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Stroke Awareness Session: Time is Brain

Understand the signs, symptoms, and neuroanatomy of stroke to act fast in emergencies. Learn about brain regions and arterial circulation for effective response. Knowledgeable presenter outlines key deficits associated with strokes in different brain lobes.

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Stroke Awareness Session: Time is Brain

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  1. Stroke Time is Brain Janet Liefso Acute Stroke Coordinator

  2. Acknowledgement to: Richard Wilson Linda Kelloway Andrea Fisher Work revised by: Janet Liefso, 2010

  3. Objectives For Session • Increase Stroke Recognition - signs and symptoms • Review Basic Neuroanatomy • the implications of stroke location • Review complications

  4. Jim • 67 year old semi- retired accountant married to Laura. From Niagara region - visiting friends in Teeswater • Suddenly at 2100 hours wife witnessed right arm weakness and leg weakness, unable to get up on own, speech slurred • Wife called 911- paramedics responded and redirected Jim to Goderich Hospital on stroke protocol- arrived at 2130. • Diagnosed as an ischemic stroke- given tPA at new telestroke site at 2220

  5. What Happened?

  6. Stroke is a Brain Attack • Abrupt development of a focal neurological deficit as a consequence of a local disturbance in the cerebral circulation

  7. Know the Warning Signs of Stroke • Sudden Weakness • Sudden Trouble Speaking • Sudden Vision Problems • Sudden Headache • Sudden Dizziness (especially with any of the above signs)

  8. Stroke Stroke is undoubtedly one of the most devastating events experienced by humans “Many stroke victims would rather die than live without their dignity and quality of life” Bahle, J. (1998).

  9. Key Message Stroke is an Emergency Act Fast * 6 Million Neurons a Minute are lost Time is Brain Dr. Lownie

  10. Basic Neuro-anatomy

  11. Left Brain and Right Brain

  12. THE BRAIN IS DIVIDED INTO 3 MAJOR AREAS • Cerebrum • Brain stem • Cerebellum 1 3 2

  13. THE CEREBRUM IS COMPOSED OF FOUR LOBES Each lobe has many functions

  14. THE BRAIN STEM HAS 3 MAJOR DIVISIONS • Midbrain • Pons • Medulla 1 2 3

  15. THE CEREBELLUM www.injuryprevention.ca

  16. Follow the circulation to the brain in the following slides….

  17. The Carotid Arteries Anterior & middle cerebral arteries Anterior & middle cerebral arteries R Internal carotid L Internal carotid Common carotid a Common carotid a L subclavian a R subclavian a ANTERIOR VIEW Aorta

  18. Vertebral-basilar Arteries Posterior cerebral a’s Basilar a L. Vertebral a R Vertebral a L subclavian a R subclavian a POSTERIOR VIEW Aorta

  19. Anterior and middle cerebral a’s Post communicating a Post cerebral a Basilar a Internal Carotid Vertebral a Common carotid Subclavian a Aorta

  20. CIRCLE OF WILLIS Anterior Communicating artery Anterior C. artery Internal carotids Post. Communicating artery Posterior C. artery Basilar C. artery

  21. Circle of Willis Inferior view Ant. communicating a Anterior cerebral arteries Middle cerebral arteries Internal carotid arteries Post Communicating a’s Posterior cerebral arteries Basilar artery Vertebral arteries 22

  22. CIRCULATION WITHIN THE LOBES OF THE BRAIN IS OFTEN SUPPLIED BY MORE THAN ONE CEREBRAL ARTERY E.g.. ACA and MCA to the frontal lobe

  23. Generally, the Anterior Cerebral Artery (ACA) runs between the left and right hemispheres of the brain within the great longitudinal fissure. Longitudinal fissure

  24. Generally, the Middle Cerebral Artery (MCA) runs on the lateral side of the 2 hemispheres and portions of the ventral (bottom) side of the lobes.

  25. Generally, the Posterior Cerebral Artery (PCA) is located on the bottom of the brain.

  26. POSTERIOR CEREBRAL ARTERY Note the ventral location of this artery

  27. DEFICITS IN A PATIENT WITH A STROKE CAN BE EXPLANED BY: • AREAS OF THE BRAIN • CIRCULATION OF THE BRAIN • AND/OR A COMBINATION OF BOTH

  28. A STROKE IN FRONTAL LOBE BLOOD SUPPLIED BY ACA AND MCA THIS PATIENT MAY EXPERIENCE: • Contralateral paralysis or paresis of face, arm, leg • Difficulty expressing language “ stuttering, using wrong word, articulation, repeating word(s)” (BROCA’S APHASIA) • Urinary incontinence • Personality changes and emotional lability • ,

  29. FRONTAL LOBE CONTINUED IMPORTANT STRUCTURES Controls ability to express language

  30. FRONTAL LOBE CONTINUED IMPORTANT STRUCTURES Primary motor strip Control of muscle movement

  31. “ Homunculus” DEFINITION : A figurative representation of the body map encoded in the primary motor cortex ( strip )

  32. A STROKE IN PARIETAL LOBE BLOOD SUPPLIED BY ACA, MCA, PCA THIS PATIENT MAY EXPERIENCE • Sensory deficit – loss of sensation i.e. pain, pressure, touch • Neglect – patient does not recognize a body part • Denial of deficits (often with neglect)

  33. PARIETAL LOBE CONTINUED Parietal lobe The primary sensory cortex (strip) of the parietal lobe is arranged in the same topographic scheme as the motor strip in the frontal lobe.

  34. A STROKE IN TEMPORAL LOBE BLOOD SUPPLIED BY MCA AND PCA THIS PATIENT MAY EXPERIENCE • Severe communication problem : loss of comprehension of spoken language • ( Receptive Aphasia also called Wernicke’s Aphasia) • Memory loss or disturbances in memory • Aggressiveness

  35. Note location of Wernicke’s Area

  36. A STROKE IN OCCIPITAL LOBE BLOOD SUPPLIED BY MCA AND PCA THIS PATIENT MAY EXPERIENCE VISUAL DISTURBANCES • Types of blindness- total or hemianopsia’s • Loss of recognition of objects when shown them • Hallucinations

  37. IF A STROKE IN CEREBELLUM BLOOD SUPPLIED BY VERTEBROBASILAR ARTERIES PATIENT MAY EXPERIENCE • A gait that looks similar to an inebriated person • Poor balance • Complaints of dizziness, light headedness, “floating”

  38. BLOOD SUPPLIED BY VERTEBROBASILAR AND PCA A STROKE IN THE BRAIN STEM The signs and symptoms depend on the location of the stroke in the 3 areas of the brain stem Mid brain Pons Medulla

  39. KEEP IN MIND THAT THE AREAS INTERACT AND SHARE FUNCTION TO SOME DEGREE

  40. A STROKE IN THE MEDULLA • dysphagia • cardiac, respiratory, blood pressure difficulties • limb weakness

  41. A STROKE IN THE PONS Respiratory function can be effected and often this stroke is so severe that the patient may die.

  42. Types of Stroke • Ischemic (80 %) • Caused by blockage of an artery • Usually the result of a blood clot Thrombotic or embolic • Hemorrhagic (20%) - Caused by an arterial rupture Subarachnoid hemorrhage (SAH) Intracerebral Hemorrhage (ICH)

  43. Stroke Types CIHI/NACRS, 2005-06

  44. Definition of TIA • TIA = transient ischemic attack – resolution must be complete • Sudden onset of focal neurological dysfunction, presumably of vascular origin, lasting less than 24 hours. • 1/3 last less than 15 min • 70% < 1 hour • 10 % more than 12 hours • No permanent damage

  45. Mechanism of Stroke

  46. Ischemic (80%) Hemorrhagic(20%)

  47. What is tPA? • Clot buster • Works by dissolving the clot that is blocking the vessel in the ischemic stroke patients • Not all patients are eligible • Must be initiated within 4.5 hrs. from onset of symptoms • Given by IV bolus and infusion- takes about 1 hour

  48. Penumbra

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