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NEUROLOGY > Cerebrovascular Disease 1 > Flashcards

Cerebrovascular Disease 1 Flashcards

1
Q

What occurs to the neuron in the setting of HYPOXIA or ischemia?

A
  • acute neuronal injury
    (RED neurone)
    —-visible 12-24 hrs after irreversible insult
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2
Q

How does a red neuron appear?

A
  • shrinking and ANGULATION of nuclei
  • loss of nucleolus
  • V.red cytoplasm
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3
Q

WHen do inclusions form in the brain cells?

A
  • neurodegenrative conditions (Alzheimer’s; neurofibrillary tangles)
  • ageing
  • viral infections
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4
Q

Main roles of astrocytes?

A
  1. maintains BBB (along with endothelial cells)

2. involved in REPAIR and SCAR formation

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5
Q

What is gliosis?

A
  • an astrocytic response

- v. important indicator of CNS injury

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6
Q

What cells wraps around axons in the CNS to form myelin sheath?

A
  • Oligodendrocytes
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7
Q

Which cell in the CNS is involved in demyelinating d.o?

A
  • Oligodendrocyte
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8
Q

What are oligodendrocyte sensitive to?

A
  • oxidative damage
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9
Q

Which cells line the ventricular system?

A
  • EPENDYMAL cells
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10
Q

Macrophage of the CNS

A

Microglia

  • m1: Pro-inflammatory
  • m2: aNTI-INFLAMMATORY
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11
Q

What causes neurones to die in the event of brain injury ?

A

excitotoxicity

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12
Q

Which type of stroke is seen in YOUNGER people (hemorrhagic or occlusive)?

A
  • hemorrhagic
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13
Q

Causes of hemorrhagic stroke?

A
  • amphetamine use (RAISE in BP)

- Cocaine use

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14
Q

What occurs with reduced ATP prodn in the neurone (d.t hypoxia) ?

A
  • stops the Na+/K+ pump from working (causing NEURONE depolarization)
  • activation of voltage-dependent Calcium channels (triggers the release of Glutamate into the ECM)
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15
Q

How much oxygen does the brain consume?

A
  • 20%
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16
Q

What maintains blood flow at a constant rate in the cerebral vessels?

A
  • Autoregulatory mechanisms by constant constriction and dilatation of cerebral vessels
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17
Q

When does global hypoxic ischemic damage usually occur?

A

The generalized reduction in blood flow

d.t CARDIAC arrest and severe hypotension (hypovolemic shock)

18
Q

Area of the brain specifically sensitive to hypoxic ischemia?

A

-WATERSHED areas (zones between 2 arterial territories)

19
Q

Areas in the brain with v. sensitive neurones?

A
  • neocortex and hippocampus
20
Q

Define stroke

A

sudden disturbance of cerebral function of vascular origin

- lasts over 24 hrs

21
Q

53% of cerebral infarctions are ______ in orgin

A

THROMBOTIC

22
Q

10% of cerebral hemorrhage is _____

A

intracerebral

23
Q

MOST COMMON site of thrombotic stroke

A

MCA site

24
Q

Cerebral infarction victims

A
  • men >70y.o
25
Q

Where may an emboli come from in the brain?

A
  • atheroma in ICA or aortic arch

- heart

26
Q

Risks of strokes

A
  • atheroma
  • H/T
  • serum lipids, diet, obesity
  • DM
  • Heart disease
  • neck artery disease
  • drugs
  • smoking
27
Q

IF the vascular lesion is in the MCA - what is the presentation?

A
  • weakness C/L FACE and ARM
28
Q

ACA lesion==>

A

weakness and sensory loss in C/L leg

29
Q

How would carotid artery disease present as?

A
  • c/l WEAKNESS or SENSORY loss

- if dominant hemisphere= aphasia or apraxia

30
Q

If its a vertibro-basilar artery disease?

A 
vertigo- dizziness, loss of coordination
ataxia
dysarthria- slurred speech 
dysphagia
loss of vision (in one/both eyes)
31
Q

What are the consequences of H/T?

A
  • LACUNAR infarcts
    (atheroma/ embolism/ basal ganglia)
  • multi-infarct dementia
  • ruptured aneurysm
  • hypertensive encephalopathy
32
Q

Name 4 less known causes of intracerebral hemorrhage?

A
  • amyloid deposits
  • Open heart surgry
  • vasculitis
  • neoplasms
33
Q

Where do intracerebral hemorrhage usually occur?

A

Basal ganglia

thalamus, white matter, cerebllum

34
Q

Describe the cut-surface of an intracerebral hemorrhage.

A
  • asymmetrical distortion but well-demarcated
  • herniations common
  • softening of adjacent tissue
  • surrounding edema
35
Q

Which vascular malformation has a HIGH rebleed rate (4%/year)

A

Arteriovenous Malformations (AVM)…form abnormal tortuous vessels (usual rupture in MCA territory)

36
Q

NAme other vascular malformations! And what do they additionally cause?

A

headaches and seizures

  • cavernous angiomas
  • venous angiomas
  • capillary telangectases
37
Q

Most COMMON cause of subarachnoid hemorrhage?

A

rupture of saccular aneurysm (berry aneurysm) —90% in ICA; 10% in vertebro-basillar circul….at arterial bifurcation

38
Q

Berry aneurysm risk factors:

A

smoking/ H/T/ kidney disease

39
Q

What are the signs of berry aneurysm?

A
  • ACUTE onset severe headache
  • vomiting
  • LOC

(no hx of precipitating factor) —-50% die

40
Q

Morphology fts of berry anuerysm?

A
  • infarcts of brain parenchyma
  • intracerebral hematoma
  • hematoma and RAISED ICP

NEUROLOGY (36 decks)

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