Cerebrovascular disease Flashcards
This is any abnormality of the brain caused by a pathological process of _______
Blood vessels
Which 2 processes are involved
Hypoxia, ischaemia and infarction which result from impairment of blood supply and oxygenation of tissue
Haemorrhage resulting from rupture of CNS vessels
Cerebral ischaemia can be classified as either
Global or focal
Global cerebral ischaemia
Generalised reduction in blood flow/oxygenation when there is systemic compromise to circulation
Global cerebral ischaemia occurs is MABP is below which value?
50mmHg
Examples of global cerebral ischaemia
Cardiac arrest
Hypovolaemic shock
Trauma
Focal cerebral ischaemia
Restriction of blood flow to a localised area of brain
Typically due to vascular obstruction
What ar the 2 main reasons that haemorrhage infarcts occur
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
Complex tangle of arteries and veins connected together (anastomosis) with one or more fistulas is called
Arterio-venous malformation (AVM)
AVMs usually lead to focal/global neurological deficits?
Focal
AVMs are a common cause of haemorrhage in young/old people?
Young
AVM - common location
Middle cerebral artery territory
AVM - clinical features
Often asymptomatic
Haemorrhage
Seizure
Headaches
Diagnosis is often made at time of haemorrhage, seizure or other neurological dysfunctions
AVM - seizures - frontal lobe AVM - generalised/focal seizures
Generalised
AVM - seizures - temporal lobe AVM - generalised/focal seizures
Focal
AVM - investigations
Catheter angiography
- you will see a tangle of vessels with a large feeding artery
AVM - management - most likely option
Conservative managemnt
AVM - surgical management
Endovascular embolisation
Aneurysm - definition
Localised, abnormal weak spot on a blood vessel wall
Aneurysm - how do they normally present
Due to rupture, resulting in a subarachnoid haemorrhage
Most aneurysms arise them the anterior/posterior circulation?
Anterior
Where are most aneurysms found in the brain?
around the circle of willis, at the branching points of the major arteries
At which junctions are most aneurysms found in the brain?
Junction of the anterior communicating artery with the anterior cerebral artery
Junction of the posterior communicating artery with the internal carotid artery
What does a berry aneurysm result in?
Subarachnoid haemorrhage
What is a fusiform aneurysm associated with?
Atheroma formation,
Hypertension
Non ruptured aneurysm - clinical features of an enlarging posterior communicating artery
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
Non ruptured aneurysm - clinical features of an enlarging anterior communicating artery
Compression of the optic chiasma
Aneurysm management
Craniotomy + clip the neck of the aneurysm
Endovascular coiling
