Meninges, CSF, Blood Flow, & Stroke Flashcards

Question

What is a Transient ischemic attack (TIA)?

Answer 1

Symptoms usually resolve within an hour (temporary)

Answer 2

-Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) -Sudden confusion, trouble speaking or understanding speech -Sudden trouble seeing in one or both eyes -Sudden trouble walking, dizziness, loss of balance or coordination e-Sudden severe headache with no known cause FAST – Face, Arm, Speech, Time

Answer 3

Less common than ischemic Reported to be 10-15% of all strokes (some research reports as high as 45%)

Answer 4

▪ bleeding into brain parenchyma ▪ primary destruction of neurons from hemorrhage ▪ secondary destruction from potential rise in intracranial pressure ▪ hematoma expands creating pressure

Answer 5

▪ small vessel bleeding from hypertension ▪ anticoagulation therapy ▪ cocaine use

Answer 6

More common

Answer 7

Decrease in blood flow

Answer 8

▪ thrombus/emboli occlusion ➢ extracranial embolism ➢ intracranial thrombus

Answer 9

▪ thrombolytic intervention ASAP ▪ Initial research: < 3-4.5 hour “window of time” to administer thrombolytic

Answer 10

-Family history of stroke, heart attack or TIA -age > 55 -hypertension > 140/90 - elevated cholesterol/hyperlipdemia ▪ total > 200 - cigarette smoking - diabetes-g obesity - BMI > 3 - co-existing cardiovascular disease, heart failure, - heart defect, heart infection, or abnormal heart rhythm - previous stroke or TIA - high levels of homocysteine - use of birth control pills or other hormone therapy - heavy or binge drinking - use of illicit drugs such as cocaine

Answer 11

Transient loss of blood flow “neurological deficits resolve within 24 hours” ▪ neurological symptoms usually last < 1 hour Numerous causes...atherosclerosis, emboli, arterial dissection, arteritis, cocaine and other drug use, etc... TIA = increased risk of stroke

Answer 12

Circle of Willis

Answer 13

internal carotid artery (ICA) vertebral arteries/basilar artery

Answer 14

Origin of major blood vessels of the brain ▪ anterior, middle, & posterior cerebral arteries Anastomosis pathways Small perforating arteries ▪ a group of that contribute to blood supply to: ➢ subcortical regions of brain ▪ diencephalon (thalamus, hypothalamus, subthalamus) ➢ internal capsule ▪ pathway of myelinated axons leaving and entering the cerebral cortex ▪ located between thalamus and basal ganglia ▪ limbic structures (amygdala, hippocampus, etc...) ▪ pons

Answer 15

Anterior cerebral artery (ACA) Middle (MCA) Posterior (PCA)

Answer 16

Supplies: ▪ medial (sagittal) regions of each hemisphere ➢ motor and sensory areas of lower body (see homunculus diagram) ➢ prefrontal lobe ➢ small perforating arteries supply: ▪ portions of sub-cortical structures (internal capsule and basal ganglia)

Answer 17

medial parts of the frontal lobe and paracentral lobule, which are involved in motor, sensory, and behavioral functions.

Answer 18

Contralateral leg weakness: The ACA supplies the motor cortex responsible for movement in the lower limbs, so occlusion can cause weakness or paralysis, particularly in the leg (contralateral to the lesion). Mild arm weakness: The motor area for the arms may also be affected, but usually less severely than the legs. Gait disturbance: The combination of leg weakness and potential sensory deficits may affect walking ability.

Answer 19

Contralateral sensory loss: Sensory areas in the postcentral gyrus (somatosensory cortex) corresponding to the lower limbs may be affected, leading to numbness or impaired sensation, particularly in the leg. Proprioception problems: There may be difficulty with spatial awareness or balance due to sensory loss in the leg

Answer 20

Apathy or lack of motivation: The prefrontal lobe is involved in executive functions, decision-making, and motivation. Damage can result in a lack of initiative or interest in activities. Impaired judgment and reasoning: Difficulty in planning, organizing tasks, and making sound decisions. Changes in personality: The occlusion of the ACA can cause personality shifts, with some individuals becoming more impulsive or socially inappropriate. Disinhibition: The loss of control over social behavior may occur, leading to impulsivity or socially inappropriate actions.

Answer 21

Supplies: ▪ lateral aspect of each hemisphere (frontal, parietal and temporal lobes) ▪ motor and sensory areas of trunk and upper extremities ▪ association areas ▪ prefrontal lobe ▪ portion of optic tract

Answer 22

➢ MCA infarcts will vary depending on location ➢ dominant and non-dominant hemisphere loss with MCA infarction

Answer 23

(usually the left hemisphere for most people) typically controls language and certain cognitive functions Symptoms: -aphasia -apraxia -CL sensory loss (arm, face) -CL hemiparesis (arm, face)

Answer 24

(usually the right hemisphere) controls aspects like spatial awareness, attention, and emotional processing Symptoms: -CL neglect (L-sided) -hemianopia -visuospatial deficits -denial of illness (anosognosia) -emotional blunting/disinhibition

Answer 25

Contralateral hemiparesis or hemiplegia: Weakness or paralysis of the contralateral side of the body, typically affecting the face, arm, and hand more than the leg, due to the area of the primary motor cortex that the MCA supplies. Contralateral apraxia: Difficulty performing purposeful movements, especially in the arm and hand, despite normal strength. Facial weakness: Often, the face will be more affected than the lower limbs due to the way the motor cortex is organized in the MCA territory

Answer 26

Contralateral sensory loss: Sensory impairment, especially affecting the face, arm, and hand (again, more than the lower limbs) because the MCA supplies the sensory cortex areas corresponding to these body parts. Impaired proprioception: Difficulty in knowing where limbs are in space, particularly in the arm and face. Contralateral visual field deficits: Often a homonymous hemianopia (loss of vision in the same half of the visual field in both eyes), which occurs due to the MCA's involvement in the occipital lobe’s visual processing areas

Answer 27

Contralateral neglect (more common in non-dominant hemisphere infarcts): Patients may fail to attend to or recognize stimuli on the opposite side of the body (e.g., ignoring one side of the body or visual field). Apathy, depression, or impulsivity: Emotional regulation might be disrupted due to the damage to the frontal lobe, which is involved in decision-making and emotional responses. Disinhibition or poor judgment: The frontal lobe's role in self-control and executive functions may be impaired, leading to impulsive behaviors or poor decision-making.

Answer 28

Supplies: ▪ occipital lobe ▪ inferior regions of temporal lobe

Answer 29

▪ small branches of PCA supply some of thalamus and midbrain ➢ potential for sensory or motor symptoms in addition to visual changes

Answer 30

▪ numerous small branches that originate from the circle of Willis and the ACA, MCA, PCA and basilar arteries)

Answer 31

▪ subcortical regions ➢ diencephalon (thalamus, hypothalamus, subthalamus) ▪ internal capsule ➢ pathway of myelinated axons leaving and entering the cerebral cortex ➢ located between thalamus and basal ganglia

Answer 32

▪ most common area: lenticulostriate arteries (branches of MCA)/perforating arteries ▪ supply the internal capsule and thalamus Lacunar strokes are categorized common patterns

Answer 33

➢ micro-deposits of connective tissue or fatty tissue blocks artery ➢ obstruction results in small necrotic tissue ▪ necrotic tissue is removed by macrophages: leaves “hole” (period of few months) ➢ small penetrating arteries are not usually directly affected by atherosclerosis

Answer 34

hypertension, smoking and diabetes

Answer 35

▪ contralateral hemiparesis/hemiplegia * face/arms/hands/legs

Answer 36

▪ contralateral hemiparaesthesia along face/arm/leg/trunk ▪ usually affects limbs more than face/trunk

Answer 37

▪ contralateral hemiparesis and hemiparaesthesia ▪ face/arm/trunk/leg

Answer 38

▪ combination of cerebellar/motor symptoms ▪ site of lesion involves cerebellar tracts as well as motor pathways ▪ “homolateral ataxia and crural paresis”

Answer 39

Vertebral arteries Basilar artery

Answer 40

Estimated that 10% of population have one underdeveloped VA Branches of vertebral artery - Anterior spinal artery - PICA (posterior inferior cerebellar artery)

Answer 41

▪ branches directly off of vertebral artery ▪ descends to supply anterior regions of spinal cord

Answer 42

▪ Supplies: ➢ lateral medulla and cerebellum ▪ occlusion: PICA syndrome – see notes below ▪ PICA depends solely on VA for blood supply ➢ therefore VA occlusion may “create” PICA syndrome

Answer 43

▪ R/L vertebral arteries merge to form basilar artery ➢ ascends anterior to brainstem ▪ divides into R/L posterior cerebral arteries to form part of Circle of Willis

Answer 44

▪ R/L Posterior cerebral arteries ▪ Long circumflex branches ▪ Superior cerebellar artery ▪ Anterior inferior cerebellar artery ▪ Pontine branches

Answer 45

➢ supplies superior cerebellum and portions of midbrain ➢ infarction: Perinaud Syndrome (Dorsal Midbrain Syndrome)

Answer 46

➢ supplies anterior/inferior quarter of cerebellum ➢ infarction: AICA or lateral pontine syndrome

Answer 47

➢ small vessels that emerge from basilar artery to supply pons ➢ motor tracts – corticospinal tract

Answer 48

acute complete occlusion associated with poor prognosis

Answer 49

▪ infract in the base of pons poor prognosis

Answer 50

▪ lower paramedian branches of basilar artery

Answer 51

▪ reticular system spared ➢ the patient remains “awake” but unable to function ▪ Quadriplegia ▪ Sensory

Answer 52

➢ unable to move except: ▪ blinking & move eyes vertically ▪ communication accomplished only with eye movement ➢ all motor tracts and lower CN impaired

Answer 53

➢ “can’t move but can feel pain” ▪ Spinothalmic tract intact – so pain/temp not affected ➢ bilateral loss of discriminatory touch, vibration and proprioception ▪ due to loss of medial lemniscus pathway in medulla

Answer 54

Blood vessel: ▪ superior cerebellar arteries, small arteries of PCA/basilar artery ➢ NOTE: usually non-vascular cause – pineal or midbrain tumor compression Lesion damages: ▪ superior colliculus, pre-tectal area and cerebral aqueduct

Answer 55

PICA originates directly from VA Supplies: lateral medulla and cerebellum “PICA syndrome” result of: ▪ PICA occlusion ▪ vertebral artery occlusion

Answer 56

▪ Cerebellar tract signs*: ➢ hypotonia, disequilibrium, dyssynergia ▪ Descending sympathetic tracts* ▪ Horner’s syndrome (ipsilateral)* ➢ Ptosis: drooping of eyelid (superior tarsal muscles innervated by sympathetics) ➢ Anhidrosis: decreased sweating on face ➢ Miosis: constriction of pupil ➢ Enophthalmos: appearance of eye “sunken in” ➢ Loss of ciliospinal reflex: pupil dilation in response to pain stimulus

Answer 57

Anterior spinal artery Right/Left Posterior spinal arteries

Answer 58

- supplies ventral 2/3 of spinal cord - originate from R/L vertebral arteries - various segmental branches supply anterior spinal artery at each level of spinal cord - descends along anterior midline of spinal cord

Answer 59

- originate from R/L PICA - various segmental branches supply anterior spinal artery at each level of spinal cord - R/L descend along R/L posterior region of spinal cord

Answer 60

Poor prognosis for recovery Complete loss of function below level of injury

Answer 61

Anterior cord syndrome Posterior cord syndrome

Answer 62

➢ anterior spinal artery occlusion/infarction * fig 9-6; 10-5,10-6, 10-7 Greenberg ➢ more common (than posterior stroke) ▪ but uncommon in cervical region * i.e., most infarcts in thoracic or lumbar regions

Answer 63

➢ less common ▪ due to * paired posterior spinal arteries * multiple feeder vessels

Meninges, CSF, Blood Flow, & Stroke Flashcards

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