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Year 3 Neuro > Cerebral Vasculature > Flashcards

Cerebral Vasculature Flashcards

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1
Q

Why is the brain so vulnerable?

A

Very vulnerable if blood supply is impaired because it is so metabolically active

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2
Q

What three arteries supply the brain?

A

Common carotid
Internal carotid
Vertebral artery

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3
Q

What is the benefit of the arrangement of the circle of willis?

A

If you have a blockage in one of the internal carotids e.g. atherosclerotic build up

Chance of compensatory flow from the other side

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4
Q

How does blood exit the cranial cavity?

A

Cerebral vains

Venous sinuses in the dura mater

Internal jugular vein

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5
Q

What are the layers of the brain?

A

Dura mater
(Inner meningeal layer and Outer periosteal layer)
Arachnoid mater
Pia mater

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6
Q

Is there any extradural space?

A

No space between the skull and the dura mater

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7
Q

What are the 4 types of haemorrhage?

A

Extradural
Subdural
Subarachnoid
Intracerebral

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8
Q

What are main features of extradural haemorrhage?

A

trauma, immediate clinical effects (arterial, high pressure)
Can strip dura away from the skull
Raised ICP
Some pts might have a lucid interval

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9
Q

What does a fracture to the pterion result in?

A

Main artery supplying the dura (middle meningeal artery) is behind the pterion
Rupture of this artery causes a extradural haemorrhage

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10
Q

What are main features of subdural haemorrhage?

A

trauma, can be delayed clinical effects (venous, lower pressure)
which is why patients are often kept overnight after a head injury

high impact injuries

Cresenteric collection on CT

If large enough can cause midline shift or herniation

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11
Q

What are main features of subarachnoid haemorrhage?

A 
Ruptured aneurysms (congenital) 
Weaknesses in the blood vessel walls that burst and cause subarachnoid bleeds
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12
Q

What are main features of subarachnoid haemorrhage?

A

Spontaneous hypertensive

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13
Q

What is a CVA?

A

Cerebrovascualr accident (stroke)

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14
Q

What is the definition of a CVA?

A

rapidly developing focal disturbance of brain function of presumed vascular origin and of >24 hours duration

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15
Q

What are the two types of stroke?

A

Thrombo-embolic (85%)

  • Ischaemic, blockage stops blood flow
  • AF is common cause of emboli formation

Haemorrhagic (15%)

  • Vessel bursts
  • Intracerebral or Subarachnoid
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16
Q

What is a TIA?

A

Transient ischaemic attack

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17
Q

What is the definition of a TIA?

A

rapidly developing focal disturbance of brain function of presumed vascular origin that resolves completely within 24 hours

can last seconds/minutes

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18
Q

What is an infarct?

A

Degenerative changes which occur in tissue following occlusion of an artery

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19
Q

What is cerebral ischaemia?

A

Lack of sufficient blood supply to nervous tissue resulting in permanent damage if blood flow is not restored quickly

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20
Q

What does thrombosis mean?

A

formation of a blood clot (thrombus) causing a blockage

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21
Q

What does embolism mean?

A

plugging of small vessel by material carried from larger vessel e.g. thrombi from the heart or atherosclerotic debris from the internal carotid

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22
Q

What are the risk factors for stroke?

A 
Age
Hypertension
Cardiac disease
Smoking
Diabetes mellitus

Haemorrhagic

  • Anti-coag
  • AV malformation
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23
Q

What are the three main cerebral arteries?

A

Anterior
Middle
Posterior

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24
Q

Which cerebral has the biggest perfusion field?

Study These Flashcards
A

Middle cerebral artery

It also supplies many of the subcortical, deep structures of the brain

25
What does the anterior cerebral artery supply?
Midline structures | Perfuses all the way back to the parietal-occipital fissure
26
What does the posterior cerebral artery supply?
Inferior part of the temporal lobe | Occipital lobe
27
What are the anterior cerebral artery symptoms?
Paralysis of contralateral structures (leg > arm, face) Disturbance of intellect, executive function and judgement (abulia) Loss of appropriate social behaviour
28
What are the middle cerebral artery symptoms?
Classic stroke” Contralateral hemiplegia: arm > leg Contralateral hemisensory deficits Hemianopia (loss of one side of the visual field) Aphasia (L sided lesion)
29
What are the posterior cerebral artery symptoms?
Visual deficits homonymous hemianopia visual agnosia
30
How would atherosclerosis look on a specimen?
yellow discolouration in the walls of the vessels is a build-up of atheroma, fatty deposits that cause atherosclerosis or “hardening of the arteries"
31
How does fresh blood present on a CT scan?
White lesions
32
How does blood that has become a haematoma present (after time has passed)?
Black lesions
33
What are some RFs for subdural haematoma?
Old age | Alcoholism
34
What are symptoms of raised ICP?
``` Throbbing Headache worse when coughing, sneezing and in the morning Blurred vision (Papillodema) Feeling less alert than usual Vomiting Changes in behaviour Weakness Fatigue Irritability ```
35
What is the treatment for a subdural haematoma < 10mm in size, non-expansile without significant dysfunction?
``` Observation + follow up imaging Prophylactic anti-epileptics for 7 days e.g. phenytoin Correct coagulopathy Raise head of bed ```
36
What is the treatment for a subdural haematoma < 10mm in size or expansile or with significant dysfunction?
``` Surgery first line - Burr-hole craniotomy - Trauma craniotomy - Hemicraniotomy In addition to above ```
37
What investigations are done for a head injury?
Head CT within 1 hour if any of the following present: ``` GCS < 13 initially GCS < 15 at 2 hrs after injury Suspected skull fracture Post-trauma seizure Focal neurological deficit <1 episodes of vomiting ``` CT within 8 hours if no but on anti-coag OR loss of consciousness/amnesia + RFs - >65 yrs - history of bleeding disorder - trauma - > 30 mins retrograde amnesia of events preceding injury
38
What can cause raised ICP?
``` Severe head injury Stroke Brain abscess Meningtis/Encephalitis Hydrocephalus AV malformation/fistula Venous sinus thrombosis ```
39
What is idiopathic IH?
Intracranial hypertension in women in their 20s/30s ``` Associated with: Overweight Endocrine problems Abs, steroids, COCP Anaemia or polycythaemia CKD Lupus ```
40
What investigations are done for raised ICP?
CT or MRI | Lumbar puncture
41
What is the medical treatment of idiopathic IH?
``` Weight loss Stop medications Diuretics Steroids for headaches and reduce risk of vision loss Regular LPs ```
42
What is the surgical treatment of idiopathic IH?
Shunt | Optic nerve sheath fenestration
43
When do you monitor ICP?
Pts with head injury: +GCS 3-8 and abnormal CT scan OR Normal CT but 2 of the following 40+ yrs Motor posturing SBP <90mmHg
44
What is the gold standard for monitoring ICP?
Intraventricular fluid filled catheter transducer systems
45
What is the treatment for raised ICP?
CSF drainage Head of bed elevation Analgesia Diuretics
46
What are causes of spontaneous SAH?
Intracranial aneurysm Arteriovenous malformation Pituitary apoplexy Arterial dissection
47
What are some conditions associated with berry aneurysms?
adult polycystic kidney disease, Ehlers-Danlos syndrome and coarctation of the aorta
48
What are the classic presenting features of a SAH?
Headache: sudden-onset (‘thunderclap’ or ‘baseball bat’), severe and occipital N+V Meningism Coma Seizures Sudden death ECG changes including ST elevation may be seen
49
How do you diagnose SAH?
CT head - bright | LP - min 12 hours post symptoms onset, xanthochromia seen
50
What is the management of SAH?
Neurosurgery referral ASAP after confirmation Treatment depends on cause Intracranial aneurysms - Coil, some require craniotomy + clipping Hydrocephalus - External ventricular drain
51
What symptoms are more likely in haemorrhagic strokes?
Decreased level of consciousness Headache N+V Seizures
52
What is the FAST campaign?
Face - 'Has their face fallen on one side? Can they smile?' Arms - 'Can they raise both arms and keep them there?' Speech - 'Is their speech slurred?' Ttime - 'Time to call 999 if you see any single one of these signs.'
53
What investigations are done for suspected stroke?
CT MRI Urgently
54
How do you manage ischaemic strokes?
Thrombolysis if - pt presents within 4.5 hours of symptom onset - pt has not had prev intracranial haemorrhage or uncontrolled hypertension Exclude haemorrhagic ASAP and start 300mg asprin
55
What is treatment for a TIA?
Immediate antithrombotic therapy - Clopidogrel for secondary prevention OR Asprin 75mg If pt has had TIA in the past 7 days or more than one: arrange to be seen by stroke specialist urgently Statin e.g. Atorvastatin Consider anti-coag for AF e.g. LMWH Carotid doppler
56
What is the management of haemorrhagic strokes?
``` Most pts not suitable for surgery Supportive Stop anti-coagulants Lower BP Early mobilisation ```
57
How do you assess storke?
ROSIER score >0 means stroke is likely -1: Syncope and Seizure +1: Asymmetric facial weakness, arm weakness, leg weakness, speech disturbance or visual field defect
58
What are possible features of TIAs?
``` unilateral weakness or sensory loss. aphasia or dysarthria ataxia, vertigo, or loss of balance visual problems sudden transient loss of vision in one eye (amaurosis fugax) diplopia homonymous hemianopia ```

Year 3 Neuro (17 decks)

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