Anatomy and Physiology XIII

Question 1

How is vasospasm due to blood breakdown of subarachnoid hemorrhage treated?

Answer 1

With nimodipine (calcium channel blocker) (p.424)

Question 2

What most commonly causes intraparenchymal (hypertensive) hemorrhages?

Answer 2

Systemic hypertension most commonly (p.424)

Question 3

Name three causes of intraparenchymal hemorrhages other than the most common cause.

Answer 3

Amyloid angiopathy, vasculitis, neoplasm (p.424)

Question 4

Where do intraparenchymal hemorrhages most commonly occur?

Answer 4

In the basal ganglia and internal capsule, but can also be lobar (p.424)

Question 5

What is another name for intraparenchymal hemorrhages of the internal capsule?

Answer 5

Charcot-Bouchard aneurysms of the lenticulostriate vessels (p.424)

Question 6

After how much time of hypoxia does irreversible brain damage begin?

Answer 6

After 5 minutes of hypoxia (p.425)

Question 7

What areas of the brain are most vulnerable to hypoxia?

Answer 7

The hippocampus, neocortex, cerebellum, and watershed areas (p.425)

Question 8

What is seen in brain tissue of ischemic disease/ stroke 12-48 hours after the ischemic event?

Answer 8

Red neurons (p.425)

Question 9

What is seen in brain tissue of ischemic disease/ stroke 24-72 hours after the ischemic event?

Answer 9

Necrosis and neutrophils (p.425)

Question 10

What is seen in brain tissue of ischemic disease/ stroke 3-5 days after the ischemic event?

Answer 10

Macrophages (p.425)

Question 11

What is seen in brain tissue of ischemic disease/ stroke 1-2 weeks after the ischemic event?

Answer 11

Reactive gliosis and vascular proliferation (p.425)

Question 12

What is seen in brain tissue of ischemic disease/ stroke greater than 2 weeks after the ischemic event?

Answer 12

Glial scar (p.425)

Question 13

Describe the CT findings of stroke.

Answer 13

Dark on non-contrast CT in approx. 24 hour.s. Bright areas on noncontrast CT indicate hemorrhage (tPA is contraindicated) (p.425)

Question 14

Describe the MRI findings of stroke.

Answer 14

Bright on diffusion-weighted MRI in 3-30 minutes and remains bright for 10 days (p.425)

Question 15

How does atherosclerosis lead to ischemic brain disease/ stroke?

Answer 15

Thrombi lead to ischemic stroke with subsequent necrosis. Cystic cavity forms with reactive gliosis (p.425)

Question 16

How does hemorrhagic stroke cause ischemic brain disease/ stroke?

Answer 16

Through intracerebral bleeding (often due to hypertension, anticoagulation, and cancer (where abnormal vessels bleed)); Also may be caused secondarily due to ischemic stroke followed by reperfusion (due to increased vessel fragility) (p.425)

Question 17

How does ischemic stroke cause ischemic brain disease/ stroke?

Answer 17

Atherosclerotic emboli block large vessels; lacunar strokes block small vessels (p.425)

Question 18

How does transient ischemic attack (TIA) cause ischemic brain disease/ stroke?

Answer 18

Ischemic deficits due to focal ischemia (p.425)

Question 19

Name four possible causes of ischemic stroke.

Answer 19

Atrial fibrillation, carotid dissectioun, patent foramen ovale, endocarditis (p.425)

Question 20

What is the treatment for ischemic stroke and what is the timeframe to give this treatment?

Answer 20

tPA within 4.5 hours (p.425)

Question 21

What are the contraindications for giving a patient with ischemic stroke tPA?

Answer 21

Patient must present within three hours of onset of ischemic event and there must not be any major risk of hemorrhage (p.425)

Question 22

What is a TIA?

Answer 22

Brief, reversible episode of focal neurologic dysfunction typically lasting less than one hour without acute infarction (p.425)

Question 23

What are typical MRI findings in a patient with a TIA?

Answer 23

Negative MRI findings (p.425)

Question 24

What are dural venous sinuses?

Answer 24

Large venous channels running through the dura that drain blood from the cerebral veins and receive CSF from arachnoid granulations (p.425)

Question 25

To where do the dural venous sinuses empty?

Answer 25

Into the internal jugular vein (p.425)