Cerebrovascular Disease

Question 1

_______ a clinical term that refers to a rapid loss of brain function due to a disturbance in the blood supply. It could be either an infarct or hemorrhage.

Answer 1

Stroke

Question 2

Hemodynamic factors such as ______, ______, or _______ may play a major role in the pathogenesis of cerebrovascular disease.

Answer 2

reduced cardiac output, reduced oxygenations of the blood, or hematologic disorders

Question 3

A global reduction of the perfusion pressure from hypotension can produce infection in the most distal fields of arterial irrigation. These are called _______ infarcts.

Answer 3

Watershed

Question 4

The most frequent site of atheromatous compromise of larger vessels is at the bifurcation of the ______ artery in the neck.

Answer 4

common carotid artery

Question 5

A ____ infarct is a small infarct less than 2-15 mm diameter.

Answer 5

Lacunar

Question 6

Lacunar infarcts most commonly occur in the ___________ and _____ and are caused by occlusion of small penetrating arterioles by arteriolosclerosis.

Answer 6

basal ganglia internal capsule, pons

Question 7

________ is one of the major causes of arteriolosclerosis causing lacunar infarcts.

Answer 7

Hypertension

Question 8

A hemorrhagic infarct can be distinguished from a simple hemorrhage by the presence of _________.

Answer 8

necrotic (infarcted) brain

Question 9

______ is inflammation of vessels which leads to narrowing and thrombosis resulting in the infarction of territory of that vessel.

Answer 9

Vasculitis

Question 10

1-4 hours after infarct:

Answer 10

May not be able to appreciate any changes

Question 11

6-48 hours after the infarct:

Answer 11

Neurons are dead and red, neutrophils are the dominant cellular response, patchy sharply demarcated areas of pallor are seen microscopically. Grossly, edema begins.

Question 12

2-6 days after the infarct:

Answer 12

Macrophages infiltrate int the infarct to phagocytose necrotic debris. The infarct is soft and swollen and the tissue begins to degenerate.

Question 13

One to several weeks after the infarct:

Answer 13

This timing is considered subactue. Adjacent to the infarct are reactive astrocytes and small proliferating blood vessels. Disintegration of the necrotic brain is prominent and macrophages are abundant. Grossly, the tissue is gelatinous and friable w/ a distinct border.

Question 14

Months to years after the infarct:

Answer 14

This is considered an old or remote infarct. All that remains is a cystic cavity filled with fluid. Microscopically there is gloss at the edge of the cavity

Question 15

Hypertension may cause micro aneurysms also known as _________.

Answer 15

Charcot-Bouchard aneurysms

Question 16

Frequent sites of hypertensive hemorrhage are(4) ____________.

Answer 16

putamen, thalamus, pons, and cerebellum

Question 17

_______ are small aneurysms that occur at branch points of major cerebral vessels.

Answer 17

Berry aneurysms

Question 18

A long term complication of berry aneurysms is scarring of the subarachnoid space leading to ________.

Answer 18

hydrocephalus

Question 19

Describe arteriovenous malformation (AVM)

Answer 19

Composed of arteries connected to veins without capillaries. Grossly they appear as tangle of thickened vessels separated by gliotic brain tissue. These may bleed and cause parenchymal and or subarachnoid hemorrhage.

Question 20

Cavernous hemangiomas

Answer 20

Consist of thin-walled fibrotic walls without intervening brain parenchyma. Bleeding is less common with cavernous hemangioma.

Question 21

Cerebral Amyloid Angiopathy

Answer 21

Amyloid is a protein that is folded in a beta-pleated sheet configuration. It is visible using a congo red stain and polarized light. Amyloid may deposit in the walls of small and medium size arteries leading to weakening of the vessel and hemorrhage. Results in lobar hemorrhage.

Question 22

Lobar hemorrhage is ______.

Answer 22

a hemorrhage in a distal cite, different from deep hemorrhages that occur secondary to hypertension.