Acute CNS Injury

7/25/2019 Acute CNS Injury

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Acute CNS injury:Acute CNS injury:

anoxia, re-oxygenation &anoxia, re-oxygenation &

oxidative stressoxidative stress

(or(or What happens to brain cellsWhat happens to brain cells

during a strokeduring a stroke))


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Overview

1. ntroduction: !"at is a disa#i$ity% 'ortant CNS regions (disa#i$ities)

. Oxygen and CNS *unction

+. Cere#ra$ #$ood *$ow & Oxygen transort

. CNS yoxia Anoxia Stro/e

ead njury & intracrania$ "yertension

0esiratory *ai$ure. 0e-oxygenation (#$ood *$ow is restored)

2. 3istur#ed e$ectrica$ signa$ing


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1. !"at is a 3isa#i$ity%

4 Neuro'uscu$ar i'air'ent

4 Sensory derivation (vision, "earing orseec")

4 Cognitive dys*unction ($earning, "ig"errocessing)


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"tt:www.*i.au.d/u/j$#c1*ig15+.jg

6otor ('usc$e) syste'

Neuro'uscu$ar junction (N67)


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Sensory: 8ision

"tt:genera$.rau.ac.9asyc"0esourcesonoursNeurosyc"'ages."t'


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Sensory: earing

"tt:www.#rainconnection.co''ed'edart$anat5;5.jg


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Sensory: Seec"

"tt:"o'e.uc"icago.edu


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Sensory: Seec"

"tt(:www.cere#ro'ente.org

.#rn5)"istoriaarea#roca.gi*

Brocass Area -- Broca's aphasiainvo$ves a $ac/ o* a#i$ity to roduce co"erent

$anguage, inc$uding so/en, written and signed *or's.

Wernicke's area"ave di**icu$ty understanding $anguage in any *or'. ="ey can

sea/ *$uent$y, *or'ing $ong and co'$ex sentences, #ut t"eir strings o* wordso*ten $ac/ co"erent 'eaning.


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Cognition

="e cortical association areasare t"oug"t to #e t"e anatomical basis for

thought and perception,since sti'u$ation o* t"ese areas roduce $itt$e or no

o#vert #e"aviora$ c"anges, #ut receivesensory inut *ro' "ig"-order sensory

syste's and projectto 'otor cortex.

"tt:i*csun1.i*isio$.una'.'x>rainseec"."t'


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. Oxygen and CNS ?unction

"tt:"ea$t".a$$re*er.co'"ea$t"stro/e-secondary-to-cardiogenic-e'#o$is'-centra$-nervous-syste'."t'$


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Neuron

"tt:www.'#.j"u.edutins'edia55@5Neuron@5Sc"e'a1.jg

"tt:www-er''.c#cu.ca'.ac.u/555;;"."t'

"tt:casar.#gsu.edu


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6itoc"ondria

"tt:www.scris.edu'e'#ioc"e'ayagi'ito."t'$"tt:www.scris.edu'e'#ioc"e'ayagi'ito."t'$

="ree-di'ensiona$ 'ode$ wasreconstructed #y e$ectron to'ogra"y.

="e outer 'e'#rane and cristae are

s"own in ur$e and ye$$ow,

resective$y.

"tt:www.cytoc"e'istry.netCe$$-#io$ogy'itoc"1."t'"tt:www.cytoc"e'istry.netCe$$-#io$ogy'itoc"1."t'

=rans'ission e$ectron 'icrogra"

(=6) o* 'itoc"ondrion

Mitochondriaare structures t"at turn oxgen and glucose into energ!="is

rocess is esecia$$y vita$ to #rain ce$$s. Although the brain accounts for onl "#

of the bod's $eight, it consumes more than "%# of the bod's oxgen!All ofthis energ is re&uired because neurons transmit signalsamong themselves to

an even greater extent than do cells in the rest of the bod!


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"

*ue$ (g$ucose)

#iosynt"etic wor/

A3B CDA0 A=B 'ec"anica$ wor/0SB0A=ON transort wor/

("

O

(("" E E OO COCO++ ))** E COE CO++

p)p)

Aero#ic 'eta#o$is'Aero#ic 'eta#o$is'


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+can yie$d metabolic informationwit" "ig"-reso$ution i'ages, and t"us it

"as t"e a#i$ity to detect s'a$$ 'a$ignant $esions wit" increased 'eta#o$is' *or

en"anced ce$$ ro$i*eration.


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Sensory: 8ision

"tt:genera$.rau.ac.9asyc"0esourcesonoursNeurosyc"'ages."t'


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CNS Oxygen Consu'tion

"tt:www.too.uc$.ac.#eneuroF#$indness."t'$

yes oen yes c$osed

>$ind, recent$yCongenita$ #$indness


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"tt(:www.'d.uc$.ac.#

egrenBro

jetsAdvc"i$d"ood

(i$e

(sy."t'$

regiona$ 'eta#o$ic activity G g$ucose uti$i9ation

Nor'a$ adu$tC"i$dren, ei$esy

in*ants

lectrical signalingG energy (A=B) roduction & consu'tion to 'aintainionic gradients, #iosynt"esis, action otentia$s & synatic trans'ission


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D.K. Mulkey et al. (2003) J Appl hysiol !"#!$0%!2$

yeroxia: 3orsa$ 'edu$$a o#$ongatayeroxia: 3orsa$ 'edu$$a o#$ongata


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C"anges in #rain oxygenation corre$ate wit" execution o* a 'enta$ tas/ (i.e. nu'erica$ ca$cu$ation)


C>? BtO


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Cere#ra$ u$se ressure & tissue BO

"tt:cc*oru'.co'content202;5
http://ccforum.com/content/9/6/R670/figure/F1?highres=y


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!"at is a nor'a$ O$eve$ in t"e

#rain (Nor'oxia)%

Nor'oxia (CNS): H15 to + '' g

nsired air: 1@ O)at sea $eve$, B>G;25 ''g

BIOG 5.1 x ;25 G 1.2 '' g O)

ung (A$veo$i): BAOG 155 '' g O)

Arteria$ #$ood: BaOG I-155 '' g O)


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?igure 1 ?igure

Jas exc"ange & O-CO"o'eostasis

+ genera$ rocesses


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.+lumbing/

?ro' 7.>. !estKs

&'espiratory hysiology

the essentials


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+ath$a for 0iffusion of "1 ("

A$veo$ar-cai$$ary 'e'#rane: w"ere t"e resiratory

and cardiovascu$ar syste's co'e toget"er.

>erne &evy: ?ig. +-, .L ?ig. +-, .


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+ath$a for 0iffusion of "1 ("

>erne&evy: ?igs. +-2, . >erne&evy: ?igs. +-2, .

7.>.!estKs &'espiratory

hysiologythe essentials

"

((""

)b


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+. Cere#ra$ >$ood ?$ow &

Oxygen =ransort


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" ransport

7.>.!estKs &'espiratory

hysiologythe essentials

")b"

+a"

0 i * i t t i t i


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>$ood carries Oin two *or's:

1. in "ysica$ so$ution as Odisso$ved in t"e aMueous

"ase (


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Cere#ra$ 8ascu$ature

M2 Angiograph

"tt:www.'g"-interventiona$-neurorad.orgdiagnostic'ra."t'$ "tt:www.sywe#.co'>rain>i'ages#$ood.gi*

( i ( it


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="e 'axi'u' a'ount o* Ot"at can #e 'ade to co'#ine

c"e'ica$$y wit" # in a unit vo$u'e o* #$ood. !"ere...

1g # co'#ines wit" 1.+ '$ O

nor'a$ # content G 1 g #155 '$ o* #$ood

Ocarrying caacity G (1 g #155 '$) (1.+ '$1 g #)

G 5.1 '$ O155 '$ o* #$ood

@ saturation o* # G #O 155 Ocarrying

caacity

"(arring (apacit


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BOo* #$ood vs. #O

"tt:www.cv'.o/state.eduCoursesv'ed1?JD0S$ecture5+*ig+F1.gi*


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0eca$$

Nor'oxia (CNS): H15 to + '' g

nsired air: 1@ O)at sea $eve$, B>G;25 ''g

BIO)G 5.1 x ;25 G 1.2 '' g O)

ung (A$veo$i): BAO)G 155 '' g O)

Arteria$ #$ood: BaO)G I-155 '' g O)

1. CNS yoxia Anoxia

( yoxe'ia )


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Stro/e

"tt:www.'cg.edu'edarti'ages55-A0-Stro/e.jg


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!"at is a stro/e%

4 A stro/e is t"e sudden deat" o* #rain ce$$sdue to interrution o* #$ood su$y. !"en#$ood *$ow to t"e #rain is i'aired, oxygen

and i'ortant nutrients cannot #ede$ivered. ="e resu$t is a#nor'a$ #rain*unction.

4A stro/e is a$so re*erred to as acere#rovascu$ar accident or C8A.

"tt:www.'edicinenet.co'stro/eartic$e."t'


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"tt:www.$ing.uenn.educoursesSu''erF55$ing551i'ages#rainF$oca$i9ation.gi*


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Causes o* stro/e, 1

Blockage of arter

ardening o* t"e arteries $eading to t"e

#rain


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Causes o* stro/e,

"tt:www.stro/ecenter.orgeducationaisFvesse$sais55."t'$

Blockage of arter

4 C$ogging o* arteries wit"in t"e #rain (e.g.

$acunar stro/e)


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Causes o* stro/e, +

Blockage of arter4 '#o$is' to t"e #rain *ro' t"e "eart or an

artery

"tt:"ea$t".a$$re*er.co'"ea$t"stro/e-secondary-to-cardiogenic-e'#o$is'-stro/e-1."t'$


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Causes o* stro/e,

2upture of an arter3i!e! hemorrhage4

4 Cere#ra$ "e'orr"age (#$eeding

wit"in t"e #rain su#stance)

4 Su#arac"noid "e'orr"age (#$eeding#etween t"e #rain and t"e inside o*t"e s/u$$)


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Necrosis

Ane'ic n*arct. (n genera$ *ro' in

situ t"ro'#otic occ$usion).

e'orr"agic n*arct. ="ere is necrosis in

addition to t"e "e'orr"age. (n genera$ resu$ts

*ro' e'#o$ic occ$usion). 3istri#ution o* 'idd$e

cere#ra$ artery. (n*arct o* end-arteria$ 9one).

"tt:'edic.ut".t'c.eduedrogBA=Neuroa.=6


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ead trau'a

="is is w"atPs $e*t o* a 6ustang t"at was #eing driven #y a 1; yearo$d "ig" sc"oo$ student w"o decided t"at t"ey needed a *ew #eerPs#e*ore going to sc"oo$ to Q$oosen uQ #e*ore c$ass. >ad ideaRR A Ba$'tree got in "is way.


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(ranial 5olumes

15@

>$ood15@

CS?15@

xtrace$$u$ar;5@ ntrace$$u$ar (+@ Neurona$ - +@ g$ia$)

155@ =ota$ Crania$ 8o$u'e


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ow is CB 'easured%


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6onitoring CB

ntraventricu$ar Bressure Cat"eter


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ntracrania$ Bressure

="e ressure-vo$u'e curve o* t"e intracrania$ contents. As t"e vo$u'e o* an

exanding 'ass increases, CB rises on$y s$ig"t$y unti$ t"e co'ensatory

'ec"anis's are overco'e. ="is oint is reac"ed at t"e e$#ow o* t"e curve

w"en *urt"er exansion o* t"e 'ass causes a stee rise in CB.

"tt:www.*s'.ac.*js'sanaest"esia!?SA"t'$u5u5F51."t'

4 #rain swe$$ing

4 #$ood4 (tu'or)


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Nor'a$$y >$ood Bressure ntracrania$ Bressure


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Causes o* stro/e

2upture of an arter3i!e! hemorrhage4

4 Cere#ra$ "e'orr"age (#$eeding

wit"in t"e #rain su#stance)

4 Su#arac"noid "e'orr"age (#$eeding#etween t"e #rain and t"e inside o*t"e s/u$$)


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ncreased =issue 6ass

6(+6(+

!"at does intracrania$ "yertension do to


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!"at does intracrania$ "yertension do to

neuro$ogica$ *unction%

(erebral +erfusion +ressureG('ean arteria$ #$ood ressure) - (CB)

* CB 6AB t"en #$ood *$ow to t"e CNS ceasesR

CB

6AB


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Acute 0esiratory ?ai$ure

( drug overdose )

3i d * 8 ti$ t C t $


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3isorders o* 8enti$atory Contro$

Acute resiratory *ai$ure resu$ts *ro' overdosing:

4 sedatives

4 oiates

4 narcotics

4 anest"esia

n eac" case, $ung venti$ation due to:

inut *ro' #rainste' reticu$ar activating syste'

inut *ro' resiratory r"yt"' generator

COsensitivity o* t"e centra$ & eri"era$ c"e'orecetors (#rain

ce$$s t"at increase #reat"ing)


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0esiratory ?ai$ure

4 D$ti'ate$y, resu$ts in abnormal#reat"ing atterns

4 w"ic" u$'onary venti$ation,

4 w"ic" decreases venti$ation-er*usion 'atc"ing,

4 $eading to oor #$ood gases,4 CNS "yoxia

4 and eventua$$y, deat" (#rain ce$$s cease to *unction).


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. 0e-oxygenation

777


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0eactive Oxygen Secies (0OS)

7.3. >a$entine (1I), . +


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0eer*usion njury

"tt:www.t"eresurrector.co'i'g*reeradica$s.jg


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0e-oxygenation: sueroxide

yeroxia: excess oxygen &


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yeroxia: excess oxygen &

Sueroxide roduction

(CA1 "ioca'us)

Oxidative Stress


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Oxidative StressSIGMA-ALDRICH


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0e-oxygenation injury

( G oxidative stress, too 'any O*ree radica$s )

2eactive xygen 8ecies


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2. 3istur#ed $ectrica$ Signa$ing

"tt:cti.itc.virginia.edu


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"tt:www.a$scenter.orgi'ages"u'anF'otorFsyste'F55ix.gi*

"tt:ca'i$o$a#.s$u.edugra"icseeson2-1.jg


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"tt:www.ia.wvu.edu


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"tt:$c#r.ss.uci.eduCoursescogFneuro$ectureFs$ides'otorFsyste'S$ide.jg

"tt:www."reno$ogy.co'"o'uncu$us."t'$

o'uncu$us

Neuron
http://www.phrenology.com/franzjosephgall.html


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Neuron

"tt:www.'#.j"u.edutins'edia55@5Neuron@5Sc"e'a1.jg "tt:www.awa.co'norton*igures* ig55.gi*

Action Botentia$


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Action Botentia$

"tt:www.awa.co'norton*igures*ig55.gi*

Action Botentia$


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Action Botentia$

"tt:www.awa.co'norton*igures*ig55.gi*

"tt:gargoy$e.arcadia.edusyc"o$ogy#$usteinneuroectureFNotes

!ee/F1!ee/FActionFBotentia$.jg


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D.K. Mulkey et al. (2003) J Appl hysiol !"#!$0%!2$

6arc" 1 (8o$u'e 5, Nu'#er +) C67

arl ffects of )poxia on Brain (ell 9unction


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"tt:www.c'j."r15+55+11."t'

arl ffects of )poxia on Brain (ell 9unction

Kre*i+ir Krn,e-i

Anaest"esia 0esearc" 3eart'ent, 6cJi$$ Dniversity, 6ontrUa$, Vue#ec, Canada

CA1 ou$ation si/e resonse to CA+


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sti'u$ation during >O

Evoked PopulationSpike

Evoked Field EPSP


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Overview

1. ntroduction: !"at is a disa#i$ity% 'ortant CNS regions (disa#i$ities)

. Oxygen and CNS *unction

+. Cere#ra$ #$ood *$ow & Oxygen transort

. CNS yoxia Anoxia Stro/e

ead njury & intracrania$ "yertension

0esiratory *ai$ure

. 0e-oxygenation (#$ood *$ow is restored)

2. 3istur#ed e$ectrica$ signa$ing

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Acute CNS Injury

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