Cerebrovascular Disease Flashcards
What are the two classes of cerebrovascular disease?
Ischemic (85%)
Hemorrhagic (15%)
What are the major etiologies of global cerebral ischemia?
Low perfusion (ie atherosclerosis)
Acute decrease in blood flow (ie cardiogenic shock)
Chronic hypoxia (ie anemia)
Repeated episodes of hypoglycemia (ie insulinoma)
Clinical features of mild global ischemia?
Transient confusion with prompy recovery
Clinical features of severe global ischemia
Diffuse necrosis
Survival leads to “vegetative state”
What are 3 highly vulnerable structures in moderate global ischemia?
Pyramidal neurons of the cerebral cortex
Pyramidal neurons of the hippocampus
Purkinje layer of the cerebellum
What is the effects of damage to the pyramidal neurons of the cerebral cortex?
Laminar necrosis
What is the effect of damage to the pyramidal neurons of the hippocampus?
Damage to long term memory
What is the role of the Purkinje layer of the cerebellum?
Integrate sensory perception with motor control
What is an ischemic stroke?
Regional ischemia to the brain that results in focal neurologic deficits lasting > 24 hours
What is a regional ischemia to the brain with symptoms that last for less than 24 hours?
Transient ischemic attack
What are the subtypes of strokes?
Thrombotic stroke
Embolic stroke
Lacunar stroke
Thrombotic stroke is due to _____________
rupture of an atherosclerotic plaque
Where does atherosclerosis usually develop?
Usually develops at branch points (ie bifurcation of internal carotid and middle cerebral artery in the circle of Willis)
Does a thrombotic stroke result in a pale or hemorrhagic infarct?
Pale infarct
Where is the most common source of an emboli causing an embolic stroke?
emboli from the left side of the heart
Which artery is usually involved in an embolic stroke?
Middle cerebral artery
Does an embolic stroke result in a hemorrhagic infarct or pale infarct?
Hemorrhagic infarct
Lacunar strokes are usually secondary to __________
Hyaline arterolosclerosis
Lacunar strokes usually involve what vessels?
Lenticulostriate vessels
How do the lacunar strokes involving the lenticulostriate vessels grossly present?
Small cystic areas of infarction
What are the results of lacunar strokes afecting the internal capsule?
Pure motor stroke
What is hte result of lacunar strokes affecting the thalamus?
Pure sensory stroke
Ischemic strokes result in what kind of necrosis?
Liquefactive necrosis
How does liquefactive necrosis progress from the time of initial necrosis to end result?
Eosionophilic change in the cytoplasm of neurons (red neurons) 12 hours after infarction
Coagulative necrosis 24 hours after infarction
Infilitration by neutrophils (days 1-3)
Microglial cell infiltration (days 4-7)
Granulation tissue (weeks 2-3)
Results in fluid filled cystic space surrounded by gliosis
Remember as:
Red neurons (hrs) –> Neutrophils and microglial cells (days) –> granulation tissue (weeks) –> gliotic cyst (months)
