Cerebrovascular Disease Flashcards
What does cerebrovascular disease mean
Any abnormality of the rain caused by a pathologic process of blood vessels
Leads to brain injury due to altered blood flow
Which is the most common acute and dramatic manifestation of cerebrovascular disease
Cerebrovascular accident or stroke
Third leading cause of death in the US
Cerebrovascular accident
Is cerebrovascular accident common in Ghana
Yes
Which blood vessels are affected in cerebrovascular disease
Intracranial vessels (Anterior cerebral artery, middle cerebral artery, basilar artery or posterior cerebral artery)
extracranial vessels(Carotid artery with common carotid artery And internal carotid artery, vertebral artery ,others)
What is transient ischemic attack
Fully reversible neurological deficits lasting no more than a few minutes but occasionally up to 24 hours
Is there brain damage in transient ischemic attack
no structural brain damage
Risk factors to transient ischemic attack
atherosclerosis with superimposed hypotension or spasm of the disease vessel
Other extracranial vascular disease like embolism
What is stroke or cerebrovascular accident
Rapid onset of focal disturbance of cerebral function which has a vascular origin and of more than 24 hours duration
Is there a permanent brain damage in cerebrovascular accident
Yes
Factors affecting tissue survival in CNS ischemia
Collateral circulation Ischemia duration Systemic circulation state Hypoxia Thrombus propagation Micro circulatory bed resistance Micro circulatory bed hypertension Micro circulatory bed hyper viscosity
Micro circulatory bed diffuse thrombus
Edema
Raised icp
Most sensitive cells in the brain to ischemia
Neuron (the most )
Oligodendrocytes
AStrocytes
Microglia
Blood vessels
What happens in mild hypoxia
Selective neuronal necrosis
What happens in moderate hypoxia
Neuronal necrosis
Neuroglia necrosis
Blood vessels and Microglia spared
Underlying cause of infarction stroke
Thrombotic
Common association with atherosclerosis and plaques rupture leading to stenosis , propagation and embolization
Disease associated with infarction stroke
DM
Hypertension
CNS infarction due to thrombosis causes
Non infectious causes - pregnancy, puerperium, OCCs, hematological disroders, extreme dehydration
Infectious causes- immunosupression leading to infections, sinus infections, ear infections Compound fracture with Septic infarction
Drug abuse
Heroin
Amphetamines
Why are most emboli in the CNS hemorrhagic
Necrosis of vessel wall
Lysis of embolus with restoration of some blood flow
Reperfusion of embolus
Source of embolism in CNS
Cardia mural Carotid artery Paradoxical Fat emboli Marrow emboli Air emboli
Which are of brain is most vulnerable to emboli blockage
Middle cerebral artery
Sequence of events of vascular occlusion in CNS
Necrosis of neurons, neuroglia, Microglia, blood vessels,
4-6h -> coagulative necrosis
12-15h -> sharp demarcation
24h - reactive changes with inflammation and proliferation of Microglia, AStrocytes and capillaries
Several months- shrunken cystic lesion , glial fibrils, small blood vessels
Consequence of vertebra basillar occlusion
Infarction of brainstem, cerebellum, posterior cerebral arterial territory
Second name of CNS hemorrhage
Hemorrhagic stroke
Bleeding sites in CNS hemorrhage
Brain
Spinal cord substance
Subarachnoid space
Mixed
Major Risk factors to CNS hemorrhage
Hypertension
Congenital anomalies
Vascular malformations
Minor Risk factors to CNS hemorrhage
Vasculitis
Bleeding diarheses
Tumours
Primary intraparenchymal hemorrhage predisposing changes
Fibrinoid necrosis
Hyaline arteriosclerosis
Microaneurysm - Charcot Bouchard
Size oh hemorrhage in primary intraparenchymal
Massive more than 3 cm in cerebral hemispheres
Less than 1.5 cm in brainstem
Brain common site of spontaneous hemorrhage
Basal ganglia , pons, cerebellum
Subarachnoid hemorrhage main causes
65% saccular berry aneurysm
5% a-v cavernous malformations
20% no cause found
10% others
saccular berry aneurysm more common for male or female
Female
Secondary effects of subarachnoid hemorrhage
Rebleeding
Vasoconstriction
