Cerebrovascular disease

Question 1

This is any abnormality of the brain caused by a pathological process of _______

Answer 1

Blood vessels

Question 2

Which 2 processes are involved

Answer 2

Hypoxia, ischaemia and infarction which result from impairment of blood supply and oxygenation of tissue

Haemorrhage resulting from rupture of CNS vessels

Question 3

Cerebral ischaemia can be classified as either

Answer 3

Global or focal

Question 4

Global cerebral ischaemia

Answer 4

Generalised reduction in blood flow/oxygenation when there is systemic compromise to circulation

Question 5

Global cerebral ischaemia occurs is MABP is below which value?

Answer 5

50mmHg

Question 6

Examples of global cerebral ischaemia

Answer 6

Cardiac arrest
Hypovolaemic shock
Trauma

Question 7

Focal cerebral ischaemia

Answer 7

Restriction of blood flow to a localised area of brain

Typically due to vascular obstruction

Question 8

What ar the 2 main reasons that haemorrhage infarcts occur

Answer 8

When the BBB is disrupted or deteriorates in the context of vasogenic oedema

When intentional repercussion results in haemorrhage through damaged vessels deteriorating in the context of infarcted tissue

Question 9

Complex tangle of arteries and veins connected together (anastomosis) with one or more fistulas is called

Answer 9

Arterio-venous malformation (AVM)

Question 10

AVMs usually lead to focal/global neurological deficits?

Answer 10

Focal

Question 11

AVMs are a common cause of haemorrhage in young/old people?

Answer 11

Young

Question 12

AVM - common location

Answer 12

Middle cerebral artery territory

Question 13

AVM - clinical features

Answer 13

Often asymptomatic
Haemorrhage
Seizure
Headaches

Diagnosis is often made at time of haemorrhage, seizure or other neurological dysfunctions

Question 14

AVM - seizures - frontal lobe AVM - generalised/focal seizures

Answer 14

Generalised

Question 15

AVM - seizures - temporal lobe AVM - generalised/focal seizures

Answer 15

Focal

Question 16

AVM - investigations

Answer 16

Catheter angiography

- you will see a tangle of vessels with a large feeding artery

Question 17

AVM - management - most likely option

Answer 17

Conservative managemnt

Question 18

AVM - surgical management

Answer 18

Endovascular embolisation

Question 19

Aneurysm - definition

Answer 19

Localised, abnormal weak spot on a blood vessel wall

Question 20

Aneurysm - how do they normally present

Answer 20

Due to rupture, resulting in a subarachnoid haemorrhage

Question 21

Most aneurysms arise them the anterior/posterior circulation?

Answer 21

Anterior

Question 22

Where are most aneurysms found in the brain?

Answer 22

around the circle of willis, at the branching points of the major arteries

Question 23

At which junctions are most aneurysms found in the brain?

Answer 23

Junction of the anterior communicating artery with the anterior cerebral artery

Junction of the posterior communicating artery with the internal carotid artery

Question 24

What does a berry aneurysm result in?

Answer 24

Subarachnoid haemorrhage

Question 25

What is a fusiform aneurysm associated with?

Answer 25

Atheroma formation,

Hypertension

Question 26

Non ruptured aneurysm - clinical features of an enlarging posterior communicating artery

Answer 26

Compression on CN III causing CN III palsy
- dilated pupil that is unreactive to light and if not treated, would progress to a complete CN III palsy with ptosis and extra-ocular muscle palsy

Question 27

Non ruptured aneurysm - clinical features of an enlarging anterior communicating artery

Answer 27

Compression of the optic chiasma

Question 28

Aneurysm management

Answer 28

Craniotomy + clip the neck of the aneurysm

Endovascular coiling