17.4 Cerebrovascular Disease Flashcards
Cerebrovascular Disease
Neurologic deficit that arises due to ischemia in most cases or rarely is due to hemorrhage.
Global Cerebral Ischemia Causes
- Low perfusion from atherosclerosis
- Decrease in blood flow from shock
- Hypoxia from anemia
- Repeated hypoglycemia
What can cause repeated hypoglycemia?
Insulinoma
Where are infarctions seen in moderate global ischemia?
Watershed areas at the terminal ends of arteries like the ACA and MCA.
What are the areas that are vulnerable to moderate global ischemia?
- Pyramidal neurons of the cortex
- Pyramidal neurons of the hippocampus
- Purkinje layer of the cerebellum
Transient Ischemic Attack
Regional ischemia that results in focal neurologic deficits for less than 24 hours.
Ischemic Stroke
Regional ischemia that results in focal neurologic deficits for more than 24 hours.
What are the 3 causes of ischemic stroke?
- Thrombotic
- Embolic
- Lacunar
What kind of infarction is seen with thrombotic stroke?
Pale
What kind of infarction is seen with embolic stroke?
Hemorrhagic
What is the most common source of the embolus in embolic stroke?
Left side of the heart
What is the commonly involved artery in embolic stroke?
Middle Cerebral Artery
Lacunar Stroke
Secondary to hyaline arteriolosclerosis
What vessels are most commonly involved in lacunar stroke?
Lenticulostriate Vessels
Where do lacunar strokes typically affect?
Deep structures of the brain
What type of necrosis is seen with ischemic stroke?
Liquefactive
What is the earliest finding with ischemic stroke?
Red Neurons
After red neurons, what is the sequence following an ischemic stroke?
Neutrophils come in the microglial cells (macrophages) and the granulation-like tissue forms leading to a cystic space with gliosis.
Intracerebral Hemorrhage
Bleeding into the brain parenchyma due to rupture of Charcot-Bouchard micro aneurysms - complication of HTN
What is the most common site of Intracerebral Hemorrhage?
Basal Ganglia
Subarachnoid Hemorrhage
Bleeding into the subarachnoid space that presents with a sudden headache and nuchal rigidity
What is seen on lumbar puncture with Subarachnoid Hemorrhage?
Xanthochromia - yellowing of CSF from the bilirubin breakdown products
What is the most common cause of Subarachnoid Hemorrhage?
Berry Aneurysm
Where are berry aneurysms most often found?
Anterior Circle of Willis - branch points of the anterior communicating artery
What diseases are berry aneurysms associated with?
- Marfan’s Syndrome
- AD Polycystic Kidney Disease
What layers in the vessel wall is missing in berry aneurysms?
Media
