Cerebrovascular Disease 1

Question 1

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

Answer 1

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

Question 2

How does a red neuron appear?

Answer 2

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

Question 3

WHen do inclusions form in the brain cells?

Answer 3

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

Question 4

Main roles of astrocytes?

Answer 4

1. maintains BBB (along with endothelial cells)

2. involved in REPAIR and SCAR formation

Question 5

What is gliosis?

Answer 5

• an astrocytic response

- v. important indicator of CNS injury

Question 6

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

Answer 6

• Oligodendrocytes

Question 7

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

Answer 7

• Oligodendrocyte

Question 8

What are oligodendrocyte sensitive to?

Answer 8

• oxidative damage

Question 9

Which cells line the ventricular system?

Answer 9

• EPENDYMAL cells

Question 10

Macrophage of the CNS

Answer 10

Microglia

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

Question 11

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

Answer 11

excitotoxicity

Question 12

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

Answer 12

• hemorrhagic

Question 13

Causes of hemorrhagic stroke?

Answer 13

• amphetamine use (RAISE in BP)

- Cocaine use

Question 14

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

Answer 14

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

Question 15

How much oxygen does the brain consume?

Answer 15

• 20%

Question 16

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

Answer 16

• Autoregulatory mechanisms by constant constriction and dilatation of cerebral vessels

Question 17

When does global hypoxic ischemic damage usually occur?

Answer 17

The generalized reduction in blood flow

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

Question 18

Area of the brain specifically sensitive to hypoxic ischemia?

Answer 18

-WATERSHED areas (zones between 2 arterial territories)

Question 19

Areas in the brain with v. sensitive neurones?

Answer 19

• neocortex and hippocampus

Question 20

Define stroke

Answer 20

sudden disturbance of cerebral function of vascular origin

- lasts over 24 hrs

Question 21

53% of cerebral infarctions are ______ in orgin

Answer 21

THROMBOTIC

Question 22

10% of cerebral hemorrhage is _____

Answer 22

intracerebral

Question 23

MOST COMMON site of thrombotic stroke

Answer 23

MCA site

Question 24

Cerebral infarction victims

Answer 24

• men >70y.o

Question 25

Where may an emboli come from in the brain?

Answer 25

- atheroma in ICA or aortic arch | - heart

Question 26

Risks of strokes

Answer 26

- atheroma - H/T - serum lipids, diet, obesity - DM - Heart disease - neck artery disease - drugs - smoking

Question 27

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

Answer 27

- weakness C/L FACE and ARM

Question 28

ACA lesion==>

Answer 28

weakness and sensory loss in C/L leg

Question 29

How would carotid artery disease present as?

Answer 29

- c/l WEAKNESS or SENSORY loss | - if dominant hemisphere= aphasia or apraxia

Question 30

If its a vertibro-basilar artery disease?

Answer 30

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

Question 31

What are the consequences of H/T?

Answer 31

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

Question 32

Name 4 less known causes of intracerebral hemorrhage?

Answer 32

- amyloid deposits - Open heart surgry - vasculitis - neoplasms

Question 33

Where do intracerebral hemorrhage usually occur?

Answer 33

Basal ganglia | thalamus, white matter, cerebllum

Question 34

Describe the cut-surface of an intracerebral hemorrhage.

Answer 34

- asymmetrical distortion but well-demarcated - herniations common - softening of adjacent tissue - surrounding edema

Question 35

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

Answer 35

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

Question 36

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

Answer 36

headaches and seizures - cavernous angiomas - venous angiomas - capillary telangectases

Question 37

Most COMMON cause of subarachnoid hemorrhage?

Answer 37

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

Question 38

Berry aneurysm risk factors:

Answer 38

smoking/ H/T/ kidney disease

Question 39

What are the signs of berry aneurysm?

Answer 39

- ACUTE onset severe headache - vomiting - LOC (no hx of precipitating factor) ----50% die

Question 40

Morphology fts of berry anuerysm?

Answer 40

- infarcts of brain parenchyma - intracerebral hematoma - hematoma and RAISED ICP