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Stroke & its consequencesPatient WW• Medical history:
– History of high blood pressure (hypertension)– Massive Stroke in Right Hemisphere
• Behavioral changes:– Partially paralyzed on left side.– Poor emotional control and judgment.– Unaware of his illness (anosognosia).
WW was Woodrow Wilson, 28th US President of USA
Special thanks to Chris Rorden, U. South Carolina
• Similar cases exist today– Sen Tim Johnson (D-South Dakota)– An hemorrhagic stroke (arteriovenous malformation)
StrokeStroke is a leading cause of disability. In western world:
1. Heart Disease2. Stroke (10% of deaths worldwide)3. Cancer
In USA alone- 500,000 people suffer stroke per year- 150,000 people die of stroke per year- 4 million living with stroke- $30 billion in health care costs
• 2/3 of strokes in people > 65 y-old
types of stroke
thrombotic emobolic
Ischemic (80%):the brain artery is clogged
(aka obstructive)
Haemorrhagic (20%):the brain artery ruptures: bleeding
- Some are transitory ischemic attacks (TIA).
- ‘Infarct’: Dead tissue following stroke
• Lesions look different depending on:– How old the lesion is: acute vs. 3 days old– Type of scan (CT, MRI)
• Example of Stroke:
T2 MRI
CT
acute +3days
newer MRI protocols• Diffusion-weighted imaging
– Strokes show up immediately.– Shows permanent white-matter damage.
•
Imaging Infarcts
• MRA (Magnetic Resonance Angiography):
MRI MRA stroke MRA Xray
Obstructive strokes: treatment
• Treatment:– Counterindicated for haemorrhagic strokes
• Prevention of all strokes– Control blood pressure– No smoking– Reduce cholesterol
– stent
Neuronal death in stroke
1. Obstruction 2. Reduction of O2 & glucose 3. Na/K pump stops working:4. Increase in action potentials5. Release of glutamate
1. Open Na channels -> Na rushes in -> so does water -> swelling 2. open Ca channels -> activate enzymes -> lesion cell
Stroke: Consequences
• As always, it depends on which brain area is affected
Example: – Haemorraghic Stroke: It usually lesions orbitofrontal cortex
Haemorrhagic strokes• aneurysm ruptures bleeding
• Symptoms:– Really bad headache .– Throwing up– Other neurological symptoms
• Treatment: Surgery to clip aneurysm
• Consequences: Orbitofrontal lesion (OFC)
• Symptoms: – Changes in personality
– This is true also of lesion of OFC lesion by other mechanisms (trauma, dementia)
aneurism: a sac-like protrusion of an artery caused by a weakened vessel wall
• symptoms
– Social disinhibition– Poor emotion regulation – Denial of deficit– Inability to navigate the social world
• Anatomy– Orbitofrontal Cortex– Amygdala
orbitofrontal lesion
Visual Areas for recognizing objectsLesion
Activation in fMRI in healthy adults
stimulus
Cerebral Achromatopsia: bilateral damage to V4
Visual brain area for Color perception
Area important for speech
• Left frontal cortex• Non-productive aphasia (broca’s aphasia)
• Also brought about by dementia that affects same area
• http://psych.rice.edu/mmtbn/
Hippocampus
• Memory deficit
• But so does Alzheimer’s disease
In sum
• Two types of stroke– Ischemic– Haemorraghic
Behavioral consequences are determined by location of lesion!
Spared slides
•
Ischemic Strokes
Major Arteries Carotid Anterior Cerebral Middle CerebralPosterior Cerebral
Occlusion of middle cerebral artery (MCA)
• embolism travels up carotid artery
• MCA supplies lateral bank of cortex (image from strokecenter.org)
• Damages regions near superior temporal sulcus (sylvian fissure) (figure shows regions damaged in 24 MCA patients, Mort et al. 2003)