Anatomy and Physiology Basic anatomy of the brain and Signs and symptoms of a stroke

Symptoms Point to Stroke Location A stroke can occur anywhere in the brain or just outside it. The symptoms that a stroke victim experiences depend on which area(s) of the brain are involved. When a stroke occurs in the right hemisphere of the cerebrum, the result may be paralysis on the left side of the body, difficulty reasoning or thinking out solutions to even the simplest problem. A stroke in the left hemisphere can result in paralysis of the right side of the body and may disrupt the ability to speak. A stroke involving the cerebellum may result in a lack of coordination (ataxia), clumsiness and balance problems, shaking, or other muscular difficulties. This can interfere with a persons ability to walk, talk, eat and perform other self -care tasks. Brain stem strokes are the most devastating and life threatening because they can disrupt the involuntary functions essential to life. People who survive may remain in a vegetative state or be left with severe impairments.

Blood Flow to the Brain The heart pumps oxygen- and nutrient-laden blood to the brain, face, and scalp via two major sets of vessels: the carotid arteries and the vertebral arteries. The jugular and other veins bring blood out of the brain.

The carotid arteries run along the front of the neck one on the left and one on the right. They are what you feel when you take your pulse just under your jaw. The carotid arteries split into external and internal arteries near the top of the neck. The external carotid arteries supply blood to the face and scalp. The internal carotid arteries supply blood to the front (anterior) three-fifths of cerebrum, except for parts of the temporal and occipital lobes. The vertebral arteries travel along the spinal column and cannot be felt from the outside. They join to form a single basilar artery (hence the name vertebrobasilar arteries) near the brain stem at the base of the skull. The arteries supply blood to the posterior twofifths of the cerebrum, part of the cerebellum, and the brain stem. Because the brain relies on only two sets of major arteries for its blood supply, it is very important that these arteries are healthy. Often when an ischemic stroke occurs, the carotid or vertebral artery system is blocked with a fatty buildup called plaque, allowing little or no blood to flow to the brain. During a hemorrhagic stroke, an artery in or on the surface of the brain has ruptured or is leaking, causing bleeding and damage in or around the brain.

These arteries that conduct blood to the brain the internal-carotid and vertebral arteries connect through the Circle of Willis, which loops around the brainstem at the base of the brain. From this circle, other arteries the anterior cerebral artery (ACA), the middle cerebral artery (MCA), and the posterior cerebral artery (PCA) 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 blocked, the smaller arteries that the circle supplies can receive blood from the other arteries. This phenomenon is called collateral circulation. Collateral circulation is a process in which small (normally closed) arteries open up and connect two larger arteries or different parts of the same artery. They can serve as alternate routes of blood supply. Sometimes when an artery in the brain is blocked due to ischemic stroke or transient ischemic attack (TIA), open collateral vessels can allow blood to "detour" around the blockage, restoring blood flow to the affected part of the brain. Everyone has collateral vessels, at least in microscopic form. These vessels normally aren't open. However, they grow and enlarge in some people with coronary heart disease or other blood vessel disease. While everyone has collateral vessels, they don't open in all people. The Circle of Willis has a downside, however. Cerebral aneurysms tend to occur at the junctions between the arteries that make up the Circle.