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YEAR 4 OLDER PEOPLE INTEGRATED CARE > Stroke anatomy > Flashcards

Stroke anatomy Flashcards

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1
Q

Name different lobes of brain

A

Frontal
Parietal
Temporal
Occipital
Cerebellum
(also have brainstem)

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2
Q

Functions of frontal lobe?

A
  • Personality/behaviour regulation and judgement
  • planning
  • decision making
  • concentration
  • voluntary motor functions
  • expression of speech
  • continence
  • primary motor cortex - precentral gyrus
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3
Q

Functions of temporal lobe?

A
  • hearing
  • olfaction
  • memory
  • emotion
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4
Q

Functions of the parietal lobe?

A
  • comprehension of speech and language
  • body image
  • awareness of external environment
  • calculations, writing
  • sensory functions - pain, heat etc
  • Primary somatrosensory cortex (post central gyrus)
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5
Q

Functions of the occipital lobe?

A
  • Primary visual cortex
  • Processing visual information
  • storing visual memories
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6
Q

Functions of cerebellum?

A
  • Coordination
  • Balance
  • Stores memories of previously learned movement patterns
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7
Q

Functions of brainstem - midbrain, pons, medulla oblongata?

A
  • Breathing
  • Swallowing
  • HR
  • Arousal and wakefulness
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8
Q

Which brain lobe is Broca’s area in?

A

Frontal lobe

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9
Q

What is Broca’s area function?

A

Expression of speech

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10
Q

Type of dysphasia related to Broca’s area?

A

Expressive dysphasia
- understand what is being said
- stacatto speech

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11
Q

Which side of frontal lobe has to be damaged to cause expressive dysphasia?

A

Left hand side - this is where Broca’s area is !

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12
Q

Where is weakness resulting from frontal lobe damage

A

Contralateral !

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13
Q

Which lobe is Wernicke’s area in?

A

Parietal lobe

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14
Q

Type of dysphasia caused by damage to Wernicke’s area?

A

Receptive dysphasia
- fluent speech that is nonsensical
- do not understand what is being said

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15
Q

Which side of brain and lobe leads to receptive dysphasia?

A

LEFT
Parietal lobe

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16
Q

Damage to which side of parietal lobe leads to neglect (of body?)

A

Right

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17
Q

Name of visual defect caused by damage in parietal lobe?

A

Contralateral inferior homonymous quadrantanopia

why? Superior optic radiations pass by parietal lobe

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18
Q

Describe what we mean by cerebral dominance

A

Some functions are represented more in one hemisphere
* L hemisphere dominant for language and mathmatical/logical functions
* R hemisphere dominant for body image, visuospatial awareness, emotion

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19
Q

What are Broca’s and Wernicke’s areas connected by?

A

Arcuate fasciculus

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20
Q

Label 1-7

A
  1. frontal lobe
  2. parietal lobe
  3. occipital lobe
  4. cerebellum
  5. brainstem
  6. hippocampus
  7. temporal lobe
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21
Q

Circle of willis

Label A-D

A

A = Anterior communicating artery
B = Anterior cerebral artery
C = ophthamic artery
D = Anterior choroidal artery

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22
Q

What does anterior communicating artery do?

A

Connects the anterior cerebral arteries

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23
Q

What does the anterior cerebral artery supply?

A

Supplies the medial aspect of frontal and parietal lobes
Has branches that supply the corpus callosum

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24
Q

What does ophthalmic artery supply?

A

Blood to the eyes and nose

25
Q

What does anterior chorodial artery supply?

A

Blood to the midbrain

26
Q

Label E - H

A

E = Posterior cerebral artery
F = Superior cerebellar artery
G = basilar artery
H = Anterior inferior cerebellar artery

27
Q

What does posterior cerebral artery supply?

A

Midbrain en passant, occipital, temporal lobes, thalamus

28
Q

Major branches of basilar artery?

A

Terminal bifurcation gives rise to posterior cerebral artery
Superior cerebellar artery
Pontine arteries
Anterior inferior cerebellar artery

29
Q

What does basilar artery supply?

A

Cerebellum and pons

30
Q

What does superior cerebellar artery supply?

A

Superior aspect of cerebellum and midbrain en passant (by passing it)

31
Q

What does anterior inferior cerebellar artery supply?

A

Antero-inferior aspect of the cerebellum and lateral pons

32
Q

Label I - L

A

I = vertebral artery
J = Anterior spinal artery
K = Posterior inferior cerebellar artery
L = Pontine arteries

33
Q

What are the two important branches of the vertebral arteries?

A

Anterior spinal arteries
Posterior inferior cerebellar arteries

34
Q

What do anterior spinal arteries supply?

A

Anterior 2/3rd of spinal cord

35
Q

What do posterior inferior cerebellar arteries supply?

A

Postero-inferior aspect of the cerebellum

36
Q

What do pontine arteries supply?

A

Pons

37
Q

Label M, N and O

A

M = Posterior communicating artery
N = Middle cerebral artery
O = Internal carotid artery

38
Q

Role of posterior communicating arteries?

A

Connect posterior and anterior circulation

39
Q

What is the MCA a continuation of?

A

ICA

40
Q

What does MCA supply?

A

Have cortical branches which supply lateral aspect of cerebral hemispheres:
* cortex and underlying white matter
* lateral part of frontal lobe
* lateral parietal lobe
* superior temporal lobe

Have deeper branches - called the lenticulostriate arteries which supply:
* deep grey matter structures –> lentiform nucleus, caudate, internal capsule

41
Q

Main blood vessel in anterior circulation?
What does it supply?

A

ICA is the main one feeding the anterior circulation
Supplies most of cerebral hemispheres

42
Q

Main artery in posterior circulation?
What does it supply?

A

Posterior circulation is fed by verterbal arteries
Supplies the brainstem, cerebellum, some of temporal lobe, occipital lobe

43
Q

Which arteries supply the frontal lobe?

A

ACA, MCA

43
Q

Which arteries supply the frontal lobe?

A

ACA, MCA

44
Q

Which arteries supply the parietal lobe?

A

ACA, MCA

45
Q

Which arteries supply Occipital lobe?

A

PCA

46
Q

Which arteries supply the temporal lobe?

A

MCA, PCA

47
Q

Which arteries supply the cerebellum?

A

Basilar, PICA, AICA, SCA

48
Q

Which arteries supply the brainstem?

A

Vertebral
Basilar

49
Q

Blood supply to hippocampus?

A

PCA

50
Q

Which arteries are included when we talk about a total anterior cicrulation infarct/syndrome (TACI/TACS)?

A

The MCA and ACA

51
Q

By describing anatomy of the brain, explain why ACA (anterior cerebral artery) infarct can lead to urinary incontinence

A
  • ACA supplies the frontal lobe.
  • Frontal lobe contains paracentral lobules which are responsible for continence
  • If there is an infarct affecting ACA, this affects blood supply to frontal lobe. So affects functioning of paracentral lobules
  • Get urinary incontinence as a result
52
Q

Using your knowledge of the homonculus and blood supply to the brain, explain why a ACA infarct affects the LL more than the UL and face

A

ACA supplies frontal and parietal lobes.
Looking at homonculus, the ACA supplies parts of the brain that have a topographical representation of the trunk, legs and foot.

53
Q

Why does a ACA stroke lead to contralateral lower limb weakness?

A

ACA infarct is an UMN lesion.
Major motor pathway is the **corticospinal pathway. **
1. UMN axon passes down through internal capsule
2. enter brainstem via cerebral peduncle
3. it decussates in the medulla where corticospinal fibres cross the midline
4. this forms the lateral corticospinal tract which continues down through spinal cord to LMN
5. Synapses here - which then synapses onto a muscle.

54
Q

Why is the forehead spared in stroke?

A
  • Part of facial motor nucleus that supplies the upper half of the face recieves UMNs from both hemispheres.
  • Part of facial motor nucleus that supplies lower half of face only recieves a contralateral UMN input
  • So, UMN lesions involving the face will spare the forehead, as they have both ipsilateral and contralateral innervation.
55
Q

How does a stroke lead to spasticity of the limbs?

A
  • Normally, UMNs net effect on LMN is inhibition (corticospinal tracts descned through the cord, and terminate on inhibitory interneurones - which inhibit the LMN)
  • Stroke destroys excitatory inputs which down through CST. Also interupt descending inhibitory inputs on LMN.
  • LMN still has excitatory inputs from muscle spindles.
  • BUT, LMN has lost excitatory CST projections and with that, lost the descending inhibitory influences.
  • So LMN activity increases –> fires off more frequent APs –> more frequent muscle contractions –> increase muscle tone –> spasticity.
56
Q

Why is there a characteristic flexed spasticity in Upper Limb (UL) in stroke.

A

All muscles - flexors and extensors - are affected equally.
But, in UL, flexors are more powerful. SO when we have this loss of inhibition in LMN, we get overactivity in the monosynaptic reflex arc.
Bc flexors are more powereful than extensors, this leads to flexed deformity in a spastic upper limb.

57
Q

What is spinal shock (w/ regard to stroke)?

A

A phenomenon that occurs in days immediatley after a UMN lesion (stroke)
* initally have flaccid paralysis with areflexia (like a LMN lesion)
* then tone increases (hypertonia)
* and reflexes become exagerrated (hyperreflexia)
* leads to characteristic spasticity seen in stroke

YEAR 4 OLDER PEOPLE INTEGRATED CARE (21 decks)

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