Clinical Neuroscience Week 2 - The Cerebrum, Cerebral Cortex, Blood Supply, and Substructures (Hard)

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Questions and Answers

Which structure is directly involved in both visual processing AND spatial awareness?

  • Cuneus (correct)
  • Cingulate gyrus
  • Thalamus
  • Uncus

Which of these functions is NOT primarily associated with the right hemisphere?

  • Logical reasoning (correct)
  • Facial recognition
  • Creativity
  • Visual spatial processing

Which brain structure interfaces directly with the thalamus to relay information about touch and pressure from the body?

  • Pre-motor cortex
  • Cerebellum
  • Somatosensory cortex (correct)
  • Primary motor cortex

The Precentral gyri are entirely motor, meaning they are involved in...

<p>Planning and executing movements (C)</p> Signup and view all the answers

What is the primary function of the corpus callosum?

<p>Connecting the two cerebral hemispheres (B)</p> Signup and view all the answers

Which of the following brain regions plays a crucial role in memory, emotions, and smell?

<p>Uncus (A)</p> Signup and view all the answers

Which of these is NOT a key section of the corpus callosum?

<p>Caudate (C)</p> Signup and view all the answers

Which two major fissures delineate the cerebrum from other brain structures?

<p>Longitudinal fissure and Transverse cerebral fissure (B)</p> Signup and view all the answers

A patient exhibits difficulty producing speech, suggesting damage to which brain area?

<p>Broca's area (B)</p> Signup and view all the answers

Which lobe of the brain is primarily responsible for processing auditory information?

<p>Temporal lobe (C)</p> Signup and view all the answers

What is the primary function of the thalamus?

<p>Relaying sensory and motor information (C)</p> Signup and view all the answers

What is the primary difference between the Pre-motor cortex and the Primary motor cortex?

<p>The Pre-motor cortex is responsible for complex movement planning, while the Primary motor cortex executes those movements. (A)</p> Signup and view all the answers

Which of the following brain structures is NOT located on the inferior aspect of the brain?

<p>Cingulate gyrus (D)</p> Signup and view all the answers

What is the main purpose of the olfactory bulb?

<p>Processing olfactory information (A)</p> Signup and view all the answers

In which lobe of the brain is Wernicke's area primarily located?

<p>Temporal lobe (C)</p> Signup and view all the answers

The central sulcus divides which two lobes of the brain?

<p>Frontal and Parietal (B)</p> Signup and view all the answers

What condition is characterized by bleeding occurring between the dura mater and the arachnoid mater due to a tear in a blood vessel?

<p>Subdural hemorrhage (B)</p> Signup and view all the answers

Which type of stroke occurs when a clot blocks a vessel supplying blood to the brain?

<p>Ischemic stroke (D)</p> Signup and view all the answers

What is a common diagnostic procedure used to assess conditions like a stroke by examining the subarachnoid space?

<p>Lumbar puncture (spinal tap) (D)</p> Signup and view all the answers

Which of the following statements accurately describes a subarachnoid hematoma?

<p>It is a life-threatening condition caused by bleeding into the space between the brain and pia mater. (D)</p> Signup and view all the answers

In the context of stroke management, which statement regarding the clinical presentation is true?

<p>Understanding cerebral structures is essential for effective initial management. (B)</p> Signup and view all the answers

What symptoms may result from damage to the anterior inferior cerebellar artery?

<p>Dysarthria and facial paralysis (A)</p> Signup and view all the answers

Which artery is primarily responsible for supplying blood to the largest part of the cerebellum?

<p>Posterior inferior cerebellar artery (A)</p> Signup and view all the answers

What is a common result of vertebrobasilar artery occlusion?

<p>Slurred speech and difficulty swallowing (B)</p> Signup and view all the answers

What role do the cranial meninges have in protecting the central nervous system?

<p>They provide structural support and protection. (B)</p> Signup and view all the answers

What is true about the superior sagittal sinus?

<p>It drains blood from the brain’s hemispheres. (A)</p> Signup and view all the answers

What structures drain blood into the internal jugular veins?

<p>Both A and C (A)</p> Signup and view all the answers

Which layer of the cranial meninges is the most superficial?

<p>Dura mater (A)</p> Signup and view all the answers

Which type of drainage is facilitated by deep cerebral veins?

<p>Blood from internal structures (B)</p> Signup and view all the answers

What is a consequence of damage to the dural sinuses?

<p>Increase in intracranial pressure (C)</p> Signup and view all the answers

Which artery is considered a common location for strokes?

<p>Posterior inferior cerebellar artery (D)</p> Signup and view all the answers

What is the primary treatment approach for ischemic strokes?

<p>Reperfusion via tPA or TNK, thrombectomy, or recanalization (B)</p> Signup and view all the answers

Which artery supplies the lateral aspects of the frontal, temporal, and parietal lobes?

<p>Middle cerebral artery (D)</p> Signup and view all the answers

Which symptom is commonly associated with a stroke in the anterior cerebral artery?

<p>Contralateral hemiplegia (leg more than arm) (D)</p> Signup and view all the answers

What is the thinnest portion of the brain's ventricular system?

<p>Cerebral aqueduct (B)</p> Signup and view all the answers

What common issue can lead to hydrocephalus?

<p>Genetic problems from gene mutations (B)</p> Signup and view all the answers

Which symptom is associated with a basilar artery stroke?

<p>Locked-in syndrome (D)</p> Signup and view all the answers

How does CSF flow through the ventricular system?

<p>Lateral ventricles &gt; 3rd ventricle &gt; cerebral aqueduct &gt; subarachnoid space (A)</p> Signup and view all the answers

In which area of the brain does the third ventricle reside?

<p>Between the right and left thalamus (B)</p> Signup and view all the answers

What is the primary consequence of an AVM in the brain?

<p>Potential for hemorrhagic stroke (A)</p> Signup and view all the answers

What occurs during recanalization in the treatment of ischemic stroke?

<p>Opening of blocked blood vessels (C)</p> Signup and view all the answers

What does a score of 0 indicate on the NIH Stroke Scale?

<p>No detectable stroke symptoms (D)</p> Signup and view all the answers

Which imaging method is considered the fastest for diagnosing stroke?

<p>Head CT (B)</p> Signup and view all the answers

What is a significant risk associated with administering tPA to stroke patients?

<p>Hemorrhagic conversion (A)</p> Signup and view all the answers

What condition is indicated when a head CT shows a region of decreased density associated with cerebral ischemia?

<p>Ischemic stroke (B)</p> Signup and view all the answers

What does the penumbra refer to in the context of ischemic strokes?

<p>Salvageable brain tissue at risk of infarction (A)</p> Signup and view all the answers

Which of the following is a primary treatment option for acute ischemic stroke?

<p>TNK (Tenecteplase) (A)</p> Signup and view all the answers

Which score on the NIH Stroke Scale suggests moderate impairment in a stroke patient?

<p>5-15 (B)</p> Signup and view all the answers

What is a contraindication for administering tPA in a stroke patient?

<p>Platelet count less than 100,000/mm^3 (C)</p> Signup and view all the answers

Which imaging method is most sensitive to ischemic strokes?

<p>MRI (A)</p> Signup and view all the answers

What is a potential outcome of hemorrhagic conversion following an ischemic stroke?

<p>Increased risk of further bleeding (B)</p> Signup and view all the answers

What should be the first step after assessing vital signs and serum glucose in suspected stroke patients?

<p>Perform a head CT without contrast (D)</p> Signup and view all the answers

What condition is indicated by sudden weakness or numbness in the face, arm, or leg?

<p>Stroke (D)</p> Signup and view all the answers

Which of the following best describes TNK (Tenecteplase)?

<p>Genetically modified tPA increasingly used for ischemic strokes (A)</p> Signup and view all the answers

What is one limitation of MRI compared to head CT?

<p>Longer examination time (D)</p> Signup and view all the answers

Which of the following is NOT a function of the insular lobe?

<p>Control of voluntary muscle movements (B)</p> Signup and view all the answers

Damage to the occipital lobe can result in various visual disturbances. Which of the following is NOT a common consequence of occipital lobe damage?

<p>Loss of sensation in the face and limbs (A)</p> Signup and view all the answers

How does the Circle of Willis contribute to maintaining adequate cerebral perfusion?

<p>It allows for alternative pathways of blood flow in case of blockages or damage. (C)</p> Signup and view all the answers

Which of the following is a primary function of the parietal lobe?

<p>Interpreting sensory information, including touch, temperature, and pain (A)</p> Signup and view all the answers

What is the primary characteristic of apraxia?

<p>A weakness in the ability to initiate and execute learned movements. (B)</p> Signup and view all the answers

Which of these is NOT part of the Circle of Willis?

<p>Middle cerebral artery (B)</p> Signup and view all the answers

What is the primary function of the anterior communicating artery in the Circle of Willis?

<p>To connect the left and right anterior cerebral arteries (B)</p> Signup and view all the answers

What is the role of the insular cortex in interoception?

<p>It integrates sensory information from the body, including visceral, pain, and temperature sensations. (B)</p> Signup and view all the answers

Damage to the insular lobe can lead to a range of problems. Which of the following is NOT a typical consequence of insular lobe damage?

<p>Loss of vision or visual disturbances (D)</p> Signup and view all the answers

What is the primary role of the vertebral arteries in the brain's blood supply?

<p>To supply blood to the brainstem and cerebellum (A)</p> Signup and view all the answers

Which of the following statements accurately describes the function of the prefrontal cortex?

<p>It plays a crucial role in regulating emotions, motivation, and behavioral control. (A)</p> Signup and view all the answers

A patient presents with difficulty understanding spoken language, producing fluent but meaningless sentences. This is likely caused by damage to which brain region?

<p>Wernicke's area (C)</p> Signup and view all the answers

Which of the following is NOT a function associated with the parietal lobe?

<p>Regulation of emotions and processing of auditory information. (B)</p> Signup and view all the answers

What is the primary function of the olfactory bulbs?

<p>Processing information related to smell. (B)</p> Signup and view all the answers

Damage to which brain region would likely result in difficulties with speech production and articulation?

<p>Broca's area (C)</p> Signup and view all the answers

Which of the following statements accurately describes the relationship between the cerebral hemispheres and the body?

<p>The left hemisphere controls the right side of the body, and the right hemisphere controls the left side of the body. (A)</p> Signup and view all the answers

Which of the following brain regions is NOT directly involved in language processing?

<p>Primary Motor Cortex (D)</p> Signup and view all the answers

The term 'contralateral representation' refers to:

<p>The concept that each hemisphere of the brain controls and receives information from the opposite side of the body. (D)</p> Signup and view all the answers

Which of the following lobes is primarily responsible for processing visual information?

<p>Occipital Lobe (B)</p> Signup and view all the answers

What is the role of the 'insular cortex'?

<p>It lies between and beneath other lobes and plays a role in a variety of functions, including memory, emotion, and learning. (C)</p> Signup and view all the answers

What is the significance of the 'Cortical Homunculus'?

<p>It is a visual representation of the relative size of different body parts as they are represented in the motor and sensory cortex. (A)</p> Signup and view all the answers

Which of the following statements BEST describes the function of the primary motor cortex?

<p>It is responsible for planning, organizing, and coordinating complex voluntary movements. (A)</p> Signup and view all the answers

Which of the following statements accurately describes the location of Broca's area?

<p>It is located in the frontal lobe, near the motor cortex. (C)</p> Signup and view all the answers

A patient presents with difficulty initiating and controlling voluntary movements, particularly in the right arm and leg. Damage to which brain region is MOST likely responsible for these symptoms?

<p>Left primary motor cortex (D)</p> Signup and view all the answers

Which of the following statements best explains the difference between Broca's aphasia and Wernicke's aphasia?

<p>Broca's aphasia affects speech production, while Wernicke's aphasia affects language comprehension. (C)</p> Signup and view all the answers

Which of the following brain regions is MOST closely associated with the processing of information related to touch, temperature, and pain?

<p>Primary somatosensory cortex (C)</p> Signup and view all the answers

Which of the following statements about the arachnoid mater is incorrect?

<p>It contributes to the formation of the blood-brain barrier and maintains the stiffness of the spinal cord. (B)</p> Signup and view all the answers

What is the primary function of dural reflections?

<p>They provide structural support and compartmentalize the brain, limiting its movement. (A)</p> Signup and view all the answers

Identify the correct order of the meninges from the outermost to the innermost layer.

<p>Dura mater, arachnoid mater, pia mater (C)</p> Signup and view all the answers

The tentorium cerebelli is a dural reflection that separates which structures?

<p>The cerebellum from the occipital and temporal lobes (A)</p> Signup and view all the answers

Which of the following is not a characteristic of the dura mater?

<p>It directly adheres to the surface of the brain and spinal cord. (C)</p> Signup and view all the answers

The epidural space is located between which layers?

<p>The skull and the dura mater (A)</p> Signup and view all the answers

What is the primary difference between the dura mater of the brain and the dura mater of the spinal cord?

<p>The dura mater of the brain forms multiple folds and reflections, while the spinal cord dura mater has only one layer. (B)</p> Signup and view all the answers

Where is the subarachnoid space located?

<p>Between the arachnoid mater and the pia mater (C)</p> Signup and view all the answers

Which of the following statements about the lumbar cistern is true?

<p>It is a space where procedures like lumbar punctures and epidural injections can be performed. (B)</p> Signup and view all the answers

What is the primary function of the pia mater?

<p>It tightly adheres to the brain and spinal cord, contributing to the blood-brain barrier. (B)</p> Signup and view all the answers

Which of the following is not a characteristic of a meningoma?

<p>It is caused by an infection of the meninges. (D)</p> Signup and view all the answers

Which of the following statements about an epidural hematoma is correct?

<p>It is a collection of blood that forms between the dura mater and the arachnoid mater. (B)</p> Signup and view all the answers

Which of the following structures is not a dural reflection?

<p>Arachnoid mater (C)</p> Signup and view all the answers

What is the primary function of the cerebrospinal fluid (CSF)?

<p>To cushion and protect the brain and spinal cord from injury. (C)</p> Signup and view all the answers

Which of the following statements about meningitis is incorrect?

<p>It is often caused by a bacterial infection. (C)</p> Signup and view all the answers

Which of the following is not a space within the cranial meninges?

<p>Intracranial space (D)</p> Signup and view all the answers

What is the primary function of the anterior communicating artery?

<p>Connecting the two anterior cerebral arteries, enabling collateral circulation (B)</p> Signup and view all the answers

Which of these structures is NOT directly supplied by the Circle of Willis?

<p>Cerebellum (E)</p> Signup and view all the answers

What is the likely consequence of damage to the posterior cerebral artery (PCA)?

<p>Contralateral homonymous hemianopsia, memory impairment, and visual agnosia (B)</p> Signup and view all the answers

Which of the following accurately describes the relationship between the Circle of Willis and the anterior circulation?

<p>The Circle of Willis supplies the anterior circulation, encompassing the internal carotid arteries and their branches (C)</p> Signup and view all the answers

Which artery directly supplies the medial portions of the frontal lobes and the superior medial parietal lobes?

<p>Anterior Cerebral Artery (ACA) (C)</p> Signup and view all the answers

What is the primary function of the posterior communicating arteries?

<p>Connecting the internal carotid arteries to the posterior cerebral artery (A)</p> Signup and view all the answers

What is the most likely consequence of damage to the middle cerebral artery (MCA)?

<p>Contralateral hemiplegia with greater impairment in the arm and face (C)</p> Signup and view all the answers

Which statement BEST describes the role of the Circle of Willis in cerebrovascular events?

<p>It can influence the severity and outcome of cerebrovascular events, depending on its completeness and variations (B)</p> Signup and view all the answers

What is the primary function of the superior cerebellar artery?

<p>Supplying blood to the upper part of the cerebellum, pons, and cerebral peduncles (C)</p> Signup and view all the answers

Which statement accurately describes the difference between the anterior and posterior cerebral circulation?

<p>The anterior circulation primarily supplies the front of the brain, while the posterior circulation supplies the back half (D)</p> Signup and view all the answers

What is the significance of the fact that the internal carotid arteries and vertebral arteries course through the neck and base of the skull?

<p>It enables a pathway for blood to reach the brain from the heart (C)</p> Signup and view all the answers

Which statement BEST describes the role of the Circle of Willis in ensuring comprehensive care within an interdisciplinary team?

<p>It facilitates communication and collaboration among team members by providing anatomical information about the brain (C)</p> Signup and view all the answers

Which brain region is MOST likely to be affected by a blockage in the anterior cerebral artery (ACA)?

<p>Frontal lobe (B)</p> Signup and view all the answers

What is the significance of the anterior cerebral artery being crucial for higher cognitive functions?

<p>It is involved in critical functions like reasoning, planning, and voluntary movement (E)</p> Signup and view all the answers

Which statement BEST describes the relationship between the Circle of Willis and the posterior circulation?

<p>The Circle of Willis connects to the posterior circulation through specific arteries (B)</p> Signup and view all the answers

Which artery is MOST likely to be affected by a cerebral aneurysm?

<p>Internal carotid artery (B)</p> Signup and view all the answers

Flashcards

Auditory Cortex

Part of the temporal lobe that processes sound information.

Broca's Area

Region critical for speech production and articulation, located in the frontal lobe.

Olfactory Bulbs

Forebrain structures that process smell information.

Cortical Homunculus

Map showing brain areas controlling specific body parts.

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Primary Motor Cortex

Frontal lobe area responsible for voluntary movements.

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Primary Somatosensory Cortex

Parietal lobe area processing sensory information from the body.

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Contralateral Representation

Each brain hemisphere controls the opposite body side.

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Frontal Lobe

Brain region involved in cognitive functions and voluntary movement.

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Wernicke’s Area

Region of the temporal lobe critical for language comprehension.

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Temporal Lobe

Part of the brain that processes auditory information and memory formation.

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Parietal Lobe

Lobe responsible for sensory perception and spatial orientation.

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Broca’s Aphasia

Language disorder affecting speech production, often with comprehension intact.

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Wernicke’s Aphasia

Language disorder affecting comprehension, usually speaking fluently but nonsensically.

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Insular Cortex

Brain region involved in emotion, perception, and self-awareness.

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Limbic System

Set of structures involved in emotion, memory, and motivation.

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Cerebrum

Part of the brain that performs higher functions like interpreting touch and reasoning.

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Cerebral Cortex

Outermost layer of the brain responsible for higher thought and processing.

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Left Hemisphere Function

Dominant hemisphere responsible for logic, language, and analytical tasks.

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Wernicke's Area

Language center involved in verbal comprehension located in the left hemisphere.

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Right Hemisphere Function

Non-dominant hemisphere involved in creativity and visual-spatial tasks.

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Central Sulcus

A groove that separates the frontal and parietal lobes of the brain.

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Cerebellum

Part of the brain that coordinates muscle movements and balance.

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Thalamus

Relay station for motor and sensory information in the brain.

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Corpus Callosum

Massive band of white matter connecting the two brain hemispheres.

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Somatosensory Cortex

Processes sensory information from the body, located in the parietal lobe.

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Cingulate Gyrus

Involved in emotion and behavior regulation, part of the limbic system.

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Occipital Lobe

Region of the brain that processes visual information.

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Lateral Sulcus

Groove that separates the temporal lobe from the frontal and parietal lobes.

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Apraxia

A neurological disorder affecting learned movements despite understanding requests.

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Functions of the Occipital Lobe

Interprets visual information and contains the primary visual cortex.

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Visual Disturbances

Symptoms of occipital lobe damage, including visual agnosia, partial blindness, and hallucinations.

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Insular Lobe

A lobe integrating visceral and sensory information, contributing to emotional processing.

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Interoception

The ability to sense internal bodily states, influenced by emotional experiences.

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Functions of the Insular Lobe

Involved in memory, emotional regulation, multi-sensory integration, and autonomic control.

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Circle of Willis

A circular artery system providing blood flow to all brain parts and alternative pathways if blocked.

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Main Arterial Components

Includes anterior/posterior cerebral arteries, internal carotid arteries, and vertebral artery in the Circle of Willis.

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Implications of Understanding the Circle of Willis

Helps design rehabilitation programs post-stroke by identifying affected brain areas.

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Internal carotid arteries

Arteries that supply oxygen-rich blood to the front part of the brain.

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Vertebral arteries

Arteries supplying blood to the posterior part of the brain.

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Anterior communicating artery

Small vessel connecting left and right anterior cerebral arteries.

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Middle Cerebral Artery (MCA)

The largest cerebral artery supplying the lateral cerebral cortex.

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Anterior cerebral artery (ACA)

Artery that supplies the medial portions of frontal and parietal lobes.

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Posterior cerebral artery (PCA)

Artery supplying the occipital lobe and parts of the temporal lobe.

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Contralateral hemiplegia

Weakness on one side of the body due to brain damage.

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Cerebellar ataxia

Loss of coordination and control of muscle movements.

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Aneurysms

Bulges in blood vessel walls that can rupture.

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Subarachnoid space

Area between the arachnoid membrane and pia mater surrounding the brain.

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Homonymous hemianopsia

Loss of half of the visual field on the same side in both eyes.

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Basilar artery

Artery formed by the union of two vertebral arteries, supplying brainstem and cerebellum.

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Cerebral circulation

Blood flow in the brain, vital for its functions.

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Anterior Inferior Cerebellar Artery

A branch off the basilar artery supplying the anterior and inferior cerebellum, dorsolateral medulla, and lower pons.

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Symptoms of Anterior Inferior Cerebellar Artery Damage

Includes vertigo, nausea, vomiting, nystagmus, dysarthria, hearing loss, tinnitus, and facial paralysis.

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Posterior Inferior Cerebellar Artery

The largest branch of the vertebral artery, supplying blood to the cerebellum and common location for strokes.

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Symptoms of PICA Damage

Includes headaches, vertigo, nausea, vomiting, and ataxia due to impaired blood flow.

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Vertebrobasilar Arteries

Include vertebral arteries and basilar artery supplying blood to the back of the brain.

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Symptoms of Vertebrobasilar Occlusion

Slurred speech, swallowing difficulty, double vision, and ataxia can result from occlusion.

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Vertebrobasilar Insufficiency

Results in symptoms like numbness, weakness, vertigo, and head/neck pain due to inadequate blood flow.

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Cerebral Veins

Drain blood from the brain into the dural sinuses, divided into superficial and deep veins.

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Superior Sagittal Sinus

Largest dural sinus draining from the brain’s hemispheres to the transverse sinuses.

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Cranial Meninges

Three protective layers (dura, arachnoid, pia) surrounding the CNS, supporting blood flow and cushioning the brain.

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Subdural Hemorrhage (SDH)

Bleeding between the dura mater and arachnoid mater from a torn blood vessel.

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Subarachnoid Hematoma (SAH)

Life-threatening bleeding between the pia mater and arachnoid due to a ruptured vessel.

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Lumbar Puncture (LP)

Procedure inserting a needle into the spinal canal to collect cerebrospinal fluid.

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Ischemic Stroke

Stroke caused by a clot blocking a blood vessel to the brain.

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Hemorrhagic Stroke

Stroke resulting from a burst blood vessel in the brain.

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Reperfusion

Restoration of blood flow to areas deprived of oxygen.

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tPA/TNK

Medications used for thrombolysis in ischemic strokes.

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Thrombectomy

Surgical process to remove a thrombus from a blood vessel.

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Anterior Cerebral Artery

Supplies blood to the medial aspects of the frontal and parietal lobes.

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Posterior Cerebral Artery

Supplies the occipital lobe and parts of the thalamus.

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Hydrocephalus

Condition caused by excessive cerebrospinal fluid (CSF) in the ventricles.

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Cerebral Aqueduct

Connects the 3rd and 4th ventricles, carrying CSF.

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Lateral Ventricles

Largest ventricles in the brain storing CSF; connected to the 3rd ventricle.

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Ventricular System

System of interconnected cavities in the brain containing CSF for cushioning.

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Dura Mater

Thick, outermost layer of meninges, attaches to the skull's inner surface.

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Arachnoid Mater

Spiderweb-like middle layer of meninges filled with fluid.

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Pia Mater

Delicate innermost layer of meninges, closely adheres to the brain.

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Epidural Space

Space between the skull and dura mater, contains no adipose tissue.

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Subdural Space

Space between the dura mater and arachnoid mater; can expand if trauma occurs.

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Falx Cerebri

Sickle-shaped structure separating the cerebral hemispheres.

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Tentorium Cerebelli

Tent-like structure separating cerebellum from cerebrum.

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Falx Cerebelli

Thin fold of dura mater separating the cerebellum's hemispheres.

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Dural Reflections

Folds of dura mater creating partitions within the cranial cavity.

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Cerebrospinal Fluid

Fluid that cushions and protects the brain and spinal cord.

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Meningitis

Infection of the meninges, may lead to serious complications.

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Meningiomas

Slow-growing tumors developing in the meninges.

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Epidural Hematoma

Collection of blood between the skull and dura mater, often due to injury.

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Hyperacute Stage Symptoms

Sudden onset of face, arm, leg weakness; vision loss.

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NIH Stroke Scale

Standard assessment tool for stroke severity, scored from 0 to 42.

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NIH Stroke Scale Levels

Scores indicate stroke severity; higher scores mean greater impairment.

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Imaging Tests Post-Stroke

CT, CTA, MRI, help identify stroke type and severity.

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Head CT Purpose

Initial imaging to differentiate hemorrhage from ischemic stroke.

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tPA Administration

Clot-busting drug for ischemic stroke given within 4.5 hours of symptoms.

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Penumbra in Stroke

Brain area at risk but salvageable if treated quickly after a stroke.

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Hemorrhagic Conversion

Bleeding into the brain after restoration of blood flow post-stroke.

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Criteria for tPA

Must show ischemic stroke, neurologic deficit, symptoms within specific time.

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Limitations of MRIs

Cannot be used for patients with pacemakers; more costly and time-consuming.

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CT vs. MRI in Stroke

CT is faster; MRI provides better resolution and earlier ischemia detection.

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Acute Stroke Signs

Sudden weakness, vision loss, trouble speaking, severe headache, dizziness.

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Thrombectomy Purpose

Surgical removal of a clot to restore blood flow after ischemic stroke.

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tPA Contraindications

Conditions preventing tPA use include recent trauma, bleeding, or high blood pressure.

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Stroke Imaging Guidelines

Immediate imaging essential for identifying large vessel occlusions for treatment.

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Study Notes

Cerebrum and Cerebral Cortex

  • The cerebrum is responsible for higher-level functions like interpretation of senses, speech, reasoning, emotions, learning, and movement.
  • It consists of two cerebral hemispheres and subcortical structures.
  • The left hemisphere is typically dominant, controlling the right side of the body and associated with logic and analytical reasoning, and houses language centers. Broca's area is for verbal expression and speech production. Wernicke's area deals with verbal comprehension.
  • The right hemisphere is non-dominant, controlling the left side of the body and associated with creativity, visual spatial processing, and facial recognition.
  • The cerebral cortex is the outermost gray matter layer, heavily folded into gyri and sulci. It's divided into motor, sensory, and association areas.
  • Motor areas include the primary motor cortex, premotor cortex, and supplementary motor cortex.
  • Sensory areas include the primary somatosensory, primary visual, and auditory cortexes. Other areas are dedicated to smell, taste, and vestibular senses.
  • Association areas integrate information from multiple brain regions for complex sensory perceptions, cognitive functions, and motor processes.

Cerebellum and Brainstem

  • The cerebellum, located under the cerebrum, coordinates muscle movements and maintains posture and balance.
  • The brainstem acts as a relay center connecting the cerebrum and cerebellum to the spinal cord.

Surface Features - Lobes and Landmarks

  • Sulci (grooves) and gyri (ridges) divide the cerebral hemispheres into four lobes: frontal, parietal, temporal, and occipital.
  • Lateral sulcus and central sulcus are major sulci.
  • The central sulcus separates the frontal lobe from the parietal lobe.
  • The parietal-occipital sulcus separates the parietal lobe from the occipital lobe.
  • The cingulate sulcus and calcarine sulcus are other important sulci.
  • Frontal lobe: responsible for cognitive and motor functions, including voluntary movement, executive functions (problem-solving, reasoning, planning, attention, and working memory), and expressive language (Broca's area).
  • Parietal lobe: responsible for sensory perception and spatial awareness, including proprioception.
  • Occipital lobe: processes visual information and contains the primary visual cortex.
  • Temporal lobe: processes auditory information and is important for language comprehension (Wernicke's area), memory formation, and emotion regulation.
  • Insular cortex: located deep within the lateral sulcus, integrating visceral, pain, and temperature sensations, involved in interoception, emotional processing, and other functions.

Corpus Callosum and Other Substructures

  • The corpus callosum is a massive band of white matter connecting the cerebral hemispheres. Its components (from anterior to posterior) are the rostrum, genu, body, and splenium.
  • The anterior commissure lies beneath the corpus callosum.
  • Precentral gyri are entirely motor, while postcentral gyri are entirely sensory.
  • The cingulate gyri is part of the limbic system and involved in behavior, pain, memory, attention, and autonomic motor function.
  • Cuneus (wedge-shaped) plays a role in visual processing.
  • The uncus is a hook-shaped structure in the temporal lobe, involved in memory, emotions, and smell.
  • The thalamus is an egg-shaped structure that acts as a relay station for sensory and motor information from the body.

Surface Features - Inferior Aspect

  • The longitudinal fissure separates the two cerebral hemispheres.
  • The olfactory bulb processes smell information.
  • The optic chiasm is where optic nerve fibers cross to allow both eyes' visual information to be processed by the occipital cortex.
  • The midbrain is the topmost part of the brain stem and a connector between the brain and spinal cord.
  • Temporal pole, frontal pole, occipital pole, and uncus are identifiable landmarks on the inferior aspect.

Functional Areas of the Cerebral Cortex

  • Primary cortexes: receive information from various lobes to carry out body movements. Association with premotor regions plans and executes these movements.
  • Premotor cortex: plans more complex movements by processing sensory information.
  • Somatosensory cortex: receives touch and pressure information from the body via the thalamus and processes sensory information, spatial awareness.
  • Occipital lobe: contains the primary visual area and language processing and reading areas (Wernicke's).
  • Auditory cortex: in the temporal lobe, processes auditory information and is responsible for hearing.
  • Broca's area: critical for speech production.
  • Olfactory bulbs: process smell information.

Cortical Homunculi

  • The cortical homunculus illustrates the distorted representation of body parts in the primary motor and somatosensory cortices to reflect the degree of precision/complexity of sensation or movement.
  • Contralateral representations: One hemisphere of the brain controls and receives information from the opposite body side.

Brain Blood Supply

  • The Circle of Willis is a ring-shaped network at the base of the brain, ensuring blood supply to all parts of the brain via alternative pathways in case of blockages.
  • Major components: Anterior/posterior cerebral arteries, anterior communicating artery, internal carotid arteries, posterior cerebral arteries, posterior communicating arteries, basilar artery, and vertebral arteries.
  • Arising from the internal carotid arteries are three main branches: Anterior Cerebral Artery (ACA), Middle Cerebral Artery (MCA), and Posterior Cerebral Artery(PCA).
  • Anterior circulation (internal carotid arteries) supplies the majority of the cerebrum, with the largest artery being the MCA.
  • Posterior circulation (vertebral and basilar arteries) supplies the brainstem and cerebellum.
  • Cerebellar and brainstem vasculature includes the superior cerebellar artery, anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (PICA).
  • These arteries have specific functions and areas supplied, with injuries yielding particular sets of neurological impairments.

Venous System of the Brain

  • Cerebral veins drain blood from the brain to the dural sinuses.
  • Dural sinuses are venous channels in the dura mater (eg. Superior sagittal sinus, transverse sinus, and sigmoid sinus).
  • Drainage pathway: Superior sagittal sinus to transverse sinus to sigmoid sinus to internal jugular veins.

Cranial Meninges

  • The meninges (dura mater, arachnoid mater, pia mater) surround and protect the CNS.
  • Dura mater: thick, outermost layer, with two layers (meningeal and periosteal), houses dural sinuses and reflections.
  • Arachnoid mater: thin, middle layer with trabeculae connecting to the pia mater and containing cerebrospinal fluid, providing a cushioning effect.
  • Pia mater: innermost layer, tightly adhering to the brain's surface, highly vascularized, aiding in the blood-brain barrier and containing CSF.
  • Cranial spaces include epidural, subdural, and subarachnoid.
  • Meningitis, meningiomas, hematomas/hemorrhages (epidural, subdural, subarachnoid) are clinically relevant conditions.

Clinical Relevance of Stroke

  • Stroke: is a leading cause of disability. Ischemic stroke occurs when a vessel is blocked; hemorrhagic stroke involves a blood vessel bursting.
  • Common signs and symptoms: Sudden weakness/numbness, vision loss, speech difficulty, severe headache, dizziness/falls.
  • NIH Stroke Scale: measures stroke severity via a neurological examination to predict outcomes.
  • Acute stroke management: Imaging (CT, MRI, angiographies), clot-busting medications (tPA, TNK), thrombectomy for reperfusion.
  • Stroke-Related Terminology: Penumbra (reversible tissue injury); hemorrhagic conversion (complication from tPA, reperfusion).
  • Types of strokes with focus on blood vessels affected and associated symptoms.

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