Cerebrovascular Disease and Infections of CNS Flashcards by Ben Nye

Cerebral Artery Infarct Deficits

Anterior (2) Middle (3) Posterior (1)

ACA:
Contralateral leg hemiplegia
Alien hand syndrome: contralateral arm autonomy

MCA:
Aphasia
Face-Arm sensorimotor loss
Gaze toward lesion

PCA:
Contralateral homonymous hemianopia

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Ischemia Patterns with Causes

Global (3) and Focal (3)

Global is a generalized reduction in perfusion
Caused by cardiac arrest, shock, hypotension

Focal is localized
Caused by embolus, thrombosis, atherosclerosis

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Watershed Infarcts
General Description
Specific Examples (2) with Clinical Features (2/1)

Sickle shaped band of necrosis

ACA-MCA:
Proximal arm/leg weakness, Transcortical aphasia

MCA-PCA:
Visual processing defects

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Carotid Stenosis

Etiology, Clinical Features (4)

Atherosclerosis of internal carotid artery

Carotid bruit
Contralateral Face-Arm weakness
Contralateral visual field defects
Aphasia

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Thrombosis

Primary Cause, Common Brain Locations (3)

Atherosclerosis creating plaques than can rupture and become thrombus

Carotid bifurcation
MCA origin
Ends of Basilar Artery

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Paradoxical Embolus

Etiology and Description

Patent Foramen Ovale

Thrombus able to pass from left side of heart to right and travel through internal carotid directly to brain

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Embolus Types with Descriptions (4)

Air: deep sea divers, causes the bends

Septic: from bacterial endocarditis

Fat/Cholesterol: from long bone fracture
Can cause Shower emboli in brain

Marantic: protein from nonbacterial endocarditis

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Transient Ischemic Attacks
Clinical Description (2) Warnings (2)

Temporary brain ischemia for ~10 minutes, neurological symptoms gone within 24 hours

Neurological emergency
Often proceeds more serious cerebrovascular event such as stroke

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Stroke

Types (2) with Descriptions (2/2)

Hemorrhagic (red)
Associated with Embolus
Intra-cerebral or Subarachnoid hemorrhage

Ischemic Infarction (pale)
Associated with Thrombus, especially at MCA
Bloodless, hemorrhage is secondary

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Hypertensive Cerebrovascular Disease
Main Complications with Descriptions
Chronic HTN (3) and Malignant HTN (2)
CADASIL (2)

Lacunar Infarcts
Charcot Bouchard microaneurysms from Chronic HTN
Lenticulostriate artery infarcts in basal ganglia
Cause motor hemiparesis

Hypertensive Encephalopathy
deep brain parenchymal hemorrhages

CADASIL
Recurrent strokes and Dementia starting at 35 years old
NOTCH 3 gene association

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Cerebral Amyloid Angiopathy

Associated Condition, Complication, Morphology

Alzheimer’s Disease

Primary Intraparenchymal Lobar Hemorrhage

A-Beta Amyloid deposits in vessels

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Subarachnoid Hemorrhage

Pathogenesis, Etiology, Symptom, Sizing (2)

Develop over time due to defect in tunic media

Bursting saccular aneurysm in Anterior circulation

“Worst headache of my life”

Giant if >2 cm
Likely to rupture if >10 cm

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Arteriovenous Malformations

Description, Common Locations (3) Complication

Tangled, pulsating mass of vessels with arteriovenous shunting

Subarachnoid space
MCA and Posterior branches of Circle of Willis

AV shunting causes rupture early in life

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CNS Infection Routes
Types with Descriptions
Hematogenous, Direct, Local, PNS, Seeding

Hematogenous: most common route

Direct Implantation: trauma or congenital malformations

Local Extension: Oral or sinus infection, osteomyelitis

Peripheral Nervous System: Rabies, Herpes Zoster

Seeding: TB seeds CSF from subepidural/submeningeal granulomas

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CSF Lab Results

Bacteria (4) Virus (4) Fungus (4)

Bacteria:
Turbid fluid
Neurtrophilia
Increased protein
Decreased Glucose

Virus:
Clear fluid
Lymphocytosis
Slight protein increase
Normal glucose

Fungus:
Clear fluid
Early neutrophilia, then lymphocytosis
Decreased glucose
Increased protein

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Acute Pyogenic Meningitis
Clinical Signs (4)
Common Causes by Age Group
Neonate (2) Unvaccinated Toddler, Adolescent/Adult, Elderly (2)

Meningeal Irritation (Brudzinski, Kernig)
High fever
Headache
Waterhouse Friderichsen Syndrome

Neonate: E. coli, Group B Strep
Toddler: H. influenzae
Adolescent/Adult: N. meningitidis (in close quarters)
Elderly: Strep pneumoniae, Listeria monocytogenes

Brain Abscesses

Causes (2) CSF Findings (3), Complications (2)

Streptococci
Staphylococci

High WBC
High protein
Normal glucose

Venous sinus thrombosis
Ventriculitis/Meningitis from rupture

Subdural Empyema Complications (3)

Thrombophlebitis causing bridging vessel infarct

Thickened dura

Extradural abscess, associated with osteomyelitis

Neisseria meningitidis

Main Risk Factor, Symptoms (4)

Crowded living conditions (dorm, barracks, jail)

Petechiae
Purpura
Purpura Fulminans: gangrene
Waterhouse Friderichsen Syndrome

Chronic Meningitis

Timeline, Symptoms (5) CSF Findings (3), Causes (3)

4+ weeks

Fever
Headache
N/V
Confusion
Stiff neck

Elevated Protein
Lymphocytic Pleocytosis
Low Glucose

Tuberculosis
Neuroborreliosis (borrelia burgdorferi)
Neurosyphilis (treponema pallidum)

Mycobacterium tuberculosis

Complications (4) Staining

Obliterative Endarteritis
Arachnoiditis
CN Palsies
Tuberculoma with central caseating necrosis

(+) Acid Fast Stain

Borrelia burgdorferi (Lyme Disease)
Symptom Progression (4), CSF Finding

Bullseye rash
4 weeks later, neurological symptoms
CN palsies
Peripheral neuropathy

Abs in CSF

Treponema pallidum

Complications (5) Morphology (1) Symptoms (4)

Communicating hydrocephalus
Heubner Arteritis (Obliterative endarteritis)
Paretic Neurosyphilis
Granular Ependymitis
Tabes Dorsalis

Thickening and fibrosis of meninges

Delusions of grandeur
Lightning pain
Absent reflexes
Charcot joints

West Nile Virus
CSF Findings (4) Symptom, Morphology (2)

Neutrophil pleocytosis initially, then Lymphocytosis
Clear
Elevated protein
Normal glucose

Polio-like syndrome with paralysis

Neuronophagia
Microglial nodules

Herpes Simplex Virus | Complication (2), Morphology (2)

Necrotizing and Hemorrhagic encephalitis of the Inferior and Medial Temporal Lobes Cowdry A intranuclear inclusions Ground glass cytoplasm

``` Herpes Zoster Virus Clinical Phases (3) with Symptoms (1/1/2) ```

Latent phase: no symptoms, virus in Trigeminal ganglia Reactive: single dermatome painful vesicular rash (Shingles) Persistent: Postherpetic neuralgia syndrome, pain to nonpainful stimuli

Cytomegalovirus At Risk Populations (2) with Complications (2/1) Morphology

Fetuses Periventricular necrosis Microcephaly Immunocompromised patients Subacute encephalitis Owl-eye inclusions

``` Poliomyelitis Clinical Presentations (2) with Symptoms (2/3) ```

Acute Anterior horn motor neuron neuronophagia Flaccid paralysis Post-Polio Syndrome 25-35 years later Decreased muscle mass and pain

Rabies (Lyssavirus) | Incubation, Infection Pathway, Symptoms (4), Mophology

1-3 months Ascends into CNS via motor neurons Paresthesias around wound Hydrophobia: mouth foaming Flaccid paralysis Respiratory center failure Negri bodies in purkinje cells

``` HIV Pathological Signs (3) Complications (4) ```

Perivascular inflammation (acute) Microglial nodules with multinucleated giant cells Myelin pallor, axonal swelling, gliosis Immune Reconstitution Inflammatory Syndrome Dementia Primary CNS Lymphoma

Progressive Multifocal Leukoencephalopathy | Pathogenesis, Pathological Signs (2)

JC Polyomavirus reactivation in immunodeficient person Oligodendrocyte demyelination Subcortical demyelination with lipid laden macrophages

Subacute Sclerosing Panencephalitis | Etiology, Symptoms (3) and Pathological Findings (3)

Paramyxovirus (measles) Cognitive decline Spasticity of limbs Seizures Widespread gliosis and demyelination Viral inclusions Neurofibrillary tangles

Cryptococcus Neoformans | At Risk Populations, Complication, Morphology, Testing (2)

Immunocompromised Fungal Meningoencephalitis Parenchymal soap bubbles India Ink Prep Cryptococcal Polysaccharide Antigen

``` Toxoplasmosis Risk Factors (2) Morphology, Pathologic Findings (4) ```

HIV Pregnancy Ring enhancing lesion Brain abscess with central necrosis Free tachyzoites and encysted bradyzoites Petechial hemorrhage Vessel proliferation

Creutzfeldt-Jakob Disease Morphology, Symptoms (2) Pathologic Finding with Tests (2)

Spongiform change with intracellular vacuoles Beta pleated sheet isoform proteins Progressive neurodegenerative disease Myoclonus Kuru Plaque Congo red stain and PAS (+)