supplies the circle of willis and the brain- 4 branches*

1. opthalamic artery (retina)

2. posterior communicating artery

3. anterior cerebral artery

4. middle cerebral artery

• supplies brainstem, cerebellum, parts of the occipital lobe (20%)
• vertebral arteries come together to form the basilar artery
• enters through the foramen magnum- takes care of posterior (cerebellum, parts of the brainste, spinal cord)
• vertebral and cerebral join at the circle of willis

• allows for bloodflow through whole area
• "traffic circle"
• 7 major components
• anterior, middle & posterior cerebral arteries
• posterior & inferior communicating arteries
• posterior & anterior spinal arteries (form posterior inferior cerebellar artery -PICA)

anterior cerebral artery (carotid)

• medial surface of hemispheres, area superior to the corpus collosum, frontal and parietal lobes
• loss of bloodflow to motor strip if damaged (contralateral limb movement impacted)

• lateral surface along sylvian fissure (temporal, frontal, parietal, parasylvian areas)
• loss of blood flow impacts speech (aphasia, dysarthria)
• *parasylvian area = key for speech and language

• medial surface
• occipital and temporal lobes
• loss of blood flow results in visual, auditory deficits

possible options:

• disable BBB (dangerous)
• transporter proteins (attach medicines to proteins to cross BBB)
• Trojan Horses
• injecting directly (nasal cavity)

• xrays (standard)
• cerebral angiography
• myelograms (spinal nerve function)
• computerized tomography

• longer and more $ than CT scan, have to stay really really still
• soft tissue; pulls hydrogen atoms to one area for tissue differentiation
• non-radiologic

• injection of radioactive
• looks at spread of disease in cancer patients
• uses MRI technology

• uses MRI technology

• used in conjuction with MRI
• directional parameters of water diffusion
• location of white matter tracts
• looks at connections in the brain
• demyelinating diseases- MS
• affects of mylenation: schizophrenia, autism

• bloodflow, metabolic activity
• "no lie MRI" (lying required greater amount of brain activity)
• sensitive to psychological processes, such as neuronal activation, blood flow and metabolism
• performing a cognitive task lead to increased neuronal activity

• pulse oximetry (more hemoglobin, more oxygen in blood)
• regional oxygen saturation- uses same technologies as pulse ox
• indirect measure of oxygen levels in brain

electroencephalogram (EEG)

electrocardiogram (EKG)

magneticencephalography (MEG)

• stroke (CVA)
• TBI
• Toxin/metabolic
• Infection-bacterial & viral
• anoxia
• neoplasm - benign and malignant
• hydrocephalus

• 750,000 new CVAs yearly
• third leading cause of death; leading cause of disability
• 2 million cva survivors
• 2/3 over age of 65
• over 1/3 surve >10years
• more men than women but women more likely to die (women different symptomology there may not know)
• of survivors 85% return to functional levels, 15% require institutional care
• comorbidity- heart disease, diabetes

• 1.2 million aphasics living in the US
• 108,000 new aphasics per year
• 1 in 250 people
• 25-40% of stroke survivors

• thrombolic
• embolic

• 60% of ischemic CVAs
• gradual, stationary blockage associated with ASCVD (arthrosclerotic carotid vascular disease)-usually larger vessels- hardening building in arteries...narrowing
• insidious onset c/b TIAs, dizziness, blurred vision, tingling in extremities
• 70-90% blockage= critical (hypoxic)
• 90% blockage=anoxic
• because of slow onset, may not recognize as stroke
• occurs at level of bifurcation

• plaque breaks off, travels
• 20% of ischemic cvas
• blockage from foreign matter migration into smaller vessels
• abrupt onset
• 20% cardiogenic - start at heart
• 80% carotid or brain
• when heart throws a clot- becomes a cerebral event
• when other location throws clot- cardiogenic (at heart)

• blockage (likely embolic, possibly thrombotic)
• short-term (<30 min) with nearly complete recovery
• RIND -reversable ischemic neuro deficits
• PRIND- partial RIND
• TIA, RIND and PRIND are warning signs
• TIA- risk of stroke within a year, 30-60% chance of full stroke within 5 years

• neuron necrosis (cell death due to that cells do not store energy)
• edema with potential for increase ICP
• absence of neurotransmitters (no neurons to release them)
• diaschisis (cells further away from impact begin to be affected )
• collateral sprouting (if some repair occurs, neurons being sprouting at right angles)
  

• 20% of all CVAs
• extra and intracerebral
• abrupt or insidious onset possible

• meninges and surface of brain 
• subdural (tbi)- between arachnoid & dura
• epidural (tbi)- between dura and skull
• subarachnoid (linked to aneurysms)- between arachnoid and pia
• subarachnoid- saccular; arteriovenous malformation (AVM): congenital, where arterioles and veins connect (typically at the base of the brain- occipital & brainstem)

• saccular
• atherosclerotic
• mycotic
• traumatic

• older population
• typically result of high bp (most common)
• weakening of wall...bulges...bursts...results in hemorrhagic event

• linked to hypertension deep within the brain and surgical intervention may be undertaken in life threatening
• CT scan at intake
• subcortical event survivor may require SLP eventually

• angioplasty
• endarectomy
• platelet inhibiting factors
• cerebrovasodialators
• TPAs
• blood thiners
• stents & filters
• surgical clipping

• trying to prevent thrombolic event 
• RISK: embolic event if there is already weakness of wall... may lead to aneurysm

• suction out plaque/scrape out (80-90% blockage of both carotid)
• RISK: cutting into carotid,* embolic event

prevent thrombolic & embolic events

***bad for hemorrhages

• F: face- one side drooping
• A: arms- motor weakness; asymmetry
• S: speech- slurred? confusing?
• T: time- CRITICAL!!! call 9-1-1 ASAP!

• time post onset= critical
• maximize period of spontaneous recovery
• ischemic:
• nuero stabilization in first 2 weeks
• function and recovery greatest in first 4 weeks
• language recovery greatest in first 3 months
• neuro recovery up to 6mos post onset

• location of infarct (focal or diffuse)
• size of infarct
• diaschisis (impact-spread)
• secondary factors (what is going on? typically with older population)

• age (depends on lifestyle)
• handedness- L handed might be better chance of recovery- more be more balanced hemisphere usage
• hemispheric dominance
• pre-morbid status (best predictor)

• primary versus secondary growths
• primary- originates in the brain
• secondary- cancer from elsewhere spreads to the brain
• tumor types:
• gliomas (most common)
• astrocytoma (more benign, slow grow)
• glioblastoma multiforme (metastic)
• meningiomas (slower growth)
• herniation secondary to edema

• enlarged ventricles from ICP or atrophy (huntington's, progressive dementia)
• obstructive (blocks flow of csf in ventricles- enlarged) vs. non-obstructive (build-up)
• onset c/b lethargy, reduced responsiveness, and cognitive decline
• recovery patterns/interventions (related to cause)
• can put in shunts- drain fluid (treatable to certain extent0

• bacterial meningitis (deadly)
• brain abscess (AIDS, cardiogenic infections, dental or middle ear infections)
• generally treatable with antibiotics, positive recovery is possible
• issue of VIRAL based illnessess (palliative care)

• "poison"
• pharmacological causes
• bacterial toxins (tetanus, diptheria, botulism)
• environmental (metal & chemical)- lead poisoning

• thiamine deficiency- ETOH
• B12 deficiency
• over/under status of certain vitamins

• hypo and hyperglycemia
• thyroid disorders
• wilson's disease (accumulation of copper- dysarthria, cognitive deficits)

• surgical procedure to open and clean carotid artery to prevent thrombotic strokes