CHAPTER IV

REVIEW OF ANATOMY & PHYSIOLOGY AND PATHOPHYSIOLOGY

This chapter discusses the anatomy & physiology and the pathophysiology of an
Ischemic Stroke. It also includes the pathophysiology map of Ischemic Stroke wherein their risk
factors, signs and symptoms, mechanisms, and further complications are being discussed
The Central Nervous System controls all of our actions, thoughts, and emotions. It
serves as the primary control center for every aspect of our body, including our thoughts,
feelings, and movements.
ANATOMY AND PHYSIOLOGY
ARTERIES
 An important part of providing blood and nutrients to organs is played by arteries. Arteries are under
constant, intense pressure. They have less smooth muscle and more elastic tissue to withstand this tension. Large
blood vessels can change in diameter and enlarge due to the presence of elastin in these veins. An artery divides
further into smaller vessels with more smooth muscle and less elastic tissue as it reaches a specific organ. The
blood flow velocity decreases in proportion to the blood vessel diameter. The arterial system is thought to hold
between 10% and 15% of the total amount of blood. The arterial system is characterized by low capacity and high
systemic pressure.
BRAIN
The human brain, an enigmatic organ weighing approximately three pounds, serves as the control center of
the body, orchestrating a myriad of functions essential for human existence. Comprised of billions of neurons and
intricate networks, the brain exhibits unparalleled complexity, allowing for cognition, emotion, perception, and
behavior. This essay delves into the description and functions of the brain, unveiling its remarkable capabilities and
indispensable role in shaping human experience. At the macroscopic level, the brain is divided into distinct regions,
each with specialized functions. The cerebrum, the largest part of the brain, is further divided into two
hemispheres: the left and right. These hemispheres are interconnected by the corpus callosum, facilitating
communication between them.

Left Hemisphere
The Left Hemisphere is responsible for language, understanding and producing language, including speaking,
reading, and writing, logic and reasoning, sequential processing and control of the right side of the body wherein it
includes motor control and sensory processing for the right side of the body.

Right Hemisphere
It is the part of the brain that is responsible for visual-spatial skills wherein it includes Processing of visual
information and helping with tasks such as spatial awareness, navigation, and understanding visual relationships.
The right hemisphere is also associated with imagination, creativity, and artistic abilities. It is Involved in
recognizing patterns, making holistic judgments, and understanding metaphors. It plays a significant role in
processing emotions and interpreting nonverbal cues. Finally, it’s function is also for motor control and sensory
processing for the left side of the body.

Both hemispheres work together through the corpus callosum, a thick bundle of nerve fibers that allows
communication between them. While these generalizations hold true for many people, it’s important to note that
brain functions are highly complex and interconnected, and individual differences exist.

CORPUS CALLOSUM

The corpus callosum stands as one of the most remarkable structures within the human brain, serving as a vital
conduit for communication between the brain’s two hemispheres. Situated deep within the cerebrum, this
complex bundle of nerve fibers plays a pivotal role in integrating information and coordinating various cognitive
functions. As a critical component of the brain’s connectivity network, understanding the anatomy and function of
the corpus callosum offers profound insights into the intricacies of human cognition and behavior.

Anatomically, the corpus callosum is a broad, thick band of nerve fibers consisting of approximately 200 to 300
million axons. These axons extend horizontally, connecting corresponding regions of the left and right cerebral
hemispheres. Comprising both myelinated and unmyelinated fibers, the corpus callosum facilitates rapid and
efficient transmission of neural impulses between the hemispheres.

CEREBRUM
 The cerebrum is in charge of memory, motor and sensory perception, conscious and unconscious action,
emotions, and intelligence. Speech and abstract thought—the capacity to imagine things that are not there—are
handled by the left hemisphere. On the other hand, the motor and sensory neurons that descend from the brain
cross to the other side in the brainstem, and the right hemisphere governs spatial thinking, which is thinking that
interprets the shape, size, direction, position, and phenomena. For example, a stroke affecting the left hemisphere
of the brain might cause abnormalities in motor and sensory function on the right side of the body. The cerebrum
is composed of four lobes:
Frontal lobe: Responsible for motor function, language, and cognitive processes, such as executive function,
attention, memory, affect, mood, personality, self-awareness, and social and moral reasoning.[16] The Broca area
is located in the left frontal lobe and is responsible for the production and articulation of speech.
Parietal lobe: Responsible for interpreting vision, hearing, motor, sensory, and memory functions.
Temporal lobe: In the left temporal lobe, the Wernicke area is responsible for understanding spoken and written
language. The temporal lobe is also an essential part of the social brain, as it processes sensory information to
retain memories, language, and emotions.[17] The temporal lobe also plays a significant role in hearing and spatial
and visual perception.
Occipital lobe: The visual cortex is located in the occipital lobe and is responsible for interpreting visual
information.
CEREBELLUM
 The cerebellum, often referred to as the “little brain,” is a structure located at the base of the brain,
tucked beneath the cerebral hemispheres. While occupying only about 10% of the total brain volume, its
significance far outweighs its size. Functionally, the cerebellum plays a crucial role in coordinating voluntary
movements, maintaining posture, and ensuring balance. Its intricate structure and precise connectivity make it a
marvel of neurological architecture. Structurally, the cerebellum resembles a miniature version of the cerebral
cortex, featuring a highly convoluted surface with fissures and folds known as folia. These folia increase the surface
area, allowing for a greater number of neurons and synaptic connections within a compact space. Within the
cerebellum, distinct layers and cell types contribute to its complex functionality. At the cellular level, the
cerebellum consists mainly of two types of neurons: Purkinje cells and granule cells. Purkinje cells, found in a single
layer, serve as the primary output neurons of the cerebellar cortex, transmitting signals to other parts of the brain
and spinal cord. Granule cells, on the other hand, are the most numerous neurons in the cerebellum and play a
crucial role in processing incoming sensory information.

Functionally, the cerebellum is involved in motor control, fine-tuning movements, and ensuring their
precision and accuracy. It receives input from various sources, including the cerebral cortex, spinal cord, and
sensory organs, integrating this information to regulate muscle activity. Through its connections with the motor
cortex and brainstem, the cerebellum fine-tunes the timing, force, and coordination of movements, allowing for
smooth and efficient execution.
The cerebellum absorbs sensory data from the brain and spinal cord to fine-tune the accuracy and
precision of motor activity. It also controls the coordination of voluntary movement. Additionally, the cerebellum
supports a number of cognitive processes, including language, attention, pleasure response, and fear memory.
BRAINSTEM

The brainstem acts as a bridge that connects the cerebrum and cerebellum to the spinal cord. The
brainstem houses the principal centers which perform autonomic functions such as breathing, temperature
regulation, respiration, heart rate, wake-sleep cycles, coughing, sneezing, digestion, vomiting, and swallowing. The
brainstem contains both white and gray matter. The white matter consists of fiber tracts (neuronal cell axons)
traveling down from the cerebral cortex for voluntary motor function and up from the spinal cord and peripheral
nerves, allowing somatosensory information to travel to the highest parts of the brain.

Non-Modifiable Factors:
 Advanced age (50 years+)
 Male Gender
 African American Race
 Cardiovascular disease
Formation of Blood clot
Large amounts of Lactic acid are
generated which causes a change
in pH
Neurons are incapable of
producing sufficient ATP for
depolarization process
Neuron cells continue to
degrade and dysfunction
Cerebrovascular accident,
INFARCT, Bleeding RMCA
PATHOPHYSIOLOGY
Modifiable Factors
 Hypertension
 Hyperlipidemia
 Obesity
 Smoking
 Diabetes
 Alcohol Consumption
Reduced Cerebral blood flow
Blockage of cerebral arteries
(<25ml per 100g of blood per
minute)
Neurons are no longer able to Reduced oxygen and nutrients
maintain aerobic respiration to the brain cells
Membrane pumps that maintain Non-Pharmacologic Intervention:
electrolyte balance begin to fail,
and cells cease to function  Low salt and Low fat Diet
Pharmacologic Intervention:
 Atorvastatin
 Citicolin
The Right Medial Cerebral Artery
 Mannitol
becomes vulnerable to damage.
 Telmisartan
Over time, the ischemic tissue
undergo necrosis  Nebivolol
 Nifedipine
 Slurred speech, Left body
weakness, Edema
Signs and Symptoms

Diagnostics: Diagnosis
CT scan Risk Factors
Disease Process
Medical Interventions
Diagnostics