4th Exam: Cerebrovascular Disease

Question 1

Worse than these big 3 cancers combined:

Answer 1

lung, breast, colorectal

Question 2

How are Stroke and heart disease related?

Answer 2

Essentially different expressions of the same disorder

Question 3

Infarction:

Answer 3

Abnormality: asymmetric, dead tissue is removed, don’t get a scar, get a cavity

Question 4

Is collateral circulation possible in the brain?

Answer 4

yes

Question 5

Infarct in PCA Territory:

Answer 5

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”

Question 6

Acute ischemic infarct:

Answer 6

Change in nuclei of neurons, change in cytoplasm and background, occasional neutrophils

Question 7

Early organization:

Answer 7

Newly growing capillary wall, formation of granulation tissue, macs & endothelial cells

Question 8

What happens 2-3wk after infarct?

Answer 8

More macs and caps

Question 9

Early cavitation of infarct:

Answer 9

Hemosiderin pigment from breakdown of RBCs, tissue density reduced

Question 10

What is left after infarct cavitation is completed?

Answer 10

Tiny vessels, remnants of “granulation tissue” that participated in organization of necrotic brain tissue

Question 11

Lenticulostriate Arteries:

Answer 11

blocked often, narrow, come off at R angles, small cavitations in lenticulostriate territory: “lacunar” infarcts

Question 12

Cause of hemorrhagic infarction:

Answer 12

reperfusion of infarcted area, interference w venous drainage

Question 13

Intracerebral Hemorrhage:

Answer 13

Most common location: deep gray mater, freq ruptures into ventricle, may originate from tiny microaneurysms (Charcot-Bouchard) which are freq present on lenticulostriate as.

Question 14

Location of intracerebral hemorrhage:

Answer 14

1. Deep gray matter 2. Pons 3. Cerebellum 4. White matter

Question 15

Ppl at high risk for hemorrhages

Answer 15

high BP

Question 16

Cx ft of infarct:

Answer 16

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

Question 17

Cx ft of hemorrhage:

Answer 17

No TIA, onset during activity, headache (often severe), rapidly evolving neurological deficit including state of consciousness, severe hypertension (occasionally moderate), bloody CSF

Question 18

TF? Microaneurysms are often seen in ppl under 65

Answer 18

F. not even that many in older patients

Question 19

Saccular Aneurysms, aka:

Answer 19

congenital or berry

Question 20

Saccular Aneurysms:

Answer 20

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

Question 21

How is a pts ability to read affected by a stroke of left occipital lobe?

Answer 21

No vision in R visual field, R occipital lobe intact, vision in L visual field, route to corpus callosum (language) destroyed, cannot read

Question 22

How is a pts ability to write affected by a stroke of left occipital lobe?

Answer 22

it’s not, “Alexia Without Agraphia”

Question 23

TIA sf:

Answer 23

Transient ischemic attack