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47 Cards in this Set

  • Front
  • Back
Frontal Lobe functions
Primary motor area “motor strip”
Personality (affective response to situation)
Moral, ethical, and social values
Abstract thought
Long-term memory
Broca’s speech center on dominant side
Volunteer eye movement
Parietal Lobe functions
Sensation, texture, size, shape, and spatial relationships
Three-dimensional (spatial) perception
Singing, playing musical instruments, and processing nonverbal visual experiences.
Perception of body parts and body position awareness
Taste impulses for interpretation.
Temporal Lobe functions
Time
Auditory center for sound interpretation
Complicated memory patterns
Wernicke’s area for speech
Occipital Lobe functions
Vision
Visual recognition of objects
Reading comprehension
Limbic System functions
Self preservation (survival)
Primitive behavior
Moods
Visceral processes associated with emotions
Learning and memory
Cerebral circulation includes
internal carotid arteries (anterior circulation) and vertebral arteries (posterior circulation)
Carotid arteries supply blood to
frontal, parietal, and temporal lobes, the basal ganglia and part of the diencephalon (thalamus & hypothalamus)
Vertebral arteries join to form _____ _________ and supply blood to
Basilar Artery

Supply middle & lower part of temporal lobes, occipital lobes, cerebellum, brainstem & part of the dienchephalon
Anterior and posterior cerebral circulation connect at the ______ ___ _______
circle of Willis
The Middle Cerebral Artery leads bloodflow to about ___ % of the brain
80
Circle of Willis connects the
forebrain and hindbrain
Cerebral bloodflow is ____ - _____ ml/min or ____ % of cardiac output
750-1,000ml/min

20%
When cerebral bloodflow stops, these things occur:
In 30 seconds ..
2 min ..
5 min ..
neurologic metabolism alteration
neurological metabolism cessation
cell death
Cerebral autoregulation maintins systolic BP between
50 - 150 mm Hg
Cerebral autoregulation is impaired with
Cerebral ischemia
Carbon Dioxide is a potent
vasodilator
Right brain functions
Receives messages from left side of the body
Visual and spatial awareness
Musical ability
Ability to recognize others/parts of body
Negative emotions
Left brain functions
Receives message from right side of body
Logic
Analytical thought, problem solving
Mathematical ability
Positive emotions
Risk factors for stroke
Smoking, Hypertension, Obesity, Alcohol, Sedentary lifestyle, DM, High Cholesterol,
Hypertension, Heart Disease / Atrial Fibrillation / MI / Valve Disease / Cardiomyopathy,
Diabetes Mellitus, Hyperlipidemia, Smoking
Obesity / Physical Inactivity
Oral Contraceptive use
Additional Risk Factors
Carotid artery stenosis
Transient ischemic attack
Transient monocular blindness
Migraine, Hx of stroke, Hypercoagulability / Sickle Cell Disease, Alcohol and Drug use
AFib is the largest cause of
embolic stroke
Cerebral perfusion must fall to ____ of normal before brain does not receive adequate blood flow
2/3
Factors that affect blood flow to brain
systemic blood pressure
cardiac output
blood viscosity
intracranial pressures
collateral circulation
Atherosclerosis
Facts about Atherosclerosis
major cause of stroke
can lead to thrombus or emboli
starts as infiltration of lipids into the intimal layer of a vessel (fatty streak) which then develops further into a plaque
plaque cause increased turbulence of blood flow
plaque can rupture or crack, platelet & fibrin stick to roughened area (thrombus) & move to become (emboli)
Describe the ischemic cascade
Series of metabolic events that occur in response to ischemia
inadequate adenosine triphosphate (ATP) production
loss of ion homeostasis
release of excitatory amino acids (glutamate)
free radical formation
cell death
Area around the ischemic / infarcted core tissue is potentially reversible if flow restored (< 3 hrs)
Describe a transient ischemic attack
Brief, reversible episodes of neurologic dysfunction usually caused by temporary, focal cerebral ischemia
Temporary focal loss of neurologic function caused by ischemia of one of the vascular territories of the brain
May be due to microemboli that occlude vessel
Warning sign of progressive cerebrovascular disease
Neurologic deficits present with no residual effects.
Most TIA resolve within
3 hours
clinical manifestations of carotid TIA
temporary loss of vision in one eye (amaurosis fugax),
transient hemiparesis -numbness or loss of sensation or sudden inability to speak
clinical menifestation of vertebralbasilar TIA
tinnitus, vertigo, darkened or blurred vision, diplopia, ptosis,
dysarthria, dysphagia, ataxia, and unilateral or bilateral numbness or weakness
most important diagnostic test for TIA
CT of brain without contrast
Medications to prevent platelet aggregation
aspirin
ticlopidine (Ticlid)
clopidogrel (Plavix)
dipyridamole (Persantine)
warfarin
Define Ischemic stroke
Inadequate blood flow to the brain from partial or complete occlusion of artery
Ischemic strokes account for about ___ % of all strokes
85%
Define Penumbra
Tissue around infracted area of CVA
Area of decreased blood flow
Salvageable tissue
Penumbra can be salvaged by maintaining
Oxygen > or = to 92% saturation
Blood pressure > 185/105
Glucose of 140 mg/dL
Types of ischemic stroke
thrombotic
embolic
Describe Thrombotic stroke
The formation of a blood clot or coagulation that results in the narrowing of the lumen of a blood vessel with eventual occlusion.
Most common cause of cerebral infarction.
Associated with hypertension or diabetes
partial stroke with permanent neurologic deficits
Tend to develop during sleep or within one hour of arising
Thrombotic strokes are strongly associated with this chronic illness
HTN
Describe Embolic Stroke
Occlusion of a cerebral artery by an embolus, resulting in necrosis & edema of the area supplied by the involved blood vessel.
2nd most common cause of stroke.
Location of clot formation is usually the heart
Rapid onset of severe symptoms
No discernible time pattern, unrelated to activity
Manifestations occur rapidly,-----within 10 - 30 seconds
Usually remains conscious, has headache
Often with NO warning
May have rapid improvement
Usually normotensive
Most common disorder causing stroke
AFib
Describe Hemmorhagic Stroke
generally result from spontaneous bleeding into the brain tissue -
Either intracerebral or intraparenchymal hemorrhage
OR into the subarachnoid space or the ventricles (subarachnoid hemorrhage)
Hemmorhagic strokes are commonly caused by
HTN

Other causes of intracerebral hemorrhage include:
brain tumor,
trauma,
thrombolytic drugs,
ruptured aneurysms,
anticoags and thrombotics
Describe intracerebral hemmorhage
Bleeding within the brain caused by the rupture of a vessel
Hypertension is most important cause of ICH
Sudden onset of symptoms with progression over minutes to hours
Typically occurs during waking hours, during periods of activity
Clinical Manifestations of ICH
Severe headache with nausea and vomiting
Hypertension and decreased LOC
Rapid onset to complete hemiplegia
Putamen [which is in the forebrain & involved with movement], internal capsule, central white matter hemorrhage
weakness of one side, including the face, arm and leg, slurred speech & deviation of eyes.
Rapid progression of symptoms r/t severe hemorrhage include hemiplegia, fixed & dilated pupils, abnormal body posturing, & coma.
Describe Thalamic hemmorhage
hemiplegia with more sensory than motor loss
problems with vision and eye movement
Describe Cerebellar hemmorhage
severe headache, vomiting, inability to walk, dysphagia, dysarthria, eye movement disturbances
Describe Pons hemmorhage
most serious, life functions affected (respiration)
hemiplegia leading to complete paralysis, coma, abnormal body positioning, fixed pupils, hyperthermia and death
Describe Subarachnoid hemmorhage
Occurs when there is intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater membranes on the surface of the brain