The Anatomy & Physiology

of Stroke
Objectives of this Session:
• Define the Anatomy of the Brain and
Cerebral Vascular System
• Recognize the Dynamics of a Stroke
or “Brain Attack”
• Comfort Level with CT in the Evaluation
 Stroke
Br
dema
ain
E
At

A
tac
t
rc
fa

CV
In

Ischemia
Hem
orrh
age

TIA Embolus
 First Things First, Some Definitions…….
CVA-Cerebral Vascular Accident-Stroke caused by pathologic
changes in intra or extra cranial blood supply
Edema-Swelling in tissue or structure, usually due to traumatic event
Embolus- abnormal mass of undissolved material that is transported
from one part of the circulation to another
Hemorrhage-Bleeding, or the act of bleeding outside of a vessel
Ischemic (Ischemia)Inadequate blood supply to an area of tissue
Infarct-Localized death (necrosis) of brain tissue due to loss of
blood supply
TIA- Transient Ischemic Attack, “mini stroke” usually causes by
embolus
Thrombus-A solid mass formed in a Blood Vessel by deposition of
elements from circulating blood
 The Brain
Major Anatomy
 What’s This White Matter
Gray Matter Stuff-

Brain Structure is defined by

areas of the brain and tissue
types within those areas.
In normal brain development
some tissue is Myelinated (white
matter) and some is not (gray
matter)
Myelin is hypothesized to aid in
nerve impulse conduction and
nerve cell support.

Disease states(Multiple Sclerosis)

can cause De-Myelination or
Gray Matter White Matter
destruction of white matter.
 Some Statistics and Definitions…….
• Stroke is a Cardiovascular Disease

• Four main types of Stroke

• 2 Caused by Blood clots (80%)
• Ischemic
• Cerebral Thrombosis
• Cerebral Embolism
• 2 Caused by Hemorrhage(20%)
•Hemorrhagic
• Cerebral Hemorrhage
• Subarachnoid Hemorrhage

• Stroke is now the # 3 killer of Americans

• Stroke is the # 1 Cause of Serious Disability of Americans
* Source American Heart Association
Definition of a Stroke……………..

A Stroke is a result of a blood vessel

getting “clogged” or a blood vessel
bursting . The part of the brain that
is perfused by the blood vessel then
looses the ability to function and the
parts of the body controlled by that
part of the brain looses function.
Stroke……….Treatment and Interventions
The first three hours of a stroke are
termed the “critical period.” It is in this
period of time that a stroke needs to be
diagnosed and treated if there is a
reasonable chance of survival of affected
brain tissues.

Treatment of stroke is usually via a delivery

of TPA or a Uro-Kinase type of
pharmaceutical that dissolves the thrombus
and allows for re-perfusion of the affected
brain tissue. Surgical or interventional
techniques may also be used to address
issues.
 Factors Contributing to Stroke
Manageable Less Manageable
• High Blood Pressure • Age (risk doubles after each
decade after 55)
• Heart Disease
• Male (19% greater risk)
• Cigarette Smoking
• Race (African American have
• Transient Ischemic higher risk)
Attacks (TIA)
• Diabetes Mellitus (HBP
• High Red Blood Correlation)
Count • Heredity
• Prior Stroke
Other Factors: Geographic location, Season and climate, Socioeconomic
factors , Excessive alcohol intake, Drug abuse
 The danger of embolus
releasing from a thrombus
and totally obstructing
a distal vessel to form an
ischemic infarct of tissue

Thrombus
Cross section of
Blood vessel

Other imaging techniques can be used to diagnose Thrombus

thrombus. Ultrasound, is non-invasive and cost
effective. Angiographic procedures and MR angio Emb
olu
s
can be major tools but can also have deleterious
effects due to embolus or vessel injury.
CT is effective tool for Stroke Analysis Em
bolu
s
 Arterial Blood Supply to
the Brain…...
Collateral Circulation is
Possible and that is important
in keeping tissue at risk alive
Anterior Cerebral
Internal Carotid
Middle Cerebral
Posterior Cerebral
Lets Check Out The Plumbing
Anterio-Cerebral Artery
Middle Cerebral Artery
Posterior Cerebral Artery
Basilar Artery
External Carotid Artery
Internal Carotid Artery
Carotid Bifurcation

Vertebral Arteries

Common Carotid Arteries

Subclavian Artery
Brachio-cephalic Artery
Aortic Arch
Circle of Willis and Associated Anatomic Structures
…………………..Up close and personal:
The Dynamics of a Brain Attack………….

The degree of thrombus or

stenosis and location will have
a direct effect on severity of
the ischemic event
 The result of a Brain Attack…..

Area of Ischemic
Infarct in Right
Temporal-Parietal
Region of the Brain

Remember that innervation

is opposite for brain and
body…. Most right sided
strokes affect left sided
anatomy and vice versa
 LightSpeed
Stroke Evaluation
Case

Images Courtesy of
Dr. Lawrence Tanenbaum
Edison Imaging
LightSpeed Case Study of Ischemic Infarct

Images Courtesy of Dr. Lawrence Tanenbaum-Edison Imaging

Summary of Brain Attack:

CT plays a major role in evaluation of

cerebral vascular and brain tissue.
Provides Valuable Information for
Clinical Pathways

• Cardio-vascular disease

• CT is the first line of attack for imaging in

evaluation of Stroke symptoms

• Brain Attack can Affect up to 350,000

deaths a year

• Social and genetic aspects impact susecep-

ability to stroke