SSM SCRN Review 2023

Stroke Risk Factors - Answer- Age Gender (men >women) Genetics Stroke Primary Prevention - Answer- Tobacco cessation Blood pressure reduction Stroke Secondary Prevention - Answer- Prevention of another stroke Targets treatment for change once disease is present i.e. Blood Pressure control, LDL control, recognition of S/S stroke Frontal Lobe Functions - Answer- Regulates personality and affect Impulsivity and judgement Abstract thinking Conjugate eye movements Frontal Lobe Precentral Gyrus - Answer- AKA Motor Strip Broca's area: Articulation, speed and rhythm of speech Parietal Lobe Functions - Answer- Somatosensory cortex: Interpretation of: Pain, temperature, light touch, vibration, two-point discrimination, proprioception Temporal Lobe - Answer- Functions: Hearing, Memory, Learning Wernicke's area - Answer- located in Temporal lobe responsible for understanding spoken language Occiptal lobe - Answer- Functions: Vision The right half of the occiptal lobe interprets information received from the right half of both the right and left eyes (and vice versa) Cerebrum - Answer- Made up of Basial ganglia and Limbic system Basial ganglia - Answer- Coordinates movement Limbic system - Answer- Amygdala, Cingulate gyrus, Hippocampus Amygdala and Cingulate gyrus - Answer- Memory and emotion Hippocampus - Answer- Memory and learning Diencephalong - Answer- Thalmus, Hypothalmus, Pituitary and pineal gland Thalamus - Answer- Receives input from cerebral cortex and acts as relay center Hypothalamus - Answer- Hunger Thirst Autonomic functions Endocrine functions Pituitary and pineal gland - Answer- Hormonal modulation Sleep-wake cycle Spinothalamic Tract - Answer- An ascending pathway of the spinal cord . It is responsible for the transmission of pain, temperature, and crude touch to the somatosensory region of the thalamus. Corticospinal tract - Answer- A descending tract of the spinal cord which contains bundles of axons which originate in the cerebral cortex and descend to synapse within the brainstem or spinal cord. The neurons are called "upper motor neurons". Cerebellum - Answer- Coordination of motor function: Rapid alternating movements Balance and Position sense Brain Stem - Answer- Medulla, Midbrain, Pons Medulla - Answer- Foramen magnum to the pons CN XII, IX, X, XI Corticospinal tracts- pyramids: decussate and cross midline Midbrain - Answer- Coordinates Eye Movement, some reflexes related to hearing and vision CN II, III, IV Pons - Answer- Between medulla and midbrain CN VI, VII, VIII, V message center between cerebellum and cerebrum Cranial Nerve I - Answer- Olfactory-smell Cranial Nerve II - Answer- Optic- transmits visual information, visual fields, deficit=hemianopsia Cranial Nerve III - Answer- Occularmotor- eyeballs look up deficit=diplopia, strabismus, ptosis, pupil dilation Cranial Nerve IV - Answer- Trochlear- move eyeball down and in deficit=diplopia, strabismus Cranial Nerve V - Answer- Trigeminal-sensation to the skin of the face, muscles of mastication deficit=decreased facial sensation Cranial Nerve VI - Answer- Abducens- move eyball down and out deficit=strabismus Cranial Nerve VII - Answer- Facial- facial muscle innervation deficit= facial droop or weakness Cranial Nerve VIII - Answer- Acoustic- hearing and balance deficit= spinning, dizziness Cranial Nerve IX - Answer- Glossopharyngeal- oral sensation, taste, salvation Cranial Nerve X - Answer- Vagus- parasympathetic innervation to multiple organs deficit= increased blood pressure, increased heart rate, difficulty swallowing Cranial Nerve XI - Answer- Spinal Accessory- Shoulder Elevation and head turning deficit= winged scapula, difficulty shrugging shoulders Cranial Nerve XII - Answer- Hypoglossal- tongue movement deficit= tongue fasiculation, atrophy, weak tongue movement How much of the body's oxygen supply does the brain require? - Answer- 20% of body's oxygen supply How much of the cardiac output does the brain require? - Answer- 15% of cardiac output Anterior circulation - Answer- originates from carotid arteries Posterior circulation - Answer- originates from vertebral arteries Circle of Willis (COW) - Answer- merge of anterior and posterior circulation Large vessel strokes - Answer- Carotid, vertebral, COW, ACA, MCA, PCA ischemic stroke: occlusion occurs due to thrombus or embolus ICH: hemorrhage occurs at junctions and vessel turns SAH: Aneurysms form at vessel junctions and turns Small vessel strokes - Answer- smaller branching vessels Ischemic stroke: occlusion occurs due to atherosclerosis or other pathology ICH: Hemorrhage occurs due to amloyid angiopathy, tumor or vascular malformation Carotid Artery - Answer- major structure branching from aortic arch Symptoms from Carotid Artery Stroke - Answer- Aphasia if dominant side Contralateral neglect if non-dominat side motor and sensory loss face, are and leg on contralateral side visual field deficit contralateral to occluded carotid artery Anterior Circulation is made up of what arteries? - Answer- Anterior Cerebral Artery (ACA) Middle Cerebral Artery (MCA) Posterior Cerebral Artery (PCA) Anterior Cerebral Artery Supplies - Answer- 5 segments A1-A3 commonly discussed Supplies: Frontal lobe, olfactory cortex, corpus callosum, leg motor cortex Symptoms of ACA stroke? - Answer- Major symptoms: Apathy, abulia and disinhibition Conjugate eye deviation Contralateral motor/sensory loss leg>arm Middle Cerebral Artery - Answer- Major structures: M1-M4 Large cerebral territory Speech and language Motor and sensory cortex Gaze Basal ganglia and internal capusle Symptoms of MCA Stroke? - Answer- Major stroke symptoms: Aphasia (dominant hemisphere) Neglect (non-dominant hemisphere) Forced eye deviation/gaze preference Contralateral homonymous heminaopsia Contralateral motor/sensory loss face/arm>leg Posterior Cerebral Artery (PCA) - Answer- Major structures: Occiptial lobe Midbrain Thalamus Corpus Callosum Symptoms of PCA stroke? - Answer- Major stroke symptoms: contraleral loss of pain temp and senstation visual field loss Horner's syndrome Weber's syndrome Perinaud's syndrome Horner's Syndrome - Answer- Ptosis, miosis and dilation lag Ipsilateral impaired flushing and sweating Weber's syndrome - Answer- Midbrain stroke from PCA or BA infarct Contralateral weakness of upper and lower extremities (corticospinal tract) Ipsilateral gaze wekaness (craninal nerve 3) Also known as Lateral medullary syndrome Perinaud's Syndrome - Answer- Also know as dorsal midbrain syndrome Vertical gaze palsy- sun setting sign Pupils mid-dilated, light dissociation Convergence-retraction nystagmus Wallenberg Syndrome - Answer- Verterbral or PICA stroke Ipsilateral CN V involvement (sensory, pain, temp loss on ipsilateral face) Ipsilateral ataxia (cerbellum) Nystagmus, N/V, vertigo Horner syndrome Posterior Circulation is made up of what arteries? - Answer- Verterbral arteries Basilar artery Anterior Inferior Cerbellar Artery (AICA) Posterior Inferior Cerbellar Artery (PICA) Posterior inferior Cerbellar artery stroke symptoms? - Answer- Major structure=major symptoms Horner syndrome Wallenberg syndrome Ipislateral limb ataxia Decrease pain and temperature sensation contralateral body Anterior Inferior Cerbellar Artery - Answer- Major structure=major symptoms Ipsilateral deafness Ipsilateral facial motor/sensory loss Ipsilateral limb ataxia Decreased pain and temperature senstation contralateral body Basilar Artery Stroke Symptoms - Answer- Decreased LOC Facial paresis Occulomotor difficulties facial paresis Ataxia Quadraparesis Causes Millard-Gubler syndrome or Ventral-pontine