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BRAIN - Vascular Flashcards

1
Q

DDx haemorrhagic strokes

A
  • Idiopathic
  • Primary causes
  1. Arterial hypertension (< 5mm T2*)
  2. Cerebral amyloid angiopathy
  3. Intracranial neoplasia (Multicentric: hemangiosarc, metastases, histiocytic SK, intravascular lymphoma
    primary: gliomas, meningiomas, choroid plexus t, pituitary, …)
  • Secondary causes
  1. Coagulopathy (von willebrand factor def, Angiostrongylus vasorum)
  2. Parasite migration
  3. Bacterial/septicemia
  4. Hemorrhagic transformation
  5. Vasculopathy
  6. Cerebral vascular malformation (Arteriovenous, Venous, Cavernous, Capillary malformations or telangiectases)
  7. postprocedural
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2
Q

Give 3 diagnostic tests in case of CVD

A

Coagulation panel
Dosage of Von Willebrand factor
Coproscopy in search of Angiostrongylus
Serology for Angiostrongylus

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3
Q

What are the 4 lacunar ischemic syndromes?

A

Striates arteries: ipsilateral circling, ipsilateral head turn, contralateral menace deficit, contralateral PR deficit

Paramedian: vestibular

Extensive dorsal: vestibular, contralateral menace deficit

Ventrolateral: circling, contralateral PR deficit

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4
Q

Which signs are usually present in T2-FLAIR to evaluate two findings consistent with strokes <24h old?

A

Hyperintense vessel signs
Hyperintense swollen cortical gyri

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5
Q

% of cats with hypertensive encephalopathy presented retinal lesions

A

93% (28/30)

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6
Q

DDx ischemic strokes

A
  • Atherosclerosis: hypothyroidism, diabetes, hyperlipemia
  • Emboli: metastatic tumor cells, septic thromboemboli, migrating parasite or parasitic emboli (Dirofilaria immit), leishmania, intravascular lymphoma, fibrocartilaginous embolism
  • Hypertension: CKD, hyperthyroidism, pheochromocytoma, hyperadrenocorticism, primary hyperaldosteronism
  • Vasospam (Cuterebra migrans)
  • Hypercoagulable state: hyperadrenocorticism, protein losing nephropathy/enteropathy, systemic neoplasia (including splenic HSK), immune mediated haemolytic anaemia, sepsis, infective endocarditis
  • Cardiomyopathy
  • Hemodynamic (anaesthetic)
  • Idiopathic (~50%): CKC & Greyhound are predisposed
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7
Q

Ischemia occurs when the CBF is reduced by more than: 33%, 50%, 60%, 75%, 90%

A

60%

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8
Q

What is the typical histologic manifestation of spontaneous hypertensive encephalopathy in cats?

A

Bilaterally symmetrical edema of the subcortical cerebral white matter

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9
Q

What is the name of the lesion when a main artery is obstructed?

A

Territorial infarct

For obstruction of the smaller perforating arteries, it is referred as a lacunar infarct.

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10
Q

Which of the followings cross the BBB?

Amlodipine
Penicillin
Carbamazepine
Morphine
Cytosine arabinoside
Doxorubicin
Glucose
Neutral amino acids
Glutamate
Glycine
Potassium
Chloramphenicol
Sulfonamides
Vincristine
Gabapentin
Ampicillin

A

Cross: carbamezepine, morphine, cytosine arabinoside, glucose, neutral amino acids, glutamate, glycine, potassium, chloramphenicol, gabapentin, sulfonamides, ampicillin

Do not cross: amlodipine, penicillin, doxorubicin, vincristine

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11
Q

Mannitol is able to pass the BBB: true or false?

A

False

But, with prolonged use, mannitol can also disrupt the blood–brain barrier, and it may pass into the brain parenchyma and cause a rebound effect, with subsequent increases in ICP.

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12
Q

What are the most common neurological signs in hypertensive cats (vision excluded)? Most common underlying diseases?

A

Most common neurological signs
Ataxia
Various manifestations of seizures
Altered behaviour
Retinal lesions found in 28/30 cats

Most common underlying diseases
CKD (34%)
Hyperthyroidism (21%)
Primary hyperaldosteronism (2%)
Idiopathic (34%)

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13
Q

canine/feline cerebrovascular blood supply

A

from basilar and internal carotid arteries

in cat craniocaudal blood flow through basilar artery + external carotid artery (via maxillary art) supply most of the blood to arterial circle
+rete mirabile in max art

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14
Q

supply of rostral cerebellar artery

A

rostral cerebellar hemisphere and vermis (lateral, intermediate, medial branches)
dorsal medulla

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15
Q

supply of caudal cerebellar artery

A

from basilar artery

caudoventral aspect of cerebelar hemispheres and vermis (including floculus and nodulus)
lateral aspect medulla

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16
Q

CBF should be constant at a MAP between..

A

50 and 150 mmHg

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17
Q

major intracranial arterial supply

A

rostral cerebral: rostral/rostromedial cerebrum
middle cerebral: lateral cerebrum
caudal cerebral: caudo-dorsal and caudo-medial cerebrum

medial striate: glob pallidus, putamen, medial int capsule, head caudale
lat striate: doral caudate, lat int caps, claustrum
rostral choroidal: caudate caudal, int capsule, thalamus lat, optic tract
proximal perforating: rostromedial/ventromedial thalamus
distal perforating: caudolat thalamus, subthalamic nuclei
caudal perforating: caudal/medial/paramedian thalamus, ventromed midbrain, median/paramedian pons

18
Q

patophysiology of ischemic CVD

A

primary injury: due to energy failure
failure na+/k+ ->cytotoxic odema
failure aerobic metab ->lactic acidosis -> cytotox
loss ionic gradient ->increase Ca2+ release-> activ protease/lipases-> mb damage and free radical fomation

secondary injury: due to compromise of vascular endoth and suporting cells (4/6h-24/48h)
damage to BBB -> vasogenic edema and inflam cells infiltrate
hemoragic conversion (extravation blood productà

19
Q

brain region susceptibles to ischemia

A

cerebral cortex (GM hippocampus, cerebellar cortex, basal and thalamic nuceli

20
Q

physiopathology of intracranial hemorrhage

A

primary injury: direct damage to growing hematoma
compression tissue (6h)
increasing ICP
breakdown blood product -> proinflam and prooxidant, stim glutamate release

secondary: peaks 3-5d, may persist up to 7d
perihemoragic edema due to thrombin-induced activ inflam cascade, overexp matrix metalloprotease; cause increase ICP
ischemia secondary to increase ICP or ruptured vessel

21
Q

vascular malformation causing clinical signs without bleeding

A

vascular hamartoma, meningiomatosis (mass effect)

22
Q

CT of acute hemmorhage

A
  1. hyperattenuation due to fibrin, globin (40-60 HU acute, 60-80 whithin hiurs), normal <40)
  2. hyperatt increase for 72h than decrease, isoat 1m (beginning at perif)
  3. peripheral contrast enhan 6d-6w)
23
Q

CSF alteration in hemmoragic stroke

A

mild increase prot/PNN/mononuclear due to disruption of BBB

xanthochromia, erythrophagocytosis

elevation IL-6

24
Q

prognosis for ischemic/hemorragic stroke

A

ischemic: 23% died within first 30d
concurrent condition assoc with shorter survival and more recurr

hemorr: single non trauma >5 mm long term good in 60%, multiple non trauma > 5 mm poor outcome in 70%

25
Q

sign associated with
1. paramedian thalamic ischemic infarction
2. dorsal midbrain infarction
3. cerebellar interpositus nucleus

A
  1. controlat medial strabismus (esotropia) + vestibular ataxia, head tilted, nystagmus + episodic non intentional tremors
  2. convergence retraction nystagmus
  3. ispsilateral mydriasis + cerebellar signs
26
Q

maj arteries affected by stroke in dog

A

rostral cerebellar (47%) > perforating: caudal thalamus + rostral BS (42%) >striate

27
Q

specific localisation of ischemic stroke acording to etiology

A

hypertensive: deep (thal, basal nuclei)
amyloid angiopathy: G/W matter junction

28
Q

In ischemic stroke delay for
1. FLAIR hyper
2. Periferal enhancement
3. T2 hyper
4. DWI hyper

A
  1. 3-8 h
  2. 7-10 d
  3. 6-12 h
  4. minutes, reverse in 24h-5d

DWI lesion, normal FLAIR => less than 3h

29
Q

diff for T1 hyperintensity

A

blood breakdown product
fat
proteinaceous fluid
melanin
calcification
necrosis
paramagnetic sub: iron, manganese, cooper

30
Q

blood breakdown product timing for hemorrhagic strokes

A

< 24h intrac oxyhb
1-3d intrac desoxyhb
3-7d intrac methb
7-14d extrac methb
>14d extrac hemosiderin and ferritin (in macrophages)

31
Q

differential for hypo SWI/T2*

A

hemosiderin (paramagnetic)
mineralisation
gaz
fibrous tissus
iron deposit

other causes than hemo are T1/T2 hypo (diamagnetic)

32
Q

ADC difference between glioma and ischemia

A

glioma has lower ADC than ischemia (ADC inversively proport to cell density

33
Q

causes of mydriasis

A

ophtalmologic (increase intraocul pressure…)
optic or oculomotor nerve
sympathetic innerv eye
plant : Datura stramonium
phenylephrine (sympatomimetic)

34
Q

most frequent signs and pathology associated with microbleeds

A

vestibular
proteinuria

dogs are older and smaller than non affected
associated with shorter survival time
maj small poodle and shitzu
association with cortical atrophy

35
Q

T2 black out effect: definition, exemples

A

low signal in T2 due paramagnetic substance reduced signal in DWI (inverse of T2 black out effect)

hemorrhage, brain abcess, toxoplasmose, aspergilose, metastatic lesion, blastomycose

36
Q

finding in diffusion/adc sequence to date hemor

AD

A

in stratified intracereb hemorrhage
ADC apparence of peripheral hypo in hyperacute and iso/hypo in acute
T2 hypointense rim in hemo: conversion of oxyhemog to desoxyhem

37
Q

MRI features of intracranial hemorrhage

A

complet T1/T2 hypointense peripheral rim, periferal enhancement pattern

<2d T1 hypo, T2 hypo and hyper, GRE hypo
2-14d T1 hyper, T2 hyper, GRE hyper
>14d T1 iso to hypo, T2 hypo to hyper GRE hypo

38
Q

Normal D-dimer is an appropriate negative predictor for canine ischemic stroke
True or false?

A

false

39
Q

Is T2star seq affected by gadolinium?

A

FALSE
gadolinium paramagnetic: T2 shortening effect

40
Q

comparison SWI/T2star to detect hemorrhage

A

SWI more artefect in frotal sinus
better detection microbleed with SWI
SWI: differenciate dia and paramagnetic with phase images (right handed para hypo and dia hyper)
19% presumed hemor in T2star diagnosed as vessel in SWI

paramagnetic subst increase local magnetic field stength, diamagnetic decrease

41
Q

subacute cortical laminar necrosis
1. causes
2. assoc with hyper/hypoperf MRI
3. T1 intensity
4. which lamina more affected

A
  1. hypoxia, hypogly, fluid overload, smoke inhalation, ischemia, encephalitis, prolonged seizure act
  2. hyperperfusion
  3. T1 hyper
  4. lamina 3

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