17.4 Cerebrovascular Disease

Question 1

Cerebrovascular Disease

Answer 1

Neurologic deficit that arises due to ischemia in most cases or rarely is due to hemorrhage.

Question 2

Global Cerebral Ischemia Causes

Answer 2

• Low perfusion from atherosclerosis
• Decrease in blood flow from shock
• Hypoxia from anemia
• Repeated hypoglycemia

Question 3

What can cause repeated hypoglycemia?

Answer 3

Insulinoma

Question 4

Where are infarctions seen in moderate global ischemia?

Answer 4

Watershed areas at the terminal ends of arteries like the ACA and MCA.

Question 5

What are the areas that are vulnerable to moderate global ischemia?

Answer 5

• Pyramidal neurons of the cortex
• Pyramidal neurons of the hippocampus
• Purkinje layer of the cerebellum

Question 6

Transient Ischemic Attack

Answer 6

Regional ischemia that results in focal neurologic deficits for less than 24 hours.

Question 7

Ischemic Stroke

Answer 7

Regional ischemia that results in focal neurologic deficits for more than 24 hours.

Question 8

What are the 3 causes of ischemic stroke?

Answer 8

• Thrombotic
• Embolic
• Lacunar

Question 9

What kind of infarction is seen with thrombotic stroke?

Answer 9

Pale

Question 10

What kind of infarction is seen with embolic stroke?

Answer 10

Hemorrhagic

Question 11

What is the most common source of the embolus in embolic stroke?

Answer 11

Left side of the heart

Question 12

What is the commonly involved artery in embolic stroke?

Answer 12

Middle Cerebral Artery

Question 13

Lacunar Stroke

Answer 13

Secondary to hyaline arteriolosclerosis

Question 14

What vessels are most commonly involved in lacunar stroke?

Answer 14

Lenticulostriate Vessels

Question 15

Where do lacunar strokes typically affect?

Answer 15

Deep structures of the brain

Question 16

What type of necrosis is seen with ischemic stroke?

Answer 16

Liquefactive

Question 17

What is the earliest finding with ischemic stroke?

Answer 17

Red Neurons

Question 18

After red neurons, what is the sequence following an ischemic stroke?

Answer 18

Neutrophils come in the microglial cells (macrophages) and the granulation-like tissue forms leading to a cystic space with gliosis.

Question 19

Intracerebral Hemorrhage

Answer 19

Bleeding into the brain parenchyma due to rupture of Charcot-Bouchard micro aneurysms - complication of HTN

Question 20

What is the most common site of Intracerebral Hemorrhage?

Answer 20

Basal Ganglia

Question 21

Subarachnoid Hemorrhage

Answer 21

Bleeding into the subarachnoid space that presents with a sudden headache and nuchal rigidity

Question 22

What is seen on lumbar puncture with Subarachnoid Hemorrhage?

Answer 22

Xanthochromia - yellowing of CSF from the bilirubin breakdown products

Question 23

What is the most common cause of Subarachnoid Hemorrhage?

Answer 23

Berry Aneurysm

Question 24

Where are berry aneurysms most often found?

Answer 24

Anterior Circle of Willis - branch points of the anterior communicating artery

Question 25

What diseases are berry aneurysms associated with?

Answer 25

• Marfan’s Syndrome

- AD Polycystic Kidney Disease

Question 26

What layers in the vessel wall is missing in berry aneurysms?

Answer 26

Media