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Patho-
physiology Of
Regulation of Stroke
Cerebral
Blood brain blood flow
barrier and
Brain CSF
Neuroanatomy
Cerebrovascular
neuroanatomy
CEREBROVASCULAR
NEUROANATOMY
• Knowledge of neuroanatomy is crucial for physician.
• To properly understand diseases of the CV system, it is
substantial to have a working knowledge of cerebral circulation.
• Predicting where the lesion is will help you hone in on specific areas on
the head CT during acute stroke
• Understanding the anatomy allows the physician to learn what
regions of the brain are most likely to be affected in any given
clinical case
The blood supply of the brain is maintained by the anterior and the posterior cerebral circulation, see (a), and the
Circle of Willis, see (b), as a backup circulation (adapted from illustrations of Gray (1918), (c) the complex spatial
shape of the Circle of Willis (Saafeld et al, 2015)
Anterior Posterior
Circulation Circulation
Middle
Vertebral
cerebral
artery
artery (MCA)
Anterior
cerebral Basilar artery
artery (ACA)
Internal Posterior
Carotid cerebral
artery (ICA) artery (PCA)
ANTERIOR CIRCULATION ANATOMY :
Medial Cerebral Artery (MCA)
• Is formed at ICA terminus, marked by
bifurcation into middle cerebral artery
(MCA) and anterior cerebral artery (ACA)
branches
• Middle Cerebral Artery :
• MI Segment (horizontal),
• M2 Segment (insular),
• M3 segment (opercular),
• M4 segment (cortical)
MIDDLE CEREBRAL ARTERY (MCA)
MCA Frontal : Prefrontal,
Most of Lateral
frontal eye field,
Supplies Cerebral Cortex,
supplementary,
Frontal, Temporal,
primary motor,
Parietal
broca
Temporal : superior
temporal gyrus Parietal : gyrus
Wernicke area, angularis
subcortical temporal
Basal ganglia,
capsula interna
Cerebral cortex : Frontal Lobe
• Frontal Lobe : It is the
largest lobe, located in
front of the cerebral
hemispheres
TRAKTUS
PIRAMIDALIS
Cortex motorik
Corona radiata
LESI
Capsula interna
UMN
Brainstem
Decussatio Pyramidum
Traktus kortikospinalis lateralis
Cornu anterior
LESI
LMN
Saraf perifer
NMJ
CLINICAL FEATURE OF CEREBRI
MEDIA ARTERY OCCLUSION :
FRONTAL LOBE Dominan Cerebral Hemisphere
• Broca Afasia
Motor cortex:
• Weakness or paralysis of the contralateral face and arm >
leg , upper motor neuron sign
Prefrontal Cortex
• Personality change, Social Disturbance Behaviour
Cornu dorsalis
medulla spinalis
Dominan Hemisphere
A.Right temporal lobe sylvian fissure hematoma Wernicke Aphasia
B. Right MCA aneurysm was found on CTA
CAROTID INTERNA ARTERY
• If the thrombus propagates up to the
internal carotid artery into the MCA, or
embolized it, symtomp are identical to
proximal MCA occlusion
• Internal artery carotid perfuse the optic
nerve and retina via the ophthalmic artery,
in about 25 % symptomatic internal carotid
disease, recurrent transient monocular
blindness (amorousis fugax) warn the
lesion
Anterior Cerebral Artery
• Weakness or
paralysis
Contralateral leg
• Sensory loss
contralateral leg
• Lower limb
hipereflexia
POSTERIOR CIRCULATORY
ANATOMY
Posterior cerebral Inferior
Occipital
temporal thalamus midbrain
artery supplies lobe
lobes
Limb Nausea
Dizziness
weakness Vomiting
Ataxia Headache
POSTERIOR CEREBRAL ARTERY
OCCLUSION CLINICAL MANIFESTATION
Anton
Alexia Contralateral
Syndrom Balint
without homonym Anomia Thalamus
(cortical Syndrom
agraphia hemianopia
blindess)
Thalamic
Ability to pain :
write but Inability Oculomotor contralater
Vision loss,
inability to to apraxia, al
unaware of
read (pure naming optic ataxia, hemibody
blindness simultagnosia
word object pain,
blindness) allodynia,
hiperalgesi
Tunica intima
Tunica media
Tunica adventitia
Ng et al, 2018
ATEROSCLEROSIS
• Thrombotic : blood
clot directly at the
site of infarction
• Embolic : embolus
travel to the site of
infarction
FORMATION OF PLATELET
PLUG
1. Vascular
injury
2. Vasoconstriction
3. Platelet activation
4. Coagulation
cascade
BLOOD BRAIN BARRIER
• Diffusion barrier that regulates
movement of nutrients and waste
products between the CNS and
peripheral circulatory system
• Is formed by endothelial cells
attached to one other by thight
junction, basement membrane,
astrocytic end feet
• Protects CNS from possibly toxic
CEREBROSPINAL FLUID
• Provides mechanical protection for the
brain and the spinal cord
• Cerebrospinal fluid (CSF) is a clear fluid
present in the ventricles of the brain-
central canal of the spinal cord-
subarachnoid space
• CSF produced in the brain by
ependymal cells in the choroid plexus.
CIRCULATION OF CSF
Interventricular
Lateral
foramen of
Ventricles
Monro
Aqueduct of Third
Sylvi Ventricle
Cell death
Patophysiology of Stroke : Cerebral
Hemorrhagic
Conclusion
• Blood supply to the brain is secured by an extensive collateral
circulation system Circle of Willis
• Understanding of normal brain physiology and blood flow,also
neuroanatomy is crucial to predicting where the vascular lesion
• Stroke is a serious neurological disease, and constitutes a major cause
of death and disability throughout the world, with a good
understanding we can give best treatment and diagnose to our
patient
REFERENCE
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