Circulation of the brain

Question 1

Brain blood supply

Answer 1

2 vertebral arteries
2 internal carotid artieries

ensures continuous supply of nutrients
removal of waste

Question 2

internal carotid

Answer 2

in front of neck and divides to form middle and anterior cerebral arteries

Question 3

ACA

Answer 3

2 anterior cerebral arteries join via the anterior communication artery forming the front section of circle of willis

Question 4

Vertebral

Answer 4

2 vertabral arteries pass uo through the formaina in transverse process of Cx vertabrae and join infront of the brainstem at the basilar artery

Question 5

Upper brain stem

Answer 5

basilar artery divides into 2 posterior cerebral arteries that connect to back of circle of willis by 2 small posterior communicating arteries

Question 6

Circle of willis

Answer 6

occlusion of one internal carotid artery may not result in stroke because brain is protected from bilateral carotid occlusion through basilar supply

Question 7

Middle cerebral artery

Answer 7

Most of the outer surface
Sensorimotor cortex
Basal ganglia
Internal capsule
Broca’s area (on left)

Question 8

Anterior cerebral artery

Answer 8

Frontal lobe

Medial part of sensorimotor cortex

Question 9

Posterior cerebral artery

Answer 9

Occipital lobe
Medial aspect of temporal lobe
Thalamus

Question 10

Basilar artery

Answer 10

All of the brainstem
Cerebellum
Nuclei of cranial nerves

Question 11

Disruption to blood supply

Answer 11

loss of consciousness within seconds

irreversible damage in minutes

Question 12

Autoregulation

Answer 12

mean arterial bp of 60-150mmHg

Question 13

BP

Answer 13

constriction or dilation of arterioles in brain

Question 14

increase in CO2

Answer 14

dilation of arterioles in brain

Question 15

decrease in O2

Answer 15

constriction of arterioles in brain

Question 16

Causes of Autoregulation faliure

Answer 16

CNS disease:
Trauma
Acute stroke
Tumours
Inflammation

Question 17

Stroke/CVA

Answer 17

brain attack
A stroke, also known as a cerebrovascular accident (CVA), is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a haemorrhage (leakage of blood).

Question 18

Classification

Answer 18

Haemorrhagic stroke

Ischaemia stroke

Question 19

Haemorrhagic stroke

Answer 19

bleeding from a cerebral artery

Question 20

Subarachniod haemorrhage

Answer 20

bleeding into subarachnoid space
due to rupture of congenital anerysm or traume
sudden intense headache, vomiting, neck stiffness and loss of consciousness
10% die within two hours
40% die within two weeks

Question 21

Aneurysm

Answer 21

saccular
fusiform
ruptured

treated by surgical clipping

Question 22

Intracerebral haemorhage

Answer 22

bleeding in deeper part of brain
longstanding hypertension
arterial wall weaken
micro-aneurysm develop 
rupture and bleed
sever headache and vomitting

Question 23

Ischaemic stroke

Answer 23

80% strokes due to occulsion
atherom of cerecral artery
emboli from atheromatous plaque in hear/neck vessel

Most common vessel: MCA > PCA > ACA

brainstem stroke less common but more serious

Question 24

Embolic stroke

Answer 24

completed stroke -sudden onset
transiet ischaemic attack
repeated small emboli no infraction occurs
piece of plaque can break free and clock blood supply to the brain

Question 25

artrial fibrilation

Answer 25

Atrial fibrillation is irregular heartbeat,blood clots are more likely to form in your heart, increasing stroke risk

Question 26

thrombotic stroke

Answer 26

``` completed stroke-overnight develops over several days transient ischaemic attack sudden to full recovery 20% risk of full CVA with 4 weeks ```

Question 27

Bamford classification

Answer 27

TACS – Total anterior circulation stroke PACS – Partial anterior circulation stroke POCS– Posterior circulation stroke LACS – Lacunar stroke(deep penetrating arteries) (TAC)S=stroke (TAC)I=infarct (TAC)H=haemorrhage

Question 28

Tramatic brain injury

Answer 28

injury to the brain caused by external physical force, altered state of consciousness impairment of cognitive or physical abilities disturbances of behaviour or emotional functioning temporary or permanent

Question 29

Mechanism of injury

Answer 29

Penetrating injury-risk of infection Compression - inner cerebral traume Deceleration- outer cerebral injury discrete cognitive deficit Diffuse axonal injury-- poor communication between brain structures, reduces processing speed, global impairment

Question 30

Extradural haemorrhage

Answer 30

bleeding into extradural space | cause by severe trauma

Question 31

sunadural haemorrhage

Answer 31

bleeding in subdural space usually cause by severe trauma maybe be delayed symptons ``` headache drowsiness stupor hemiparesis coma ```

Question 32

Secondary damage of TBI

Answer 32

``` raised ICP infection ischaemic changes vasospasm complication of systemic dysfunction ```

Question 33

Transient ischaemic attack TIA

Answer 33

A TIA is a sign that part of the brain is not getting enough blood, and there is a risk of a more serious stroke in future

Question 34

Hemiplegia

Answer 34

paralysis at one side of the body

Question 35

Clinical features of stroke | MOTOR

Answer 35

Alterations in tone Low tone - flaccidity High tone – spasticity ``` Ataxia Weakness Asymmetry Loss of normal movement patterns Loss of postural adjustments loss of balance Compensations ```

Question 36

Pattern of spasticity

Answer 36

``` Flexor pattern in upper limb Shoulder elevation & retraction Internal rotation & adduction Elbow flexion & pronation Wrist flexion Finger flexion ``` ``` Extensor pattern in lower limb Hip retraction Hip extension Knee extension Ankle plantarflexion & inversion ```

Question 37

Clinical features of stroke | SENSORY

Answer 37

impaired cutaneous sensation stereognosis proprioceptive impairment visual problems Visual field loss Homonymous Hemianopia

Question 38

Clinical features of stroke | SPEECH

Answer 38

Expressive dysphasia Damage to Brocas area Usually associated with Rt hemiplegia Loose ability to produce speech Receptive dysphasia Damage to Wernikes area in temporal lobe Lose ability to understand speech global aphasia

Question 39

Clinical features of stroke | COGNITIVE

Answer 39

Perceptual Problems ``` Astereognosis Visual Agnosia Auditory Agnosia Depth perception Apraxia Anosagnosia Inattention/neglect ```

Question 40

Agnosia

Answer 40

Inability to recognise objects

Question 41

Neglet

Answer 41

more common with left hemiplegia patients fails to attend to stimuli from the left side poor prognosis if persists results in many functional problems

Question 42

Clinical features of stroke

Answer 42

``` Disorders of emotion Dysphagia Delay / absent swallow reflex Incontinence Secondary musculoskeletal problems Balance / Gait problems Functional difficulties Social problems ```

Question 43

Physiotherapy treatment

Answer 43

prevent complications, minimise impairments and to maximise function ``` Assessment Identification of problems Clinical reasoning Goal setting Objective outcomes Choice of Rx method Interdisciplinary input ```

Question 44

Factors affecting recovery

Answer 44

``` Extent and nature of lesion Integrity of collateral circulation Pre-morbid status Age Capacity of Nervous System to re-organise Environment Motivation and Attitude of patient Patient participation Patient Experience Co-exisiting conditions Nutrition/Hydration Medication ```

Question 45

Medical management

Answer 45

``` Treat as medical emergency MRI/CT scan Ischaemic stroke (80%)– aspirin, anticoagulants - thrombolysis SAH – surgery or endoplastic procedures SDH/EDH/ICH – treat hypertension TIA – aspirin, prevention work Other tests – Blood tests, angiography, echocardiology Other medication – osmotic agents Surgery – carotid endarterectomy ```

Question 46

National Stroke startergy

Answer 46

Treat Stroke as a medical emergency Effective assessment and treatment of vascular risk factors TIAs assessed and scanned within 24hrs Suspected stroke transferred to specialist stroke unit with MDT treatment and assessment Range of services available locally to support long-term needs Opportunity to return to work