In: Anatomy and Physiology
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1: Minute arteries bring blood to areas deep inside the brain. Hypertension can cause minute arteries to rupture, releasing blood into the brain tissue. An intracerebral hemorrhage is usually caused by rupture of tiny arteries within the brain tissue. Ans 2: At the base of the brain, the carotid and vertebrobasilar arteries form a circle of communicating arteries known as the Circle of Willis. From this circle, other arteries—the anterior cerebral artery, the middle cerebral artery , the posterior cerebral artery arise and travel to all parts of the brain. Because the carotid and vertebrobasilar arteries form a circle, if one of the main arteries is occluded, the distal smaller arteries that it supplies can receive blood from the other arteries. The anterior cerebral artery extends upward and forward from the internal carotid artery. It supplies the frontal lobes, the parts of the brain that control logical thought, personality, and voluntary movement, especially of the legs. The middle cerebral artery is the largest branch of the internal carotid. The artery supplies a portion of the frontal lobe and the lateral surface of the temporal and parietal lobes, including the primary motor and sensory areas of the face, throat, hand and arm, and in the dominant hemisphere, the areas for speech. The posterior cerebral arteries stem in most individuals from the basilar artery but sometimes originate from the ipsilateral internal carotid artery. Small, deep penetrating arteries known as the lenticulostriate arteries branch from the middle cerebral artery Occlusions of these vessels or penetrating branches of the Circle of Willis or vertebral or basilar arteries are referred to as lacunar strokes. Ans 3: The affected pupil does not immediately respond to direct or consensual light reflex; however, if light stimulus is prolonged, this pupil will slowly constrict to light and slowly dilate in the dark. Accommodation in the affected pupil is sluggish. The other pupil is of normal size and reacts to light. Ans 4: Smoking. Smoking is linked to both the development and rupture of cerebral aneurysms. Smoking may even cause multiple aneurysms to form in the brain. High blood pressure. High blood pressure damages and weakens arteries, making them more likely to form and to rupture. Size. The largest aneurysms are the ones most likely to rupture in a person who previously did not show symptoms. Family history. A family history of aneurysm rupture suggests a higher risk of rupture for aneurysms detected in family members. Ans 5: An end artery/ terminal artery is an artery that is the only supply of oxygenated blood to a portion of tissue. Because vital tissues such as the brain or heart muscle are vulnerable to ischaemia, arteries often form anastomoses to provide alternative supplies of fresh blood. Comment
Ans1: Minute arteries bring blood to areas deep inside the brain. Hypertension can cause minute arteries to rupture, releasing blood into the brain tissue (Belayev et al., 1996). An intracerebral hemorrhage is usually caused by rupture of tiny arteries within the brain tissue (Mayer et al., 2005).
References
Belayev, L., Busto, R., Zhao, W., & Ginsberg, M. D. (1996). Quantitative evaluation of blood-brain barrier permeability following middle cerebral artery occlusion in rats. Brain Research, 739(1-2), 88–96.
Mayer, S. A., & Rincon, F. (2005). Treatment of intracerebral haemorrhage. The Lancet Neurology, 4(10), 662–672.
Ans 2: At the base of the brain, the carotid and vertebrobasilar arteries form a circle of communicating arteries known as the Circle of Willis. From this circle, other arteries—the anterior cerebral artery, the middle cerebral artery, the posterior cerebral artery arise and travel to all parts of the brain (Lee, 1995). Because the carotid and vertebrobasilar arteries form a circle, if one of the main arteries is occluded, the distal smaller arteries that it supplies can receive blood from the other arteries (Reivich et al., 1961). The anterior cerebral artery extends upward and forward from the internal carotid artery. It supplies the frontal lobes, the parts of the brain that control logical thought, personality, and voluntary movement, especially of the legs (Heimer, 2012; Potagas et al., 2013). The middle cerebral artery is the largest branch of the internal carotid. The artery supplies a portion of the frontal lobe and the lateral surface of the temporal and parietal lobes, including the primary motor and sensory areas of the face, throat, hand and arm, and in the dominant hemisphere, the areas for speech (Robert Teasell et al., 2016). The posterior cerebral arteries stem in most individuals from the basilar artery but sometimes originate from the ipsilateral internal carotid artery. Small, deep penetrating arteries known as the lenticulostriate arteries branch from the middle cerebral artery Occlusions of these vessels or penetrating branches of the Circle of Willis or vertebral or basilar arteries are referred to as lacunar strokes (Rosner et al., 1984).
References
Heimer, L. (2012). The human brain and spinal cord: functional neuroanatomy and dissection guide. Springer Science & Business Media.
Lee, R. M. K. W. (1995). Morphology of cerebral arteries. Pharmacology & Therapeutics, 66(1), 149–173.
Potagas, C., Kasselimis, D. S., & Evdokimidis, I. (2013). Elements of Neurology Essential for Understanding of Aphasias. Aphasia and Related Neurogenic Communication Disorders, 23–47.
Reivich, M., Holling, H. E., Roberts, B., & Toole, J. F. (1961). Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. New England Journal of Medicine, 265(18), 878–885.
Robert Teasell, M. D., & Hussein, N. (2016). Clinical consequences of stroke. Evidence-Based Review of Stroke Rehabilitation. Ontario: Heart and Stroke Foundation and Canadian Stroke Network, 1–30.
Rosner, S. S., Rhoton, A. L., Ono, M., & Barry, M. (1984). Microsurgical anatomy of the anterior perforating arteries. Journal of Neurosurgery, 61(3), 468–485.
Ans 3: The affected pupil does not immediately respond to direct or consensual light reflex; however, if light stimulus is prolonged, this pupil will slowly constrict to light and slowly dilate in the dark (Beatty et al., 2000; Lowenstein, 1954). Accommodation in the affected pupil is sluggish. The other pupil is of normal size and reacts to light (Ciuffreda, 1998).
References
Beatty, J., & Lucero-Wagoner, B. (2000). The pupillary system. Handbook of Psychophysiology, 2(142-162).
Ciuffreda, K. J. (1998). Accommodation, the pupil, and presbyopia. Borish’s Clinical Refraction, 77–120.
Lowenstein, O. (1954). Clinical pupillary symptoms in lesions of the optic nerve, optic chiasm, and optic tract. AMA Archives of Ophthalmology, 52(3), 385–403.
Ans 4: Smoking. Smoking is linked to both the development and rupture of cerebral aneurysms. Smoking may even cause multiple aneurysms to form in the brain(Chalouhi et al., 2012). High blood pressure. High blood pressure damages and weakens arteries, making them more likely to form and to rupture (Ferguson, 1972). Size. The largest aneurysms are the ones most likely to rupture in a person who previously did not show symptoms (Wiebers et al., 1987). Family history. A family history of aneurysm rupture suggests a higher risk of rupture for aneurysms detected in family members (Caranci et al., 2013).
References
Caranci, F., Briganti, F., Cirillo, L., Leonardi, M., & Muto, M. (2013). Epidemiology and genetics of intracranial aneurysms. European Journal of Radiology, 82(10), 1598–1605.
Chalouhi, N., Ali, M. S., Starke, R. M., Jabbour, P. M., Tjoumakaris, S. I., Gonzalez, L. F., Rosenwasser, R. H., Koch, W. J., & Dumont, A. S. (2012). Cigarette smoke and inflammation: role in cerebral aneurysm formation and rupture. Mediators of Inflammation, 2012.
Ferguson, G. G. (1972). Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. Journal of Neurosurgery, 37(6), 666–677.
Wiebers, D. O., Whisnant, J. P., Sundt, T. M., & O’Fallon, W. M. (1987). The significance of unruptured intracranial saccular aneurysms. Journal of Neurosurgery, 66(1), 23–29.
Ans 5: An end artery/ terminal artery is an artery that is the only supply of oxygenated blood to a portion of tissue (Scharrer, 1944). Because vital tissues such as the brain or heart muscle are vulnerable to ischemia, arteries often form anastomoses to provide alternative supplies of fresh blood (Mitchell, 2005).
References
Mitchell, R. N. (2005). Hemodynamic disorders, thromboembolic disease, and shock. Pathologic Basis of Diseases, 8th Ed.; Kumar, V., Abbas, AK, Fausto, N., Aster, JC, Eds, 111–134.
Scharrer, E. (1944). The blood vessels of the nervous tissue. The Quarterly Review of Biology, 19(4), 308–318.