1. Controls skeletal muscle movement

2. Helps to regulate cardiac and visceral smotth muscle activity

3. Enables the recetpion, integration and perception of sensory information

4. Provides the foundation necessary for intelligence, anticipation and judgment

5. Facilitates adjustment ot an ever-changing external environment

Central Nervous System

Peripheral Nervous System

Central Nervous System: Brain and Spinal Cord

(Protected by the skull and vertebral column)

Function: Concentration of computational and control functions

Peripheral Nervous System: Outside structures of the CNS

Function: Input-Output system for relaying information to the CNS and transmits output messages that control effector organ

Brain - Protected by the skull

Spinal Cord - Protected by vetrebral column

What are nerves?

Nerves (cranial or spinal) are collections of nerve fibers, which are individual axons or dendrites of individual neurons

Axons/Axon Terminals - Send Messages

Dendrites - Receive Information

Individual nerve fibers in a nerve may be transmitting motor information out to the periphery or sensory information in to the CNS.

Astrocytes: Contributes to the blood-brain barrier and gives metabolic support

Oligodendrocytes: In the brain and Schwann cells in the periphery; make myelin to insulate nerve fibers

Microglia: Immune cells in the brain

Dorsal horns contain neurons that receive afferent (sensory) impulses through the dorsal routes.

[image]

Ventral horns contain the efferent lower motor neurons that leave the cord through the ventral roots.

[image]

The Cauda Equina is the collection of spinal nerves that travel downthe spinal canal below the termination of the spinal cord.

[image]

Which of the following are important components of the blood brain barrier?

A. Astrocytes

B. Microglia

C. Oligodendrocytes

D. Motor Neurons

Structure of the Brain

What are the structures of the HindBrain?

Medulla Oblongata

Pons

Cerebellum

[image]

Structure of the Brain

What are the structures of the midbrain?

2 Pairs of dorsal enlargements

Superior & Inferior Colliculi

[image]

Structure of the Brain

What are the structures of the forebrain?

Consists of 2 hemispheres covered by the cerebral cortex

Central Masses of Gray Matter

Basal Ganglia

Diencephalon with its derivatives (Thalamus and Hypothalamus)

 [image]

Segments of the Forebrain

Where is the Frontal Lobe? What structures define the location of the frontal lobe?

Extrends from the frontal pole to th ecentral sulcus (fissure)

Separated from the temporal lobe by the lateral sulcus

Segments of the Forebrain

Where is the Parietal Lobe?

Segments of the Forebrain

Where is the Temporal Lobe?

Segments of the Forebrain

Where is the Occipital Lobe?

Cranial Nerves

Cranial Nerve I

Cranial Nerves

Olfactory Nerve

Cranial Nerve I

Scent

Cranial Nerves

Cranial Nerve II

Cranial Nerves

Optic Nerve

Cranial Nerve II

Sight

Cranial Nerves

Cranial Nerve III

Oculomotor

Eye Fixation on an object

Eyelid

Pupils

Cranial Nerves

Oculomotor Nerve

Cranial Nerve III

Oculomotor Nerve

Pupils

Eyelids

Eye Fixation on object

Cranial Nerves

Cranial Nerve IV

Trochlear Nerve

Control Eye Movement

Cranial Nerves

Trochlear Nerve

Cranial Nerve IV

Trochlear Nerve

Control Eye Movement

Cranial Nerves

Cranial Nerve V

Trigeminal Nerve

(Both Motor and Sensory)

Muscles of mastication (cheweing)

Sensory input from the face

Cranial Nerves

Trigeminal Nerves

Cranial Nerve V

Trigeminal Nerve

Muscle of mastication (Chewing)

Sensory input from the face

Cranial Nerves

Cranial Nerve VI

Abducens Nerve

Abduct the eyes (2 different directions)

Cranial Nerves

Abducen Nerve

Cranial Nerve VI

Abducen Nerve

Abduct the Eyes (2 different directions)

Cranial Nerves

Cranial Nerve VII

Facial Nerve

Facial Expression

Tears

Saliva

Tongue receptors

Cranial Nerves

Facial Nerve

Cranial Nerve VII
Facial Nerves

Saliva

Tears

Toungue receptors

Facial Expressions

Cranial Nerves

Cranial Nerve VIII

Vestibulocochlear Nerve

Cochlear (Hearing)

Vestibular (Sound Balance)

Cranial Nerves

Vestibulocochlear Nerve

Cranial Nerve VIII

Vesitublocochlear Nerve

Cochlear (Hearing)

Vesibular (Sound Balance)

Cranial Nerves

Cranial Nerve IX

Glassopharyngeal

Tongue and Pharynex

Saliva

Swallowing

Tongue

Caratoid Artery

Cranial Nerves

Glassopharyngeal Nerve

Creanial Nerve IX

Glassopharyngeal Nerve

Tongue and Pharynex

Saliva

Swallowing

Tongue

Caratoid artery

Cranial Nerves

Cranial Nerve X

Vagus Nerve

Throat

Esophagus

Thorax

Abdomen

Supply the heart and smooth and many viscerous muscle glands

Cranial Nerves

Vagus Nerve

Cranial Nerve X

Vagus Nerve

Throat

Esophagus

Thorax

Abdomen

Supply the heart and mayn smooth and viscerous muscle glands

Cranial Nerves

Cranial Nerve XI

Accessory Nerve

Throat Muscles

Back and Neck Muscles

Cranial Nerves

Accessory Nerve

Cranial Nerve XI

Accessory Nerve

Throat, Back and Neck Muscles

Cranial Nerves

Cranial Nerve XII

Hypoglossal Nerve

Tongue

Speaking

Chewing

Swallowing

Cranial Nerves

Hypoglossal Nerve

Cranial Nerve XII

Hypoglossal Nerve

Tongue

Speaking

Cheweing

Swallowing

1. Awareness/Consciousness

2. Perception of Sensory Information

3. Source of Intentional Motor Activity

Processing centers that ....

1. Carry out intentional motor activity

2. Mediate reflexes

3. Maintain Hemeostasis

4. Perform Automatic Motor Functions, Including learned motor tasks (riding a bike)

Bacterial Meningitis

Meningococcal meningitis is an infection caused by Neisseria meningitides.

Bacterial Meningitis

Streptococcus pneumonae causes _______________.

Bacterial Meningitis

2 Other types of bacterial that cause meningitis, other then Streptococcus pneumonae and Neisseria Meningitides are .....

1. Haemophilus Influenza (known as H. Flu)

2. Mycobacterium Tuberculosis

Bacterial Meningitis

Although the bacteria infect the meninges, they rapidly destory ___________ and _______. Bacterial meningitis can be rapidly fatal (hours). For this reason, exposed person typically receive ____________ antibiotics.

Viral Meningitis

Viral meningitis can be caused by __________, and is usually ____.

Immunosupressed patients (HIV, chemotherapy) can get fatal viral meningitis caused by what 3 causes?

Viral meningitis can be caused by a variety of viruses, and usually is quite mild.

Immunosupressed patients (HIV, chemotherapy) can get fatal viral meningitis caused by

1. Epstein Barr virus

2. Herpes Simplex Virus

3. West Nile Virus

Which of the following genus causes Meningococcal Meningitis?

1. Neisseria

2. Pneumococcus

3. Hamophilus

4. Mycobacteria

The neurotransmitter in the presynaptic receptor is determined by the type of neuron it is

Ex: Nonadregnic neurons have norepinephrine

Ex: Cholinergic neurons have acetycholine

1. Other neurons

2. Organs

Receptors on the post synaptic cell match the receptors of the presynaptic cell; however, they can be a particular subtype.

Ex: Beta 1 or 2 Receptors

Neurotransmitter receptor activity can be terminated in 2 ways.

What are they?

1. Degradation (breakdown)

2. Reuptake and repackaging in synaptic vesicles

Sensory Component of the Nervous System

Sensory receptors have discrete nerve endings where?

Skin

Body Tissues

Sensory Component of the Nervous System

What are dermatomes?

1. Discriminative Touch (location, sharp, dull, soft, fuzzy, scratchy)

2. Temperature Sensation (hot, warm, cool, cold)

3. Body Position (flexion, extension, position in space, balance)

4. Nociception (aka Pain Sense) (Sharp, dull, stabbing, aching, burning)

First-Order Neurons: Transmit sensory information from the periphery to the spinal cord

Second-Order Neurons: Relay sensory information up the spinal cord to the thalamus

Third-Order Neurons: Relay information from the thalamus to the cerebral cortex

What are the 2 pathways from the spinal cord to the thalamic level of sensation?

1. Discriminative Pathway (Posterior columns)

Crosses at the base of the medulla - relays information to the brain for perception, arousal and motor control

2. Anterolateral pathways (spinothalamic tracts)

Cnosists of bilateral multisynaptic slow-conducting tracts; Provides for transmission of sensory information that does not require discrete localization of signal source or fine discrmination of intesity; Crosses at the level of entry to the cord

[image]

[image]

Which neurons transmit sensory information from the periphery to the CNS?

A. First-Order

B. Second-Order

C. Third-Order

D. Fourth-Order

1. Upper motor neurons project from the motor cortex to the brain stem or spinal cord

(directly or indirectly innervate the lower motor neurons)

2. Sensory feedback from the involved muscles

(continuously relayed to the cerebellum, basal ganglia and sensory cortex)

3. Lower motor neurons and a functioning neuromuscular junction that links the nervous system activity with muscle contraction

Requirements of the Motor System

Involved muscles must be able to provide sensory feedback to the .... (3 structures)

Requirements of the Motor System

Upper motor neurons project from the motor cortex to the brain stem or spinal cord to _____ or _____ innervate the lower motor neurons.

Where do motor neuron exitatory or inhibitory influences come from?

(How does a neuron know whether to fire or stop firing?)

1. Corticospinal Tracts

2. Extrapyramidal system

3. Cerebellum

* All influence the motor unit, in addition to the combination of a muscle fiber and the axon supplying it

Corticospinal (Pyramidal) Tracts

Nerve cell bodies are _______-shaped neurons in the motor cortex.

Corticospinal (Pyramidal) Tracts

The myelinated axons pass down through the brain in a bundle called ________.

Corticospinal (Pyramidal) Tracts

In the __________, the axons cross to the opposite side; this is also called _____________.

Corticospinal (Pyramidal) Tracts

Axons go down the ______ lateral spinal cord.

Corticospinal (Pyramidal) Tracts

Individual axons peel off from the rest at particular levels and synapse with ___________.

Corticospinal (Pyramidal) Tracts

The Corticospinal Tracts system is very important in ______________ movements.

Corticospinal (Pyramidal) Tracts

Explain the steps of the Corticospinal (Pyramidal) Tracts.

1. The myelinated axons pass down .....

2. In the brain stem, the axons cross .......

3. The axons then course down the .......

4. Individual axons peel off from the rest at particular levels and then .........

1. The myelinated axons pass down through the brain in a bundle called the internal capsule.

2. In the brain stem, thh axons cross to the opposite side (decussation of the pyramids)

3. The axons then course down the ventral lateral spinal cord.

4. Individual axons peel off from the rest at particular levels and then synapse with the primary motor neurons.

Corticospinal (Pyramidal) Tracts

Explain the steps of the Corticospinal (Pyramidal) Tracts.

1. The myelinated axons pass down through the brain in a bundle called the internal capsule.

2. In the brain stem, thh axons cross to the opposite side (decussation of the pyramids)

3. The axons then course down the ventral lateral spinal cord.

4. Individual axons peel off from the rest at particular levels and then synapse with the primary motor neurons.

Extrapyramidal Tracts

Nerve cell bodies originate in the _________

And send axons to the ________ or ________, where they synapse with other neurons.

Extrapyramidal Tracts

Additional synapses may be present in the ____ and _______

And finally at the lower _________ at each level of the cord.

Extrapyramidal Tracts

This system is important to __________ movement.

Extrapyramidal Tracts

Explain the steps in the extrapyramidal tract.

1. Nerve cell bodies originate in the ________ and send axons to the ___________, where they ...........

2. Additional synapses may be present in the ___________. And finally at the _________ at each level of the spinal cord.

1. Nerve cell bodies originate in the motor cortex and send axons to the thalamus or globus pallidus, where they synapse with other neurons.

2. Additional synapses may be present in the midbrain and pons. And finally at the lower motor neurons at each level of the spinal cord.

* A single tendon tap elicits repeated contractions

The 2nd and subsepquent contractions are caused by the stretch produced by the first contraction.

Why does this happen?

Because of a loss of inhibitory influences that normally woudl come down the spinal cord and prevent the 2nd and subsequent contractions

Loss can be caused by a problem int eh brain or a higher level of teh cord than the reflex being elicited. This is an upper motor neuron problem.

What is a normal planter reflex

in adults?

in children?

Adults: When the sole of the foot (plantar surface) is stroked with an object, the toes curl downward (flex position)

Children: When stroking the plantar surface of the foot on an infant, the foot extends and the toes fan upward. (Children losse the plantar response of extension/fanning and gain the response of flexion about the time they first begin to pull up and stand).

The change in the plantar reflex is brought about by maturation of motor tracts in the spinal cord which modulate the reflex arc elicited by plantar stimulation.

Toes or body parts going downward or inward

Joint angle decreases

Present in an adult when the toe extend (curl up) and fan when the plantar surface is stimulated.

(Same reflex present in an infant)

Presence of the Babinski's sign in an adult indicates damage to the brain or spinal cord, such that the modulating influences that promote a flexor plantar response do not reach the lower motor neurons that supply the toes.

Upper Motor Neuron problem

The presence of Babinski's sign in an adult indicates damage to the brain or spinal cord, so that modulating influences that promote a flexor plantar response do not reach the lower motor neurons that supply the toes.

This is an upper motor neuron problem.

What does a Decorticate Posture indicate?

What does a Decerebrate Posture Indicte?

Decorticate Posture: Flexing inward of arms and feet; indicates damage to upper midbrain

Decerebrate Posture: Extension of arms and feet; indicates damage to the lower midbrain and upper pons

Progression for Decorticate to decerebrate posture may indicate progressive deterioration of the brain stem > respiratory arrest is next!

[image]

Decorticate Position: Damage to UPPER MIDBRAIN

Decerebrate: Damage to LOWER MIDBRAIN and PONS

Progression indicates DETERIORATION OF BRAIN STEM

RESPIRATORY ARREST

A condition in which motor centers in the spinal cord send constant, strong signals to particular muscles to contract.

Why?

Due to spinal cord or brain problems, which causes:

* Either a loss of inhibitory influences on the motor centers or an increase in excitatory influences.

Spastic contractions are triggered by sensory stimuli that would normally elicit a motor reflex

The problem is that with spasticity, the sensory stimulus that evokes the contraction will be smaller than normal, and the contraction evoked is stronger then normal.

Generalized: Involve all motor centers in the cord and therefore, all muscle groups

Focal: Involving only one or a couple of motor centers and therefore, involving one or some distinct muscle groups

Spasticity may involve 1 particular limb or all 4 limbs.

Motor impulses may go to all the muscles (both flexors and extensors). In this case, the strongest muscles are the ones that prevail (win) - these are usually flexors.

Damage to the vertebral column

Supporting Ligaments

Spinal Cord

Sensory & Motor Function

Fractures

Dislocations

Subluxations

View Powerpoint Slides for pictures of Incomplete Spinal Cord Injuries

What are 3 types of Spinal Cord Injuries?

1. Central Cord Damage (CNS is damaged but not PNS) - Gray matter is damaged not white matter - caused by insufficient blood supply

2. Anterior (Ventral) Cord Syndrome

3. Brown-Sequard Syndrome

 In traumatic transection of the cord, there is an acute loss of motor, sensory, and reflex activity at and below the level of injury. This produces a flaccid paralysis with loss of DTR (deep tended reflexes) and all bowel and bladder function.

What are areas affected by

Spinal Cord Injury (SCI)?

 •Spinal reflexes

In traumatic tansection of the cord there is an acute loss of motor, sensory and reflex activity at and below the level of injury.

* This produces a flaccid paralysis with a loss of DTR and all bowel and bladder function.

Spinal Cord

At a later time, reflex activity returns to undamaged cord below the level of injury. DTR's may be ___________ and bowel and bladder function occur without _______________.

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

C1

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

C2-C3

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

C4

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

C5

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

C6

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

C7 & C8

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

T1-T5

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

T6-T10

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

T11-L5

Motor Testing to Determine the Level of Spinal Cord Injury (SCI)

S1-S5

4 Types of Paralysis

Where parts of the body are effected?

Monoplegia: 1 quarter of the body (Ex: 1 leg)

Hemiplegia: One half of the body; spinal cord is the dividing line

Tetraplegia/Quadriplegia: Neck down paralyzed

Paraplegia: Hips down paralyzed

Testing of both discriminative touch and temperature

Which of the following is associated with sensory input to the CNS?

A. The Dorsal horn of the spinal Cord

B. The Ventral horn of the spinal Cord

C. The Motor Cortex

D. The Sensory Cortex

 Trauma

Tumors

Stroke

Metabolic Derangements

Degenerative Disorders

Infections

1. Alterations in sensory and motor function

(Could be focal)

2. Changes in the level of consciousness

(Consciousness is a global function, so alterations in consciousness indicate diffuse or global brain injury)

Consciousness is a __________ function.

Alterations in consciousness indicates ....

Confusion: Impaired ability to think clearly or to perceive, respond to & remember current stimuli; also disorentation

Delirium: Motor restlessness, transient hallucinations, disorientation, & sometimes delusions.

Obtundation: Decreased alertness with associated psychomotor retardation.

Stupor: The person is not unconscious but exhibits little or no spontaneous activity

Coma: Unarousable and unresponsive to external stimuli or internal needs

Level of Consciousness

Confusion

Levels of Consciousness

Delirium

Levels of Consciousness

Obtundation

Levels of Consciousness

Stupor

Levels of Consciousness

Coma

Tool to measure consciousness

Measures:

1. Eye Opening

2. Motor Responses

3. Verbal Responses

Worst Score = 3, Best score = 15

1. Eye Opening

2. Motor Responses

3. Verbal Responses

How can the deterioration in the level of consciousness be assessed?

What does a detorioration in the level of consciousness signify?

1. Glasgow Coma Scale

2. Progression from Confusion to Stupor

A deterioration in the level of consciousness signifies progressively worsening brain injury.

Intervention: Neurosurgical

1. Effects of Ischemia

2. Excitarory Amino Acid Injury

3. Cerebral Edema

4. Injury due to increased intracranial pressure (ICP)

** These mechanisms frequently overlap **

Reduced or Interrupted blood flow

Interferes with the delivery of oxygen and glucose, as well as removal of metabolic waste.

Stroke

Hypoglycemic injury (Lower then normal blood glucose levels)

Trauma

Chronic degenerative disorders (Huntington's & Alzheimer's disease)

1. Increase in intracellular calcium

2. Calcium cascade (Calcium build up)

3. Relseases intracellular enzymes

Protein breakdown

Free radical formation

Lipid peroxidation (Degeneration of lipids)

Fragmentation (break down) of DNA

Nuclear Breakdown

4. Brain Cell injury & Death

Carbon Dioxide

Hydrogen Ions

Oxygen Concentration

1. Carbon dixoide (High CO2 produces cerebral vasodilation - keep CO2 low in vasogenic cerebral edema)

2. Hydrogen Ion (Low pH increases cerebral blood flow - treat acidosis in patient with vasogenic cerebral edema)

3. Oxygen Concentration (Low pO2 increases cerebral blood flow - keep pO2 physiologic in a patient with vasogenic cerebral edema)

Metabolic Factors Affecting Cerebral Blood Flow:

Carbon Dioxide

What do high levels of carbon dioxide do? What intervention should occur during vasogenic cerebral edema?

High CO2 produces cerebral vasodilation

Keep CO2 Levels LOW in vasogenic cerebral edema

Metabolic Factors Affecting Cerebral Blood Flow:

Hydrogen Ion

What do low pH levels do? What intervention should occur during vasogenic cerebral edema?

Low pH increases cerebral blood flow

Intervention: Treat acidosis in a patient with vasogenic cerebral edema

Acidosis: Arterial blood pH levels fall below 7.35

Metabolic Factors Affecting Cerebral Blood Flow: Oxygen Concentration

What do low levels of oxygen do? What intervention should occur during vasogenic cerebral edema?

Low Oxygen levels increase cerebral blood flow

Keep Oxygen levels normal in a patient with vasogenic cerebral edema

Herniations

Know the locations of the Septas of the Brain, including falx cerebri, tentorium cerebelli and foramen magnum.

1. Falx Cerebri

2. Tentorium Cerebelli

3. Foramen Magnum

[image]

1. Cingulate Gyrus under the falx cerebri

2. Central Transtentorial Herniation

3. Uncal herniation through the tentorium

4. Intratentorial herniation of the cerebellar tonsils

[image]

Traumatic Head Injury is structural damage to the head.

Its main causes are road accidents, falls and assaults.

2 Types of Head Injury: Closed Injury or Open Wounds

1. Primary or Direct Injuries

Damage is called by impact

Include diffuse axonal injury and the focal lesions of laceration, contusion and hemorrhage

2. Secondary Injuries

Damage results from subsequent brain swelling, infection, cerebral hypoxia

Diffuse or multi-focal, inclduing concussion, infection and hypoxic brain injury

What causes a primary or direct brain injury?

What are some physiological injuries that occur with primary or direct brain injuries?

Damage is caused by impact.

Physiological injuries include:

Diffuse Axonal Injury (Occur when the head is rapidly accelerated or decelerated, as may occur in auto accidents, falls, and assaults; cause of damage in DAI is the disruption of axons, the neural processes that allow one neuron to communicate with another)

Focal Lesions -

Lacerations: Tissue is cut or torn

Contusion: Bruising of brain tissue (blood is mixed with brain tissue)

Hemorrhage: Bleeding in the brain

What causes a secondary injury?

What are some physiological injuries that occur with secondary brain injuries?

Damage is caused by brain swelling, infection or cerebral hypoxia

Injuries are often multi-focal:

Concussion

Infection

Hypoxic Brain Injury

Epidural Hematoma

Caused by head injuries in which the skull is fractured

* Develops between the inner table of the bones of the skull and dura

Subdural Hematoma

Result of a tear in the small bridging veins that connect veins on the surface of the cortex to dural sinuses

Develops inteh area between the dura and arachnoid (subdural space)

May evelop slowly over days

What is an Epidural Hematoma?

How does it develop?

Epidural Hematoma

Caused by head injuries in which the skull is fractured

* Develops between the inner table of the bones of the skull and dura

What is a subdural Hematoma?

How does it develop?

Subdural Hematoma

Result of a tear in the small bridging veins that connect veins on the surface of the cortex to dural sinuses

Develops inteh area between the dura and arachnoid (subdural space)

May evelop slowly over days

* If the hematoma is causing compression of the brain, it might have to be evacuated

* If the hematoma is not causing compression of the brain, the patient will have to be observed closely to make sure the situation is stable. The hematoma will resolve over time.

* 2 Internal Carotid Arteries anteriorly

* Vertebral Arteries posteriorly

What are 2 Main Types of Strokes?

(aka Cerebral Vascular Accidents (CVA) or "Brain Attacks")

1. Ischemi (Thrombotic) Strokes: Caused by interruption of blood flow, usually by a clot, in a cerebral vessel and are the most common type of storked, accounting for 70-80% of all strokes.

2. Hemorrhagic Strokes: Caused by bleeding into brain tissue usually from a blood vessel rupture caused by hypertension, anurysms, anteriovenous malformations, head injury or blood dyscrasias (mixtures)

Age, Sex, Race

Family History

Hypertension

Smoking

Diabetes Mellitus

Asymptomatic Carotid Stenosis

Sickle Cell Disease

Hyperlipidemia

Atrial Fibrillation

A Prodrome (early symptom signifying the start of a disease) of a thrombotic stroke and are predictive of a stroke over the next 5 years.

Focal deficits last less then 24 hours because of a temporary disturbance of cerebral blood flow.

This provides an opportunity for intervention (anticoagulation), before a permanent stroke occurs

If the TIA is due to clot breaking off from an atheroma in the carotid artery, a roto-rooter type operation called a carotid endarterectomy or carotid angioplasty might be performed

Anticoagulation therapy

Carotid Endarterectomy (Removal of atherosclerosis to widen the artery)

Carotid angioplasty (Inserting a stent to widen artery)

Atheroma is an accumulation and swelling (-oma) in artery walls that is made up of cells (mostly macrophage cells), or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.

Commonly referred to as atheromatous plaques.

* Atherosclerosis of cerebral vessels

* More often due to an embolus (migrates from one part of the body to another) of a clot that forms elsewhere (left side of heart or at the bifurcation of the carotid)

People with predisposing conditions (Atrial Fibrillation, TIAs) can receive anticoagulant Therapy.

* Congenital Aneurysm of a Cerebral Vessel

* Acquired Aneurysm (Hypertension or Atherosclerosis)

Initial presentation is usually very severe, but recovery is actually better than from thrombotic stroke.

Motor Deficits

Dysarthria

Aphasia

Cognitive Deficits

Neglect

Cortical Blindness (Deafness, etc)

Stroke-Related Deficits

Motor Deficits

Stroke-Related Deficits

Dysarthria

Stroke-Related Deficits

Aphasia

Stroke-Related Deficits

Cognitive Deficits

Stroke-Related Deficits

Neglect

Stroke-Related Deficits

Cortical Blindness (Deafness)

Useful for thrombotic strokes only

tPA, a fbrinolytic enzyme that can dissolve the thrombus must be given sooner then 3 hours after the onset of symptoms

A patient comes into a crowded Emergency Department with symptoms of a stroke. Why should this patient be seen and treated immediately?

 1.All stroke patients are at risk for death.