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All the things > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

What are the two major causes of neurovascular disease, and what percent does each make up?

A

Ischemia (85%)

Hemorrhage (15%)

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2
Q

What are the two major types of ischemia?

A

Global and focal

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3
Q

What can cause global cerebral ischemia? (4)

A
  • Low perfusion (atherosclerosis)
  • Acute decrease in blood flow (shock)
  • Chronic hypoxia (anemia)
  • Repeated episodes of hypoglycemia
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4
Q

What characterizes mild global ischemia? What is an example of this?

A

Transient ischemia with no lasting damage– insulinoma causing transient hypoglycemia

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5
Q

What characterizes severe global ischemia?

A

Ischemia that leads to necrosis

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6
Q

Where are the infarcts characteristically located with moderate global ischemia? Why?

A
  • Watershed areas

- are ends of the circulation

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7
Q

What, generally, are the watershed areas of the brain?

A

Areas of the brain that are fed by the end of a circulation

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8
Q

How many layers of the cortex are there? Which cells here are most vulnerable to damage?

A

6

-Pyramidal cells

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9
Q

Cortical laminar necrosis = damage to what layers of the cortex?

A

3, 5, 6

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10
Q

What are the three parts of the brain that are particularly susceptible to ischemia?

A
  • 3,5,6 of cortex
  • Pyramidal cells of the hippocampus
  • Purkinje layer of the cerebellum
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11
Q

What is the definition of a TIA?

A

Regional Ischemia that lasts less than 24 hours

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12
Q

What is the defintion of an Ischemic stroke?

A

Regional Ischemia that lasts longer than 24 hours

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13
Q

What are the three majors ways of developing an ischemic stroke?

A
  1. Thrombotic
  2. Embolic
  3. Lacunar
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14
Q

Are thrombotic strokes red or pale infarctions? Why?

A
  • Pale

- Thrombus occludes and stays there

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15
Q

Are embolic strokes red or ale infarctions? Why?

A
  • Red

- Embolus is degraded after tissue dies, causing reperfusion, and thus a red infarct

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16
Q

What, generally, is the cause of a thrombotic stroke? Where in the circulation do these generally occur?

A
  • Rupture of an atherosclerotic plaque

- Usually occur at branch points

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17
Q

What is the most common site of origin for embolic strokes? Which artery in the brain is usually involved?

A
  • Left side of the heart

- Middle cerebral artery

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18
Q

What are lacunar strokes?

A

Strokes that are 2/2 hyaline arteriolosclerosis from HTN or DM

19
Q

What are the arteries that are most commonly involved in a lacunar stroke?

A

Lenticulostriate vessels

20
Q

What do the lenticulostriate vessels arise from? Supply?

A
  • Middle cerebral

- Internal capsule and RF

21
Q

What are the classical histological pattern seen with lacunar strokes?

A

“little lakes” in the deep structures of the brain

22
Q

What are the histological changes that occur in the 12-48 hour timeframe after a stroke?

A

Red neurons

23
Q

What are the histological changes that occur in the 24-72 hour timeframe after a stroke?

A

Necrosis + PMNs

24
Q

What are the histological changes that occur in the 3-5 day timeframe after a stroke?

A

Macrophages

25
Q

What are the histological changes that occur in the 1-2week timeframe after a stroke?

A

Reactive gliosis + vascular proliferation

26
Q

What are the histological changes that occur in the more than 2 week timeframe after a stroke?

A

Glial scar

27
Q

Match the timeframe following a stroke consistent with the following histological findings: Red neurons

A

12-48 hours

28
Q

Match the timeframe following a stroke consistent with the following histological findings: Necrosis + PMNs

A

24-72 hours

29
Q

Match the timeframe following a stroke consistent with the following histological findings: macrophages

A

3-5 days

30
Q

Match the timeframe following a stroke consistent with the following histological findings: reactive gliosis + vascular proliferation

A

1-2 weeks

31
Q

Match the timeframe following a stroke consistent with the following histological findings: glial scar

A

More than 2 weeks

32
Q

What is the most common site in the brain for intracerebral hemorrhage from rupture of Charcot-Bouchard aneurysm?

A

Basal ganglia

33
Q

What is the usual cause of intracerebral hemorrhage?

A

Rupture of Charcot-Bouchard microaneurysms

34
Q

What are Charcot-Bouchard aneurysms?

A

Small vessel hemorrhages in the brain, 2/2 chronic HTN

35
Q

What is the usual presentation of subarachnoid hemorrhages?

A

Sudden onset HA with nuchal rigidity

36
Q

What will an LP show with a subarachnoid hemorrhage?

A

Xanthochromia (yellow d/t bili breakdown products)

37
Q

Bleed on the bottom of the brain = what type of hemorrhage?

A

Subarachnoid

38
Q

What is the most frequent cause of subarachnoid hemorrhages?

A

Rupture of a berry aneurysm

39
Q

What are berry aneurysms?

A

Aneurysms that occur at the bifurcations in the circle of Willis

40
Q

What is the renal disease associated with Berry aneurysms?

A

ADPKD

41
Q

What are the two CT diseases associated with Berry aneurysms?

A

Marfans

Ehlers-Danlos

42
Q

Where is the most common site of a Berry aneurysm?

A

Branch points of the anterior communicating artery

43
Q

Why are berry aneurysms prone to rupture?

A

Lack a media layer

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