7/ Cerebrovascular Disease

Question 1

What are the first-line investigations for someone with a suspected stroke?

Answer 1

• FBCs, U&Es, LFT, anaemia, polycythemia, electrolyte imbalance, glucose,
• ECG for AF, MI
• CT and/or MRI for lesion and type
• cholesterol
• clotting screen

Question 2

What does an acute infarct look like on post mortem ?

Answer 2

hyperaemic rim

Question 3

What is noted on histology 4 days after ischeamic cerebral infarct?

Answer 3

‘pink’ neurones = ischaemic neuronal death

Question 4

What is the histology 2 months after iscahemic infarct?

Answer 4

• collections of foamy macrophages and some capillary proliferation

Question 5

What are the common causative pathways for ischeamic stroke?

Answer 5

• general arterial atherosclerosis in aorta or carotids, vertebral, Circle of Willis arteries - which leads to damage to vessel-wall –> formation of plaques –> complications of plaques
• these include calcification, thrombotic occlusion, ulceration, detachment, production of emboli
  Hypertension, and DM both directly and indirectly cause atherosclerosis

Question 6

What is a cystic lesion?

Answer 6

• this is an old infarct
• this is due to eventual liquefaction necrosis, which leads to cyst formation
• this occurs due to degradation of tissue by the powerful action of hydrolytic enzymes e.g. brain infarct and abscess cavity

Question 7

What is the link between hypertension and stroke?

Answer 7

• hypertension causes thickening and loss of resilience in small arteries and arterioles in the brain. the hypertensive hyalinisation may produce occlusion with resultant small lacunar infarcts, that appear most commonly in the region of the basal ganglia, internal capsule, thalamus, and hemispheric white matter
• this arteriolar sclerosis also results in vessels that are more prone to microaneurysms and rupture. the most common site for rupture is in the region of the basal ganglia.
• the hypertension haemorrhage that results from rupture is no of the causes for a stroke

Question 8

What are the symptoms of a subarachnoid haemorrhage?

Answer 8

Sudden onset severe headache

- neck stiffness, photophobia, reduced consciousness

Question 9

What is found in an LP of a subarachnoid haemorrhage?

Answer 9

xanthochromia

Question 10

What are the risk factors for SAH?

Answer 10

family Hx
various genetic disorders
- heredriatroy hamorrh

Question 11

How is an extradural haemorrhage lesion described?

Answer 11

• lenticular lesion (usually convex)