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47 Cards in this Set
- Front
- Back
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Where is blood direct after passing the CNS capillary beds? |
Directed our of the CNS through veins |
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Where does the cerebral venous system empty? |
Through one major pair of vessels - Internal Jugular Veins |
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What do the cerebral and spinal veins lack and what is this significance? |
They lack valves which means the flow through veins can be altered by pathologic processes |
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What are dural sinuses? |
Venous structures formed at the edges of the dural septa that also receive CSF drainage |
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What the the p rimary sinuses? |
Superior sagittal sinus and Transverse sinus Located at egde of falx cerebri and tentorium cerebelli |
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Where do all of the sinuses meet? |
Confluence of the sinuses |
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What is the straig sinus? |
Formed at the jct of the falx cerebri and Tentorium cerebelli |
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Where does the straight sinus start? |
Jct of inferior sagirral sinus on the inferior margin of the falx cerebri and great cerebral vein |
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Where does the straight sinus receive blood drom? |
Deep Brain structures |
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What does the dura surround? |
Sella turcica and pituitary and forms a ring of dural sinuses |
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Describe the cavernous sinuses? |
Enclose the carotid arteries and parts of cranial nerves 3,4,5, and 6 |
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What connects the cavernous sinuses? |
Anterior and Posterior intercavernous |
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Why is the cavernous sinus subject to adjacent infections? |
Due to its location near the nasal sinus can produce deficits in the cranial nerves within the sinus, affect the pituitary gland or adjacent structures |
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Describe the transverse sinus |
Drains in to the sigmoid sinus that is continuous with the internal jugular vein traveling through the jugular foramen |
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What is a stroke? |
CVA Sudden focal neurological syndrome resulting from cerebrovascular disease |
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What are the characteristics of a CVA |
Sudden onset of neurological deficits with subsequent recovery of brain function occuring gradually and to a varying degree |
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What must happen for a CVA to be classified as a stroke? |
The event must be accompanied by neurological deficits which last longer than 24hr |
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What processes canaffecct the cerebral vasculature? |
Occlusion of the vessel lumen Rupture of vessel Altered permeadbility of vessel wall Changes in the viscosity or quality of blood that affect blood flow |
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Non modifiable risk factors for stroke? |
Age Ethnicity Gender Family History Genetics |
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Modifiable risk factors for stroke? |
Arterial Hypertension TIAs Prior Stroke Cardiac Dz DM Smoking EtOH Oral Contraceptive Obesity |
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Describe an Occlusive stroke |
Due to closure of a blood vessel -Embolism, Thrombosis Most common |
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Describe Hemorrhagic Stroke |
Due to bleeding from a vessel -Hypertension, aneurysm, AV malformation May be extraparenchymal or intraparenchymal |
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Stoke Syndromes: Anterior Circulation |
More Common Anterior cerebral artery Middle cerebral artery |
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Stroke Syndromes: Posterior Circulation |
Posterior Cerebral artery Branches to thalamus Basilar artery Cerebellar arteries |
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What does the Anterior Cerebral Artery supply? |
Medial aspect of the frontal and parietal lobes -Branches extend over the border of the hemisphere onto the lateral surface |
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Deficits due to Anterior Cerebral Artery? |
Paracental lobule - movement and sensation of lower limb Frontal Lobe - Executive functions (decision making and planning) Urinary control Medial Limbic Area - Motivation attention, physical self mage Corpus Callosum |
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Clinical Picture of Anterior Cerebral Artery Stroke? |
Sensorimotor Leg deficits more than arm Paralysis of the opposite foot and lef - UMN Sensory deficits over toes, foot, and leg Transcortical motor aphasia if in dominant hemisphere |
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Describe the middle cerebral artery |
Usuall the larger of the terminal branches Moves laterally through the sylvian cistern, giving off branches to the basal ganglia and branches to the lateral and rostal aspectsof the temporal loes |
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What does the middle cerebral artery supply? |
Primary sensory and motor areas forface and arm Left side - speech area Optic radiation Parietal association cortex Frontal eye field |
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Clinical presentation of MCA stroke |
Paralysis of opposite face and arm Sensory deficits over opposite face and arm Wernikes area aphasia if on the left side Right Parietal: inattention and contralateral neglect Meyers loop - visual field defects Frontal eye fields - transient paralysis of conjugate gaze to the contralateral side |
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What else does the MCA supply? |
Basal Ganglia and internal capsule. Occlusion can interrupt axons ascending and descending without direct damage to cortex |
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Describe the posterior circulation |
Vertebral, basilar, and posterior cerebral arteries Supply the brainstem, cerebellum and posterior inferior aspcts of the cerebuum |
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Where does the posterior cerebral artery run? |
On the temporal lobes and runs posteriorly to include the ventral and medial surfaces of the temporal and occipital lobes |
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What is supplied by the PCA |
Primary visual cortex Parts of the thalamus Visual cortex- medial occipital Temporal lobe, caudal parietal lobe and corpus callosum |
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Clinical Presentation of occlusion to the Visual cortex- medial occipital Temporal lobe, caudal parietal lobe and corpus callosum |
Homonymous Hemianopia Pure Alexia - inability to read |
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Clinical Presentation to occlusion to the thalamus |
Sensory deficits with deep territory involvement. Thalamic pain syndrome |
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What supplies the brainstem? |
Branches of the vertebral, basilar and PCA Short Branches - anterior and medial Long circumfrential branches - dorsolateral structures |
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What occurs with occlusion of short branches? |
Tends to disrupt major tracts located in the anterior aspect of the brain stem -Motor pathways -Medial Lemniscus (DCML) |
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Result of short branch occlusion |
Contralateral hemiparesis and also contralateral decreased vibration, dis. touch, proprioception |
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Occlusion of the long circumferential branches |
Disrupt more dorsal located structures and tracts including... Spinocerebellar pathways Anterolateral system Spinal trigeminal nucleus Descending sympathetic fibers` |
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Result of long cercumferential branch occlusion? |
Cerebellar associated ipsilateral ataxia Horner Syndrome Decreased pain and temp from face Contralateral loss of pain and temp from body |
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Describe cranial nerve innvolvement inn relation to the brainstem |
CN 3,4 - midbrain CN 5, 6, 7 - Pons CN 9, 10, 12 - Medulla |
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Majot risk factors for Lacunar strokes |
Hypertension, diabetes, and atherosclerotic dz |
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What is MID |
Multi Infarct Dementia Can be brought on by an acculumation of small deficits due to lacunar stokes and confused with Alzheimers dz |
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Desccribe TIAs the aresult from small emboli from plaques |
If in the internal carotid may involve retinal branches of the ophthalmic artery. My result in transient blindness on affected side |
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Symptoms of TIA/Transient blindness |
Sudden onset of a fog, haze, scum, curtain, shade, blur, cloud, or mist Sudden, brief 1-5 min painless |
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What involvement is more common in TIA |
Anterior cirulation and presentation is more stereotypical for recurrent carotid TIA |
