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NEUROLOGY > Cerebrovascular Disease NeuroPathology > Flashcards

Cerebrovascular Disease NeuroPathology Flashcards

1
Q

Rapid necrosis of nerve cells and/ortheirprocesses most commonly leads to what clinical picture?

A

suddenacutefunctionalfailure(“stroke”)

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2
Q

Slow atrophy of nerve cells and/ortheirprocesses most commonly leads to what clinical picture?

A

graduallyincreasingdysfunction(age- relatedcerebralatrophy)

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3
Q

How does acute neuronal injury appear microscopically?

A
  • Shrunkenandangulated nuclei
  • Lossofthenucleolus
  • Intenselyredcytoplasm “RED NEURON”
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4
Q

At what stage are “RED NEURONS” normally seen microscopically?

A
  • After hypoxia/ischaemia
  • Typicallyvisible12-24hoursafteranirreversibleinsult (stroke)
  • shows neuronal cell death
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5
Q

If an axon is severed, what occurs on either side of the damage?

A
  • cellbodyswelling,enlargednucleolus

- Degenerationofaxonandmyelinsheathdistaltoinjury

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6
Q

What are the main functions of astrocytes?

A
  • maintainthebloodbrain barrier

* Involvedinrepairand scarformation(due tolackof fibroblasts)

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7
Q

How do astrocytes usually respond to any CNS injury?

A

Gliosis => Astrocytehyperplasiaand hypertrophy

-indicatorofCNSinjury,regardlessofcause

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8
Q

How does old gliosis appear histologically?

A
  • nuclei become smallanddark

- They lie inadensenetofprocesses(glialfibrils)

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9
Q

What type of damage are oligodendrocytes particularly susceptible to?

A

oxidativedamage

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10
Q

How do ependymal cells (which line ventricles) respond to CNS injury?

A
  • Limitedreactiontoinjury
  • disruption causes local proliferation of these cells =>smallirregularitiesontheventricularsurfaces”ependymalgranulations”
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11
Q

How do the microglia (macrophage-like cells) respond to CNS injury?

A
  • proliferate
  • Recruitedthroughinflammatorymediators
  • Aggregate aroundnecroticanddamagedtissues
  • M2 more acute, M1 - chronic
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12
Q

Why does the brain deteriorate so quickly once hypoxia and ischaemia occur?

A
  • No O2 to create more ATP
  • mitochondria inhibitATPsynthesis
    =>ATPreserveis consumedwithinafewminutes
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13
Q

Why can excito-toxicity cause oxidative stress in neurones?

A
  • excitatory signal depolarises neuon and releases glutamate
  • lack of energy means astrocytes dont reuptake glutamate
  • lots of glutamate in synapse causes lots of Ca2+ entry into post-synaptic terminal
    => mitochondrial dysfunction and oxidative stress
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14
Q

What are the main types of oedema in the brain?

A

Cytotoxicoedema - Na+/K+ channel dysfunction => cells retain Na+ and water

Ionic/osmotic oedema - water and Na+ from capillaries move into brain parenchymal extracellular space

Vasogenic oedema - BBB disrupted => leaking fluid from capillaries affects white matter

Haemorrhagic conversion - when RBCs cross BBB

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15
Q

What is meant by cerebrovascular disease?

A
  • an abnormalityofbraincausedbyapathological processinbloodvessels
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16
Q

What are the 4 main components of cerebrovascular disease?

A
  • Brainischaemiaandinfarction
  • Haemorrhages
  • Vascularmalformations
  • Aneurysms
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17
Q

What would cause a global hypoxia and ischaemic damage to the brain as opposed to a focal area of ischaemia?

A
  • CardiacArrest
  • Severehypotension (traumawithhypovolaemicshock)
  • FOCAL = vascular obstruction
18
Q

What is the definition of a stroke?

A

Suddendisturbanceofcerebralfunction ofvascularoriginthatcausesdeathorlastsover24hours

19
Q

What gender and age are most common in stroke patients?

A

Peakageofincidenceis>70yrs

Men>women

20
Q

Strokes caused by an atherosclerotic thrombus are most common in which artery of the cerebrum?

A

MiddleCerebralArteryor its branches

21
Q

Where do embolic strokes usually originate from?

A
  • atheromaininternalcarotidor aorticarch

- emboli from heart due to AF

22
Q

What are the risk factors for cerebral infarction?

A
  • Hypertension
  • Serumlipids,obesity,diet
  • Diabetesmellitus
  • Heartdisease
  • Drugs
  • Smoking
23
Q

What symptoms do patients often experience if they have a stroke due to carotid artery disease?

A
  • contra‐lateralweakness/ sensory loss

- If dominanthemisphere,maybeaphasiaorapraxia

24
Q

What symptoms would usually indicate a middle cerebral artery stroke?

A

weaknessin contralateral faceandarm

25
Q

What symptoms would usually indicate an anterior cerebral artery stroke?

A

weaknessandsensorylossin contralateral leg

26
Q

Strokes in the Vertebro‐basilararteries can cause what symptoms?

A
  • vertigo
  • ataxia
  • dysarthria
  • dysphasia
27
Q

What is meant by vascular remodelling and how can this perpetuate a stroke?

A
  • accelerated atherosclerosis
  • arteriolosclerosis (thick, stiff vessel walls prone to rupture)
  • Eventual fibrinoid necrosis of vessel walls
28
Q

Where do micro aneurysms most commonly occur in the brain circulation?

A

Branches of the middle cerebral artery near the basal ganglia

29
Q

What is a lacunar infarct?

A

Small “lake” like infarcts
up to 15mm diameter
due to damage of Lenticulostriate arteries in basal ganglia

30
Q

When can lacunar infarcts cause the most damage?

A

If they extend into internal capsule

=> can cause extensive motor weakness in face and limbs

31
Q

What are the hallmarks of hypertensive encephalopathy?

A
  • globalcerebraloedema
  • tentorialandtonsillarherniation (due to raised ICP)
  • petechiae
  • arteriolarfibrinoidnecrosis => high BP
32
Q

Where do most intracerebral haemorrhages occur?

A
  • Mostcommonlyinbasal ganglia
  • Thalamus
  • Cerebralwhitematter
  • Cerebellum
33
Q

How do intracerebral haemorrhages appear macroscopically?

A
  • Asymmetrical
  • shiftsandherniations of brain
  • Welldemarcated
  • Softeningofadjacenttissue
  • Surroundingoedema
34
Q

What vascular malformations can predispose to cerebrovascular disease?

A
  • Arteriovenous malformations

- cavernous/venous angiomas

35
Q

Why do vascular malformations predispose to haemorrhage?

A
  • Shunting fromarterytovein
    => Vein undergoessmoothmuscle hypertrophy
    => vein is notcompliantandruptureseasily
    can also form aneurysms which rupture
36
Q

What normally causes a subarachnoid haemorrhage?

A

ruptureofasaccular aneurysm(Berryaneurysm)

37
Q

Where do Berry aneurysm’s normally occur?

A

Internal carotid artery
vertebro‐basilarcirculation

usually at arterial bifurcations

38
Q

What can be seen macroscopically around a Berry aneurysm?

A
  • Intracerebral haematomasnexttoaneurysms
  • Infarctsofbrainparenchyma– due toarterialspasm
  • Haematoma may compress structures and cause featuresofraisedICP
39
Q

What are the risk factors for Berry Aneurysms?

A

smoking
hypertension
kidneydisease

40
Q

WHat symptoms are usually experienced upon rupture of a Berry Aneurysm?

A
  • Severeheadache
  • Vomiting
  • Lossofconsciousness

NEUROLOGY (29 decks)

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