Brain

Brain

1. Abnormal

   • Unilateral weakness
     • Causes
       • Vascular
         • Cerebral hemorrhage
         • Stroke
           • Types
             • Ischemic
               • Thrombotic
                 • Pale
                 • Basilar artery / MCA / Internal carotid
               • Embolic
                 • Reperfusion / Hemorrhagic
             • Intracerebral hemorrhage
               • Stress imposed by HTN / Charcot-Bouchard microaneurysm
               • Basal ganglia / Thalamus / Cerebellum
             • Subarachnoid hemorrhage
               • Rupture of berry aneurysm / AV malformation
               • At the junction of common Arteries
               • Xanthochromia
               • Sever occipital headache
             • Lacunar stroke
               • Cystic areas <1 cm
               • Hyaline
               • Arteriolosclerosis 2nd to HTN & DM
           • Symptoms
             • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
               • Facial nerve (UMNL / LMNL)
             • Sudden confusion / Trouble speaking / Difficulty understanding speech
             • Sudden trouble seeing in one or both eyes
             • Sudden trouble walking / Dizziness / Loss of balance / Lack of coordination
             • Sudden severe headache
               • Types of headache
                 • Primary
                   • Tension headaches / Cluster headaches / Migraines
                 • Secondary
                   • Allergy headaches / Hormone headaches / Caffeine headaches / Exertion headaches / Hypertension headaches / Rebound headaches / Post-traumatic headaches
           • Investigations
             • Lab tests
               • Complete Blood Count (CBRC) / Prothrombin time (PT) and INR / Partial thromboplastin time (PTT) / Blood glucose / Electrolytes / Cholesterol / HDL and LDL
             • Radiological
               • CT / MRI / Carotid Ultrasound / Cerebral Angiogram / Echocardiogram
           • Complications
             • Brain edema / Pneumonia / UTI / Seizures Bedsores / Limb contractors / Spasticity / Shoulder pain / DVT / Dysarthria / Dysphagia / Aphasia / Memory loss / Thinking difficulties / Vasospasm / Second stroke / Hemorrhagic transformation of ischemic stroke / Depression
           • Management
             • ABC / CT Scan and Glucose Test / Pharmacological and non-pharmacological reperfusion
             • Secondary Prevention
               • Noncardioembolic
                 • Antiplatelet therapy / Aspirin / Clopidogrel / Aspirin + extended-release dipyridamole
               • Cardioembolic (Atrial fibrillation)
                 • Warfarin (INR = 2.5) / Dabigatran
               • Atherosclerosis + LDL > 100 mg/dL
                 • High intensity statin therapy
               • BP > 140/90
                 • BP reduction
             • Revascularization Procedures
               • Carotid Endarterectomy
               • Carotid Stenting
               • Thrombectomy / Embolectomy
       • Infective
         • Encephalitis / Meningitis / Brain abscess
       • Neoplastic
         • Meningioma / Brain tumors / Spinal cord tumors
       • Demyelination
         • Multiple sclerosis
       • Traumatic
         • Cerebral lacerations / Hematoma/ Vertebral compression fracture
       • Iatrogenic
         • local anaesthetic injections given intra-arterially rapidly, instead of given in a nerve branch
       • Degenerative
         • Corticobasal degeneration
       • Parasomnia
         • Sleep paralysis

2. Normal

   • Blood Supply
     • Arterial Supply
       • Carotid System
         • 2 Internal carotid arteries
       • Vertebro-Basilar System
         • 2 Vertebral arteries
         • At the base of the brain branches of both systems anastomose to form the Circle of Willis
           • Circle of Willis
             • A polygonal arterial circle on the base of the brain (interpeduncular fossa) surrounding the optic chiasma
             • Arteries sharing the Circle of Willis
               • Single Anterior communicating artery
               • Two Anterior cerebral arteries
               • Two Internal carotid arteries
               • Two Posterior communicating arteries
               • Two Posterior cerebral arteries
     • Venous Drainage
       • Two Systems
         • Superficial veins
           • Drain into superior sagittal sinus (bridging veins)
           • Their laceration causes subdural hematoma
         • Deep veins
       • Devoid of valves and lying along the superficial sulci
       • Drain from the cortex and subcortical tissues
       • Terminate in the dural venous sinuses

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