?

A

Internal Carotid (anterior) and Vertebral-basilar (posterior)

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35
Q

Role of Internal Carotid artery?

A

Anterior supply, supplies majority of cerebral hemispheres

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36
Q

Role of Vertebral Basilar artery?

A

posterior supply, supplies brainstem, cerebellum and some of the cerebral hemisphere - two vertebral merge to form basilar

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37
Q

Circle of Willis

A

Branches of internal carotid and basilar arties form circle ( 2 posterior, 2 anterior, 2 middle cerebral arteries, and 3 communicating arteries. Circulatory anastomosis that supplies blood to the brain and surrounding structures

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38
Q

What is anastomosis?

A

Ring of 9 arteries that supply all blood to brain (6 large, 3 communicating arteries)

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39
Q

Internal Carotid branches into…

A

Anterior cerebral (middle) and Middle Cerebral (lateral)

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40
Q

Basilar artery branches into…

A

posterior cerebral

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41
Q

What is from the internal carotid, and supplies lateral surface of most of lateral hemispheres: frontal, parietal and temporal lobes (except for inferior temp. lobes)

A

Middle Cerebral Artery

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42
Q

What branches penetrate and supply deep structures of internal capsule, basal ganglia, optic tract, and radiations?

A

Middle Cerebral Artery

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43
Q

Damage to Middle Cerebral Artery leads to…

A

Everything but memory is impaired:

  1. Motor (contralateral hemiplegia, UE/face most affected)
  2. Sensory (contralateral hemianesthesia (UE/face most affected)
  3. Language (L. aphasia/L. aprosodia, and R/L mechanical disorder of speech disarthria)
  4. Perceptual (R. Agnosia, difficulty with spacial relationship, left neglect, constructional apraxia. L. apraxia)
  5. Vision: contralateral homonymous hemianopia
  6. MEMORY FINE
  7. Emotion/behavior: change in emotion/personality and often times executive functioning
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44
Q

What artery supplies medial aspects of frontal and parietal lobes?

A

Anterior Cerebral Artery

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45
Q

What artery branches to diencephalon, limbic, caudate, internal capsule (undersurface of parietal lobe and part of frontal)

A

Anterior Cerebral Artery

46
Q

Damage to Anterior Cerebral Artery leads to…

A

Motor: Contralateral hemiplegia (LE most affected)
Sensory: contralateral hemianesthesia (LE most affected)
Language/Perception/Vision/Visual/Memory fine
Emotion/behavior: Changes in emotion, personality, executive functions

47
Q

What artery supplies undersurface and posterior surface of temporal and occipital lobes?

A

Posterior Cerebral Artery

48
Q

Damage to Posterior Cerebral Artery leads to…

A

Motor, sensory, language, perception, emotion fine.

  • Vision (CHH)
  • Memory loss
49
Q

What artery damage can lead to memory loss?

A

Posterior Cerebral Artery (PCA)

50
Q

What artery damage can lead to contralateral homonymous hemianopia?

A

MCA, PCA

51
Q

What artery damage can lead to contralateral hemiplegia and hemianesthesia?

A

ACA (lower extremities, MCA (upper extremities and face most affected)

52
Q

What artery damage can lead to emotion/behavior change?

A

ACA and MCA

53
Q

What artery damage can lead to language deficit?

A

MCA

54
Q

What artery damage can lead to perceptual deficits?

A

MCA (maybe ACA if left)

55
Q

Where does basilar artery run along?

A

Surface of brainstem at level of pons

56
Q

Where does basilar artery wrap around?

A

Cerebellum and internal auditory artery

57
Q

Complete occlusion (blockage) of Basilar artery leads to…

A

death due to ischemia of brainstem nuclei and tracts that control vital functions

58
Q

What is ischemia?

A

an inadequate blood supply to an organ or part of the body,

59
Q

Partial occlusion (blockage) of Basilar artery leads to…

A

tetraplegia (BILATERAL since it is one artery), loss of sensation, coma, CN signs

60
Q

Severe partial occlusion of basilar artery leads to…

A

Locked-in syndrome (diving bell and butterfly) Awake, aware but can’t community, paralysis in all body

61
Q

Damage to cerebellar arteries lead to…

A

bad balance, lack of coordination, nystagmus, dizziness (superior, anterior inferior, posterior interior)

62
Q

Arteries part of Anterior Supply:

A

Internal carotid system: MCA ACA

63
Q

Arteries part of Posterior Supply:

A

Vertebral Basilar System: PCA, Cerebellar arteries

64
Q

What is local, temporary loss of blood supply called?

A

Ischemia (lose consciousness after 10 secs, electrical signal ceases after about 20 seconds)

65
Q

Ischemia

A

local, temp. loss of blood supply

66
Q

Infarct

A

area of tissue death due to loss of blood supply (if in same damage, TBI and stroke looks familiar)

67
Q

What is cerebrovascular accident (CVA)?

A

Focal neurological disorder of relatively abrupt onset due to a pathological process in blood vessel, usually within ONE hemisphere of brain (loss of blood supply/problem with blood vessel, happens in one hemisphere)

68
Q

This is a focal neurological disorder due to problem with blood vessel (loss of blood) in one hemisphere

A

Cerebrovascular accident (also known as stroke/brain attack)

69
Q

What is the leading cause of serious long term disability?

A

Stroke

70
Q

What is transient ischemic attack (TIA)?

A

Brief, focal loss of brain function (usually recovery within 24 hours, sign of risk for stroke)

71
Q

Brief, focal loss of brain function which recovery within 24 hours is called…

A

TIA (transient ischemic attack)

72
Q

Neurologic deficits from vascular disorders that persist more than 1 day and stable

A

Completed stroke

73
Q

If you have this, there will be a stroke in next three months.

A

Transient Ischemic Attack

74
Q

With this type of stroke, you are not getting better or worse.

A

Completed stroke

75
Q

Progressive stroke

A

Deficits increase intermittently over time (little strokes)

76
Q

Small little strokes

A

Progressive stroke

77
Q

What are the different types of strokes?

A
  1. Brain infarction

2. Hemorrhagic Stroke

78
Q

Brain Infarction

A

caused by blockage of blood vessel producing ischemia, resulting in infarct (tissue death)

79
Q

90% of strokes are…

A

ischemic

80
Q

What causes blockage?

A

Thrombus: formation of blood clot within artery (and stays there)

81
Q

What kind of stroke where formation of blood clots within artery?

A

Thrombotic stroke

82
Q

What is embolic stroke?

A

Blood cot formed, was dislodged, trailed in blood stream and then became trapped in arteries closer to brain.

83
Q

Embolism

A

Clot travels from site where it was formed

84
Q

Thrombus

A

blood clot that forms in a vessel

85
Q

Hemorrhagic Stroke

A

Rupture of blood vessels, with bleeding into/around cerebral tissue. Bleeding irritates brain tissue causing swelling. Surrounding tissue of brain resist expansion of bleeding and contains it, forming a mass (hematoma). Swelling and hematoma will compress and displace normal brain tissue

86
Q

Infarct Stroke v. Hermorrhagic

A

Blockage of blood resulting in tissue death v. Rupture of blood vessel, bleeding leads to swelling

87
Q

Causes of Hemorrhagic stroke

A

High Blood Pressure, aneurysm (weak spot in artery wall), amyloid protein

88
Q

What is an aneurysm?

A

Weak spot in artery wall, balloons out because of pressure of blood circulating, bursts and causes harm

89
Q

What is amyloid protein?

A

Makes vessels more prone to bursting (common in elderly)

90
Q

What is a weak spot in artery wall, balloons and bursts?

A

Aneurysm

91
Q

What makes vessels more prone to bursting? Common in elderly?

A

Amyloid Protein

92
Q

What are risk factors for stroke?

A

Hypertension, high cholesterol, diabetes, overweight, high alcohol intake, smoking, stress (lifestyle changes can reduce risk of stroke)

93
Q

What are some stroke symptoms?

A

weakness to move body part, numbness of sensation, decrease vision, speech difficulties, inability to id familiar things, sudden headache, dizziness, loss of coordination, swelling difficulties, sleepy

F- face uneven
A- arm (one)
S- speech slurred
T- time to call 911

94
Q

weakness to move body part, numbness of sensation, decrease vision, speech difficulties, inability to id familiar things, sudden headache, dizziness, loss of coordination, swelling difficulties, sleepy are symptoms of…

A

stroke

95
Q

Common deficits of stroke?

A

Motor - muscle tone is flaccid then spasticity, hyperreflexia, paralysis, hemiplegia, apraxia
Sensory - rarely in isolation, depend on where it is, have motor too
Visual - CHH
Emotional - depression, apathy, fear, frustration, emotional lability

96
Q

What happens to muscle tone in stroke?

A

Flaccid at first then spasticity (velocity dependent hypertonia). UE flexor syngery tend to be: shoulder adducted, elbow/wrist/finger flexion with supination while LE extended throughout limb

97
Q

What happens to reflexes in stroke?

A

Hyperreflexia (because UMN can’t turn off)

98
Q

What happens to perception in stroke?

A

Agnosia, body scheme, visual spatial, constructional praxis

99
Q

What happens to language in stroke?

A

Aphasia and dysarthria

100
Q

ACA

A
  • Motor: contralateral hemiplegia (LE)
  • Sensory: contralateral sensory loss (LE)
  • Language: n/a
  • Perception: L hemi possibly apraxia
  • Visual: n/a
  • Memory: n/a
  • Emotion/Behavior: difficulty with exec fxning & divergent thinking, possibly personality changes
101
Q

MCA

A
  • Motor: contralateral hemiplegia (UE/face)
  • Sensory: contralateral sensory loss (UE/face)
  • Language: aphasia (if L hemisphere), impairment in nonverbal communication (if R hemi)
  • Perception: R hemi: diff with spatial rltnshps, neglect, agnosias, constructional apraxia etc.; L hemi: apraxia
  • Visual: CHH if optic tract/radiations
  • Memory: n/a
  • Emotions/Behavior: difficulty with exec fxning & divergent thinking, impulsive, personality changes, etc.
102
Q

PCA

A
  • Motor: minimal involvement (if yes, contralateral hemiplegia)
  • Sensory: minimal involvement (if yes, contralateral hemianesthesia)
  • Language: n/a (if motor involvement above, though, may have dysarthria)
  • Perception: n/a
  • Visual: CHH
  • Memory: memory loss
  • Emotions/behavior: n/a
103
Q

Basilar

A

• Motor: bilateral weakness or paralysis
• Sensory: bilateral sensory loss
• Language: dysarthria
• Cerebellar signs: vertigo, dizziness, nystagmus
• Locked-in syndrome
• (not a symptom, but if a complete occlusion = death)
(pons, cerebellum)

104
Q

This branches and supply part of optic chiasm, optic tract, parts of thalamus

A

Posterior Cerebral Artery

105
Q

“Harry has hemianesthesia and hemiplegia (UE face impacted). He greets you in garbled, halting phrases and grammatical function words. He can follow simple commands but can’t express himself.” Which hemisphere has lesion?

A

Left

106
Q

“Harry has hemianesthesia and hemiplegia (UE face impacted). He greets you in garbled, halting phrases and grammatical function words. He can follow simple commands but can’t express himself.” What is name of his communication difficulty?

A

Broca’s Aphasia

107
Q

“Harry has hemianesthesia and hemiplegia (UE face impacted). He greets you in garbled, halting phrases and grammatical function words. He can follow simple commands but can’t express himself. “ What side of his body is he experiencing sensory or motor loss on?

A

Right

108
Q

“Harry has hemianesthesia and hemiplegia (UE face impacted). He greets you in garbled, halting phrases and grammatical function words. He can follow simple commands but can’t express himself.” If his cause of symptoms was stroke, what artery would be implicated?

A

Left MCA

109
Q

“Sarah feels weakness on one side of body, confusion, difficulty swallowing then feels 100% normal again. She can make tea on her own. But when they are at the hospital cafeteria, son asks her to make tea and she can’t.” What do you think happened to cause symptoms she experienced?

A

Transient Ischemic Attack

110
Q

“Sarah feels weakness on one side of body, confusion, difficulty swallowing then feels 100% normal again. She can make tea on her own. But when they are at the hospital cafeteria, son asks her to make tea and she can’t.” Was it necessary to go to hospital?

A

Yes because she is at higher risk for CVA stroke.

111
Q

“Sarah feels weakness on one side of body, confusion, difficulty swallowing then feels 100% normal again. She can make tea on her own. But when they are at the hospital cafeteria, son asks her to make tea and she can’t.” What deficit is associated with her making cup of tea?

A

Ideomotor Limb Apraxia

112
Q

“Sarah feels weakness on one side of body, confusion, difficulty swallowing then feels 100% normal again. She can make tea on her own. But when they are at the hospital cafeteria, son asks her to make tea and she can’t.” Where is Sarah’s lesion?

A

Left Premotor and Suppl Motor.

Neuroscience Lecture 14 and 15 (4 decks)

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