Lecture 5: Clinical anatomy (nervous system)

Question 1

Signs with stroke (most common)

Answer 1

Face - is it drooping

Arms - can you raise both

Speech - is it slurred or jumbled

Time - to call 911 right awa

Question 2

Ischemic stroke

Answer 2

Blood supply to an area becomes blocked

Question 3

Hemorrhagic stroke

Answer 3

Artery (usually) ruptures resulting in blood loss (often due to hypertension)

Question 4

What happens when there is a stroke in superficial vessels?

Answer 4

e.g. aneurysms of the circle of willis

Blood leaks into subarachnoid space

Question 5

What are the 2 common causes of Ischemic stroke?

Answer 5

Thrombosis - clot forming within artery, coincident with atherosclerosis

Embolus - travelling mass, often a clot or a detached atherosclerotic plaque that becomes lodged within an artery

Question 6

Risk factors for ischemic stroke

Answer 6

Age

Family history

Smoking

Hypercholsterolmia

Hypertension

Question 7

Different blockages affect different areas of brain

Answer 7

See figure

Question 8

Axial CT, stroke

Answer 8

See figure

Question 9

What is the largest of the cerebral arteries?

Answer 9

Middle cerebral, supplies large territory of lateral convey surface of brain

Question 10

What happens when blood supply to brain is compromised

Answer 10

Lack of oxygen and glucose triggers series of cellular events that lead to cell death

Treatment needs to be urgent!!

Question 11

What is Tissue Plasminogen Activator (tPA)

Answer 11

AKA Activase

tPA converts plasminogen (an inactive enzyme) into plasmin (an active enzyme)

Plasmin degrades proteins contained within a clot, which is why tPA is referred to as ‘clot- buster’

Question 12

When must tPA be given?

Answer 12

Up to 4.5 hours after onset of stroke

Question 13

Who is eligible for tPA?

Answer 13

Not patients with hemorraghic

Not patients with history of cerebral hemorrhage, abnormal platelet count or coagulation

CT scan is required to ID clot

Question 14

Alternative approaches to stroke

Answer 14

Clot extraction

Angioplasty

Stenting

Mechanical clot disruption

Intra arterial tPA

Question 15

Features of spinal cord injury

Answer 15

Conscious, able to respond to questions.

Pupillary responses to light were normal (equal and reactive to light)

Loss of feeling or movement in arms and legs

B.P.: 90/50; HR: 60, RR: 26 (shallow breathing)

Fever of 39.4 0C and skin was warm and dry to the touch

Question 16

Where are motor neurons required for inspiration located?

Answer 16

spinal cord segments C3, C4, and C5

axons of these neurons are in the phrenic nerve

Question 17

What does shallow difficult breathing in person with spinal injury indicate?

Answer 17

suggests that the neurons innervating the diaphragm are damaged (rapid breathing is response to shallow breathing).

Question 18

What do symptoms of dry skin and fever indicate in patient with spinal cord injury?

Answer 18

Damage to descending fibres controlling sympathetic pre ganglions

Question 19

What are colloid cysts?

Answer 19

Benign, gelatinous filled spherical masses

Question 20

Where do colloid cysts arise?

Answer 20

Arise immediately posterior to the foramen of Monro in the roof of the third ventricle

Question 21

What do symptomatic patients with colloid cysts demonstrate?

Answer 21

Hydrocephalus

Question 22

Treatment of colloid cyst

Answer 22

Surgery

Goal: restore the patency of the foramen of Monro

Endoscopic removal of the cyst using stereotactic surgery

Hydrocephalus is also often treated by shunts from the ventricles into the peritoneal cavity to decrease intracranial pressure