• Ischemia
• trauma
• tumors
• metabolic derangements

1. Ischemia
2. hypoxia

Ischemia interferes with the delivery of what 3 factors to the brain?

(i) oxygen

(ii) glucose

(iii) removal of metabolic wastes.

Name 4 ways hypoxia can occur.

(i) reduced atmospheric pressure

(ii) anemia

(iii) carbon monoxide poisoning

(iv) failure of lungs to oxygenate blood.

(i) generalized reduction in blood flow (as in cardiac arrest)

(ii) occlusion of a blood vessel, e.g., in an area in brain (stroke)

1. hippocampus
2. cerebellum (Purkinje cells)
3. basal ganglia

Name 3 cerebrovascular diseases that involves disorders to cerebral blood vessels in the brain.

1. Ischemic and hemorrhage stroke
2. aneurysms
3. arteriovenous malformations

The blood vessels in the brain are comprised of what 2 types of arteries?

(i) internal carotid arteries

(ii) the vertebral arteries.

• ophthalmic
• posterior communicating
• anterior choroidal
• anterior cerebral
• middle cerebral

(i) middle cerebral

(ii) anterior cerebral.

The anterior cerebral artery supplies blood to:

(i) frontal lobe

(ii) parietal lobe

The middle cerebral artery supplies blood to:

(i) motor

(ii) prefrontal cortex.

(i) medulla

(ii) pons

(iii) cerebellum

(iv) midbrain

(v) diencephalon

(i) deep cerebral venous system

(ii) superficial venous system.

1. carbon dioxide (CO₂₎
2. hydrogen ion (H⁺⁾
3. oxygen concentrations (O₂₎

What effect does an increase in carbon dioxide in blood cause?

• vessels become dilated and leads to an increase in PCO₂
• stimulation for vasodilation
• cerebral flow is increased

• Increased hydrogen ion concentration
• decreased oxygen.

Autoregulation controls blood flow in ______.

______ innervate cerebral blood flow vessels

Name 3 characteristics of a stroke

1. a neurologic deficit caused by vascular disorder that injures brain tissue
2. time dependent tissue damage
3. both (i) cerebrovascular, and, (ii) neurologic disorder.

Name stroke risk factors: 

• Age
• gender
• race
• heart disease
• hypertension
• high cholesterol levels
• smoking
• prior stroke
• diabetes mellitus
• sickle cell anemia
• obesity
• sedentary life styles
• alcohol abuse
• cocaine.

Name 2 types of stroke:

(i) Ischemic

(ii) hemorrhagic

In an ____ , blood flow in a cerebral blood vessel is interrupted. It is the most common type of stroke.

What happens to blood vessels during an ISCHEMIC STROKE?

What type of clot forms when platelets stick to arterial wall of intact blood vessels?

In a Thrombus, platelets are attracted to areas called __ ( where endothelial cells contain large quantities of lipids)

___ is a drifting blood clot in blood stream

An embolus that becomes stuck in a blood vessel blocks circulation to areas downstream, killing tissues is called ___

Tissue damage caused by embolism is called an ___

Infarcts in brain are called ___ or ____.

strokes

brain attacks

Name 5 classifications of Strokes:

(i) Large artery atherosclerotic disease

(ii) Small vessel or penetrating artery disease (lacunar stroke)

(iii)  Cardiogenic embolism

(iv) Cryptogenic stroke

(v) Unusual causes.

A central core of dead (or dying) cells is surrounded by brain cells that have minimal supply of blood. This is referred to as the ___ or ___.

penumbra

halo

What type of stroke occurs when a localized area in brain does not receive blood supply for less than one hour (zone of penumbra without central infarction)

TRANSIENT ISCHEMIC STROKE

What are causes of transient ischemic stroke:

(i) atherosclerotic disease of blood vessels in brain

(ii) emboli

What is the most common cause of ischemic stroke?

What is the most common site of thrombotic stroke?

     junction

In Thrombotic stroke, the cerebral infarction occurs due to:

(i) chronic atherosclerosis at local site

(ii) local thrombosis

(iii) failure of blood vessels to supply blood to local brain cells due to stenosis

A thrombotic stroke occurs in ____of brain

in most cases, a single artery is affected in a ___

LACUNAR STROKE occurs in what parts of the brain?

(i) non-cortical parts of brain

(ii) in brainstem.

___ result from occlusion of smaller branches of cerebral arteries

In process of healing from a lacunar stroke, lacunar infarcts leave behind ____

Name two vessels affected during lacunar strokes.

(i) middle cerebral

(ii) posterior cerebral.

Name causes for lacunar strokes:

• embolism
• hypertension
• small vessel occlusive disease
• hematologic abnormalities
• small intracerebral hemorrhages
• vasospasm

Lacunar strokes  do not cause ___

Name 2 classical “lacunar syndromes” 

1. motor hemiplegia
2. sensory hemiplegia.

____ results from moving or traveling blood clot;

What type of stroke is characterized below: 

• travels from origin to brain;
• affects larger cerebral vessels;
• lodges often at bifurcations;
• frequent site: middle cerebral artery
• most originate in thrombus in left heart but may also originate in carotid arteries;
• predisposing factors, e.g., rheumatic heart disease, atrial fibrillation

CARDIOGENIC EMBOLIC STROKE

What is the frequent site of a cardiogenic embolic stroke?

What is the most frequently, fatal stroke?

A hemorrhagic stroke is rupture of ____

In a hemorrhagic stroke, ___ occurs and adjacent brain tissue becomes compressed

A ____ occurs suddenly, usually when person is active

Name 4 predisposing factors for a hemorrhagic stroke

1. age
2. hypertension
3. aneurysm
4. trauma.

Name three factors that determine acute stroke:

(i) cerebral artery

(ii) area of brain tissue

(iii) adequacy of collateral circulation.

Name 9 symptoms of acute stroke:

(i) focal

(ii) sudden

(iii) one-sided

(iv) weakness of arm, face and leg

(v) numbness

(vi) loss of vision in one eye

(vii) language disturbance (aphasia)

(viii) slurred speech

(ix) sudden, unexplained imbalance (ataxia)

What part of brain is affected when an anterior cerebral artery is involved?

What part of brain area is affected when middle cerebral artery

    is involved?

What brain area is affected when a posterior cerebral artery is involved?

What brain area is affected when a Basilar and vertebral arteries are involved?