Cerebrovascular Flashcards
What causes CVAs?
Vascular occlusion, cardiovascular collapse, hemorrhage
What is the most important in degree of injury for a ischemic stroke?
TIME
How do CNS hemorrhages occur?
Traumatic or Non traumatic
What causes non traumatic hemorrhage strokes?
Hypertension or atypical vessles
What are signs of a CVA?
Sudden onset
Neuro deficit
What are watershed zones?
Between MCA, ACA
Penetrating arteries of MCA
Hippocampus
Purkinje cells of Cerebellum
What are watershed zones?
Between MCA, ACA
Penetrating arteries of MCA
Hippocampus
Purkinje cells of Cerebellum
What are common causes of infarct?
Atherosclerosis (carotid/cerebral arteries)
Cardiac Valvular disease
Cardiac mural thrombi
Vasculitis
What type of necrosis is caused by a infarct?
Coagulation necrosis but BOARDS is Liquefactive
The location of infarct affects where the injury occurs, what are these injuries?
Total MCA occlusion both internal structures and outer
Partial thrombus over lenticulate arteries only affects internal structures
Partial thrombus past the lenticulate arteries only affects cortex
What type of infarcts are in the brain?
Non-hemorrhagic: No reperfusion injury after due to thrombus formation
Hemorrhagic: Reperfusion injury, weaker vessels
-usually due to embolus
What are the stages of cerebral infartcion?
Acute (week or less)
Subacute: 1-4 weeks
Remote: Months to Years
What are the stages of acute infarct?
Coagulation necrosis (RED neurons)
Axonal degen (spheroid bodies)
Cerebral Edema (might need to do craniomty to relieve pressure)
Vascular proliferation
Neutrophil response (not as many as in MI)
What are changes in the subacute stage?
Macrophages
Reactive Gliosis (gemistocytes)
What are changes in the subacute stage?
Macrophages (FOAMY)
Reactive Gliosis (gemistocytes, Small nuclei pushed to the side)
What are changes in the remote stage?
Cyst Formation
Glial Scarring
What happens in perinatal asphyxia in premature infants?
Germinal matrix hemorrhage
Intraventricular hemorrhage
What happens to term infants that experience perinatal asphyxia?
Oligos are vunerable
Periventricular leukomalacia
Multicystic encephalopathy (basket brain)
What causes cerebral palsy?
Survivors of perinatal asphyxia
What causes spontaneous hemorrhage?
Hypertension
Ruptured aneurysm
Vascular malformation
Other: amyloid, vasculitis
What is the most common sites of HTN hemorrhage?
BG (65%), Pons 15%, Cerebellum 10%
Where do saccular berry aneurysms occur?
They arise at branch points
Result in subarachnoid hemorrhage (WHOL)
Might rupture into ventricles to split the brain
What is the main cause of saccular berry aneurysms?
Abnormality of internal elastica
Where is the most common site of saccular aneurysms?
Anterior communicating/anterior cerebral junction (40%)
Posterior communicating and MCA junction
What are some types of vascular malformations?
Arteriorvenous malformations (AVMs)
Cavernous angioma
Telangiectasia
What causes AVMs?
hemorrhage, seizure, local ischemic injury
What are some characteristics of amyloid angiopathy?
Deposits of amyloid (from APP) close relation to Alz D
Familial: APP (dutch)
-Icelandic (cystatin C mutation)
Where do amyloid deposit hemorrhage usually occur?
Within the lobar interparenchyma (White matter)
-HTN usually hits gray matter
What are some genetic Cerebrovascular diseases?
CADASIL: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
-NOTCH-3 mutations
MELAS: mitochondrial encephalopahty Lactic acidosis stroke like episodes
-MITO dna mutations
