8 Cerebrovascular Diseases (Baumbach)

Question 1

What is ischemic/hypoxic encephalopathY?

Answer 1

generalized reduction in blood flow or P02

Question 2

Name 3 things that can cause ischemic/hypoxic encephalopathy

Answer 2

hypotension
pulmonary disease
increased intracranial pressure

Question 3

What areas are especially vulnerable to ischemic/hypoxic encephalopathy?

Answer 3

• watershed zones

- neurons of the hippocampus and purkinje cells

Question 4

Where are the most likely sites of atherosclerosis affecting the brain?

Answer 4

internal carotid or cerebral arteries

Question 5

If you see crystal shapes in the middle of an embolus what is it called?

Answer 5

cholesterol embolus

Question 6

What are the 2 main categories of infarct in the brain

Answer 6

non-hemorrhagic

hemorrhagic

Question 7

Non-hemorrhagic infarcts are usually due to ______ whereas hemorrhagic infarcts are usually due to _____ and result from _______

Answer 7

1. thrombus
2. embolus
3. reperfusion

Question 8

Acute stage of an infarct is defined as _______

Answer 8

less than 1 week

Question 9

subacute stage of an infarct is defined as_______

Answer 9

1-4 weeks

Question 10

Remote stage of an infarct is defined as ___

Answer 10

months-years

Question 11

Name 5 changes seen in acute infarct stage

Answer 11

• coagulation necrosis (red neurons)
• axonal degeneration (spheroid bodies)
• cerebral edema
• vascular proliferation
• neutrophil response

Question 12

What 2 changes will you see in subacute stage?

Answer 12

• macrophages

- reactive gliosis (gemistocytes)

Question 13

What 2 changes will you see in the remote stage?

Answer 13

• cyst formation

- glial scarring

Question 14

Name 3 things that can cause ischemic/hypoxic encephalopathy

Answer 14

hypotension
pulmonary disease
increased intracranial pressure

Question 15

What areas are especially vulnerable to ischemic/hypoxic encephalopathy?

Answer 15

• watershed zones

- neurons of the hippocampus and purkinje cells

Question 16

Where are the most likely sites of atherosclerosis affecting the brain?

Answer 16

internal carotid or cerebral arteries

Question 17

If you see crystal shapes in the middle of an embolus what is it called?

Answer 17

cholesterol embolus

Question 18

What are the 2 main categories of infarct in the brain

Answer 18

non-hemorrhagic

hemorrhagic

Question 19

Premature infants are most likely to experience hemorrhage where?

Answer 19

germinal matrix hemorrhage

intraventricular hemorrhage

Question 20

Name the perinatal asphyxia patterns associated with term infants

Answer 20

• selective vulnerability of oligodendrocytes
• periventricular leukomalacia
• multicystic encephalopathy

Question 21

What is the clinical syndrome a survivor of perinatal asphyxia or trauma has?

Answer 21

cerebral palsy

Question 22

Name the 3 most common sites of hypertensive hemorrhage

Answer 22

1. basal-ganglia/thalamus (65%)
2. pons (15%)
3. cerebellum (10%)

Question 23

Saccular aneurysms form at branch points and often are due to what?

Answer 23

abnormality/lack of internal elastic lamina

Question 24

Where do most saccular aneurysms occur?

Answer 24

anterior communicating artery

Question 25

Name the 3 types of vascular malformations

Answer 25

1. arteriovenous malformation
2. cavernous angioma
3. telangiectasia

Question 26

How do vascular malformations cause injury?

Answer 26

hemorrhage, seizure, local ischemic injury (“steal” phenomena)

Question 27

Amyloid antipathy results from deposition of amyloid in the vessel wall. What are the familial forms of this?

Answer 27

Dutch (APP mutations)

Icelandic (cystatin C mutations)

Question 28

What is CADASIL?

Answer 28

“Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy”

-associated with notch-3 mutations

Question 29

What is MELAS?

Answer 29

Mitochondiral myopathy, Encephalopathy, Lactic Acidosis and Stroke like episodes
-associated with mitochondrial DNA mutations