4th Exam: Cerebrovascular Disease Flashcards
Worse than these big 3 cancers combined:
lung, breast, colorectal
How are Stroke and heart disease related?
Essentially different expressions of the same disorder
Infarction:
Abnormality: asymmetric, dead tissue is removed, don’t get a scar, get a cavity
Is collateral circulation possible in the brain?
yes
Infarct in PCA Territory:
Pt has no visual complaint, stroke destroyed inferior R primary visual cortex, lost vision in L superior quadrant of vision, “Left superior quadrant homonymous anopia”
Acute ischemic infarct:
Change in nuclei of neurons, change in cytoplasm and background, occasional neutrophils
Early organization:
Newly growing capillary wall, formation of granulation tissue, macs & endothelial cells
What happens 2-3wk after infarct?
More macs and caps
Early cavitation of infarct:
Hemosiderin pigment from breakdown of RBCs, tissue density reduced
What is left after infarct cavitation is completed?
Tiny vessels, remnants of “granulation tissue” that participated in organization of necrotic brain tissue
Lenticulostriate Arteries:
blocked often, narrow, come off at R angles, small cavitations in lenticulostriate territory: “lacunar” infarcts
Cause of hemorrhagic infarction:
reperfusion of infarcted area, interference w venous drainage
Intracerebral Hemorrhage:
Most common location: deep gray mater, freq ruptures into ventricle, may originate from tiny microaneurysms (Charcot-Bouchard) which are freq present on lenticulostriate as.
Location of intracerebral hemorrhage:
- Deep gray matter 2. Pons 3. Cerebellum 4. White matter
Ppl at high risk for hemorrhages
high BP
Cx ft of infarct:
Hx of TIA, onset at rest, min discomfort, sudden onset of focal deficit wo change in consciousness or mentation, mod hypert (occasionally normotensive), clear CSF
Cx ft of hemorrhage:
No TIA, onset during activity, headache (often severe), rapidly evolving neurological deficit including state of consciousness, severe hypertension (occasionally moderate), bloody CSF
TF? Microaneurysms are often seen in ppl under 65
F. not even that many in older patients
Saccular Aneurysms, aka:
congenital or berry
Saccular Aneurysms:
Typically at branch points of arteries- congenital weakness in the area, aneurysms enlarge and have a propensity to burst. 1 cm: most dangerous, most common cause of spontaneous (non-traumatic) subarachnoid hemorrhage, trauma & head injuries cause subarachnoid hemorrhages, but if its SPONTANEOUS, it’s berry aneurysm, most saccular aneurysms: in anterior portions of circulation, 50% of ppl w polycystic kidney disease die of berry aneurysm
How is a pts ability to read affected by a stroke of left occipital lobe?
No vision in R visual field, R occipital lobe intact, vision in L visual field, route to corpus callosum (language) destroyed, cannot read
How is a pts ability to write affected by a stroke of left occipital lobe?
it’s not, “Alexia Without Agraphia”
TIA sf:
Transient ischemic attack
