539 Final Exam

• What is the name of the holes that blood vessels and nerves enter the brain through ?

  foramina
• What is the order OXYGENATAED blood flows INTO the brain?

  Heart

  Aorta

  Arteriole

  Capillaries
• What is the order veins go into the Heart ?

  Capillaries

  Venules

  Vein

  Vena Cava

  Heart
• Right and Left External Carotid arteries go to the ...

  face
• right and left internal carotid arteries go to the...

  brain
• What is the Circle of Willis ?

  a structure formed at the base of the brain that is a protective mechanism that ensures blood can keep circulating
• What is the role of the Blood Brain Barrier ?

  prevents foreign substances from entering

  every artery is protected by BBB

  protects brain from hormones and neurotransmitters in the rest of the body
• What are some stroke symptoms ?

  sudden numbness or weakness of face, arm, or leg (especially unilateral)

  sudden confusion of speech

  sudden visual problems

  sudden loss of balance or coordination

  sudden severe headache

  sudden nausea, fever, and vomiting

  brief loss of consciousness or period of decreased conciousness
• What is a TIA ?

  "mini stroke"

  acute disruption of blood flow to the brain leading to focal neurologic deficits lasting less than 24 hours

  confined to an area of the brain or eye perfused by a specific artery

  Most TIA's last seconds to 10 minutes

  24 hour rule leads to complacency and delay
• Can TIA's be seen on CT and MRI ?

  evidence of TIA is found in 20% of CT imaging and almost 50% with MRI
• Why is it difficult to diagnose a stroke ?

  hard to distinguish between bleeds and infarctions

  hard to distinguish between embolism and thrombosis

  often difficult to determine if a TIA is merely reversible ischemia or a completed stroke with a rapid recovery
• What are the two major classifications of strokes ?

  Ischemic and Hemorrhagic
• What are the 3 types of ischemic strokes ?

  Thrombotic (60%)

  Embolic (20%)

  Lacunar (10-15%)
• What is a thrombotic stroke ?

  a blood clot forms within a blood vessel in the brain

  usually affects older population

  rapid event, but slow progression of injury
• What is an embolic stroke ?

  embolus becomes lodged in vessel and causes occlusion

  bifurcations are most common site

  sudden onset with immediate deficits
• What is a lacunar stroke ?

  small subcortical lesions resulting in paralysis and sensory loss

  caused by occlusion of small penetrating arteries

  commonly affected sites: putamen,thalamus, caudate, pons, internal capsule
• What is a hemorrhagic stroke ?

  a rupture of a blood vessel causing leakage of blood
• What are the two types of hemorrhagic strokes ?

  1. Intracerebral
  2. Extracerebral
• What is an intracerebral hemorrhage ?

  • hypertension, AVM, Berry Aneurysm
  • occurs when a blood vessel bleeds into the tissue deep within the brain
  • spontaneous or from head trauma
• What is an extracerebral hemorrhage ?

  • subarachnoid hemorrhage, epidural hemorrhage
  • blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and skull
  • spontaneous (ruptured aneurysm) or from head trauma
  • high mortality rate
• What is an aneurysm ?

  • occurs when part of a blood vessel (artery) swells
  • either the blood vessel is damaged or there is a weakness in the wall of the blood vessel
  • as blood pressure builds up it balloons out as its weakest point
  • as the aneurysm grows there is a greater risk of rupture
• What are surgical interventions for strokes ?

  clipping or coiling
• What is arteriovenous malformations (AVM's)

  tangled mess of arteries and veins

  leads to seizures and/or ICH

  believed to arise during embryonic or fetal development soon after birth
• What are the two areas the brain is divided into when describing symptoms of strokes ?

  1. anterior circulation
  2. posterior circulation
• What is the anterior circulation ?

  part of the brain that receives its blood supply from the carotid circulation, which includes the territory of the middle cerebral artery and the anterior cerebral artery
• What is the posterior circulation ?

  region of the brain which receives its blood supply from the vertebral, basilar and posterior cerebral arteries
• What is a Posterior Cerebral Artery Infarct ?

  • deep or proximal PCA strokes cause ischemia in the thalamus and/or midbrain as well in cortex
  • Clinical symptoms include
  • loss of half of vision field on side opposite to the stroke
  • ischemic injury to thalamus may result in unpleasant, burning pain on opposite side of body (thalamic syndrome)
• What is a Basilar Artery Occlusion ?

  sudden death/loss of consciousness (90% mortality)

  • top of basilar artery
  • visual and oculomotor deficits
  • somnolence, hallucinations, and dreamlike behavior
  • Proximal and mid portions of basilar artery (pons) can result in patients being "locked in"
  • complete loss of movement
  • preserved consciousness
  • preserved ocular movements
• What are the two posterior circulation types ?

  1. Posterior Cerebral Artery
  2. Basilar Artery Occlusion
• What is an Anterior Cerebral Artery Infarct ?

  • if M1 damage, weakness of leg
  • if medial frontal lobe and cingulate gyrus damaged there will be initiation deficit
  • Akinetic mutism: patient does not move or speak - patients not paralyzed but lack the will to move
• What is a middle cerebral artery infarct ?

  • contralateral hemiparesis
  • contralateral upper motor neuron facial weakness
  • contralateral sensory loss
  • contralateral ataxia (lack of voluntary coordination of muscles)
  • higher function cortical impairments
• what is the definition of Aphasia ?

  • a disruption of core language functions as a result of injury to the brain
  • a disturbance of language with a breakdown in grammar and syntax often associated with anomia and paraphasias
• what is paraphasia ?

  speech error
• what is neologistic paraphasia ?

  substituting a word for a non-word
• what is semantic paraphasia ?

  substituting a word for another word with similar meaning
• what is phonemic paraphasia ?

  substituting a sound in word for another sound
• what is dysarthria ?

  poor articulation
• what is hyphonia ?

  soft output
• What 3 components did the original model of wernicke and geschwind include ?

  1. broca's area
  2. articulate fasciculus
  3. wernicke's area
• What are the 7 types of Aphasia ?

  1. Broca's
  2. Global
  3. Transcortical Motor
  4. Wernicke's
  5. Conduction
  6. Anomic
  7. Transcortical Sensory