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Pathology > Cerebrovascular Diseases > Flashcards

Cerebrovascular Diseases Flashcards

1
Q

What is a Stroke?

A

A brain disease due to vascular pathology

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2
Q

What conditions/diseases are commonly associated with a stroke?

A

Atheroma,diabetes and hypertension

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3
Q

What are the two vascular pathologies that lead to a stroke?

A

1.Infarcation
2.Hemorrhage

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4
Q

What is an infarction?

A

Critical reduction in arterial oxygenation.

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5
Q

Name three types of an infarction?

A

1.Thrombotic
2.Embolic
3.Hypotensive

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6
Q

Name two types of a hemorrhage?

A

1.Intracerebral
2.Subarachnoid

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7
Q

What two problems lead to hypoxia and the type of hypoxic damage caused?

A

1.Major fall in BP or a systemic hypoxia causing a diffuse damage.
2.Vessel blockage causing focal damage.

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8
Q

In diffuse hypoxic damage,what does the damage depend on?

A

Severity and duration of hypoxia.

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9
Q

Which neutrons are susceptible to a diffuse hypoxic damage?

A

1.Neurons in the hippocampus
2.Purkinje cells
3.Neurons in the cerebral cortex

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10
Q

What happens to the brain in the case of a diffuse hypoxic damage?

A

It becomes oedematous,raising ICP

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11
Q

Effects of diffuse hypoxic damage?

A

Anything from mild confusion through PVS( Persistent vegetative state) to immediate death.

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12
Q

What causes both diffuse and Focal hypoxic damage?

A

Acute hypotension

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13
Q

Which areas are affected when acute hypotension causes focal damage?What kind of infarcts does it cause?

A

1.Watershed infarcts
2.Between the anterior cerebral and middle cerebral artery

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14
Q

What does a focal hypoxic damage depend on?

A

On the presence of collaterals

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15
Q

Where on the brain do collaterals exist?

A

1.On the surface e.g Circle of Willis BUT not within the brain.

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16
Q

What causes a focal hypoxic damage?

A

By a focal vascular abnormality from:
1.Thrombosis
2.Embolism

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17
Q

What do the clinical effects due to a focal hypoxic damage depend on?

A

1.Site
2.Extent and Speed of onset of vascular block

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18
Q

Thrombotic cause of focal hypoxia?

A

Atheroma

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19
Q

In which arteries does thrombosis normally occur?

A

1.Carotid birfurcation
2.Origin of middle cerebral artery
3.Origin of basilar artery

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20
Q

What are the different types of embolisms that can cause a focal hypoxic damage? And which one is the most common.

A
  1. cardiac mural thrombi(commonest)
    2.arterial thromboemboli
    3.paradoxical emboli
    4.Emboli of other material (tumour, fat, marrow, air)
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21
Q

In which conditions do cardiac mural thrombi occur?

A

1.Myocardial infarction
2.Valvular diseases
3.Atrial Fibrillation

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22
Q

What is the most common cause of an arterial thromboembolism occurring?

A

Carotid plaques

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23
Q

Which group of people are affected by paradoxical emboli?

A

Children with cardiac anomalies

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24
Q

Which artery is mostly affected in the case of a cerebral embolism?

A

Middle cerebral artery territory

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25
Q

Where do emboli normally lodge?

A

At Branches or Stenoses

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26
Q

What kind of embolism occur after fractures?

A

Shower embolism of fat.

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27
Q

Effects of shower embolism of fat?

A

They cause capillary blockages which disturb higher cortical functions and consciousness (often with no localising signs)

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28
Q

Characteristic of a bone marrow embolism?

A

Widespread hemorrhagic lesions of white matter.

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29
Q

How are cerebral infarcts classified? And what does the classification depend on?

A

1.Red or pale
2 Depends on presence or absence of haemorrhage from infarcted vessels

30
Q

Where do venous infarcts usually occur?

A

Beside sinuses

31
Q

What are venous infarcts associated with?

A

1.infection
2.dehydration
3. drugs (especially oral contraceptives)

32
Q

What are the microscopic changes that occur in an infarct?

A

1.increased eosinophilia of neurons
2.then neuronal death and cell infiltrate
3.eventual gliosis

33
Q

Which type of emboli shows petechial haemorrhages?

A

Bone marrow

34
Q

What is the most common cause of a subarachnoid haemorrhage?

A

A cerebral artery berry(saccular ) aneurysm

35
Q

What are the other causes of a subarachnoid haemorrhage?

A

1.Extension from a intracerebral haemorrhage
2.Vasculitis
3.bleeding diseases
4.Trauma
5.Tumour

36
Q

Where do Berry Aneurysms normally occur?

A

Occur near the major branch points of the Circle of Willis
More common on the anterior part of the circle of Willis.

37
Q

Describe berry aneurysms?

A

thin-walled out-pouching
usually < 1 cm diameter
wall consists usually only of intima

38
Q

Which part of the berry aneurysms bursts?And where does the blood flow into?

A

1.rupture at apex
2.usually into subarachnoid space, but sometimes into brain or both

39
Q

Causes of berry aneurysms?

A
  1. Genetic factors
40
Q

Predisposing factors of berry aneurysms?

A

Cigarette smoking and hypertension are predisposing factors

41
Q

Around which age do berry aneurysms burst?

A

40-50s

42
Q

What may precipitate a berry aneurysm?

A

A sudden rise in ICP or BP

43
Q

What are the effects of the rupture of a berry aneurysm on the patient?

A

1.Sudden severe headache and rapid loss of consciousness
2.10-15%die
3.Most recover consciousness in minutes
4.The patient may show meningism
5.Rebleeding is common making the prognosis worse.

44
Q

What are the early effects of a Subarachnoid haemorrhage.

A

increased risk of vasospasm of other vessels due to vascular mediators
which can lead to additional ischaemic injury, espec. if spasm involves Circle of Willis

45
Q

Late sequelae due to subarachnoid haemorrhage?

A

Meningeal scarring and fibrosis
Possible obstruction of CSF flow/reabsoprtion

46
Q

Describe the colour of subarachnoid haemorrhage?

A

initially it is bright red blood
later, yellow colour when the red cells degenerate.

47
Q

Other names for an intracerebra haemorrhage?

A

Parenchymal haemorrhage
cerebral haemorrhage

48
Q

What are intracerebral associated with?

A

Hypertension

49
Q

Besides hypertension what are the causes of intracerebral hypertension?

A

1.Vascular malformations
2.Bleeding diseases
3.Vasculitis
4.Angiomas
5.AV malformations

50
Q

What structures of the brain are affected during an intracerebral haemorrhage?

A

Basal ganglia
brainstem
cerebellum
cerebral cortex

51
Q

Where can intracerebral haemorrhages extend into?

A

Ventricles and or subarachnoid space

52
Q

What surrounds the hematoma seen in survivors of an intaerebral haemorrhage?And how is the hepatoma repaired?

A

1.It is surrounded by a zone of reaction
2.then repair with gliosis

53
Q

What is the importance of hypertension in CVD?

A

Common cause of CVD

54
Q

What is hypertension frequently associated with?

A

Atheroma and diabetes

55
Q

In terms pf CVDs,what is hypertension responsible for?

A

1.intracerebral hemorrhages
2.Rupture of berry aneurysms, so subarachnoid haemorrhages
3.Lacunar infarcts
4.Hypertensive encephalopathy

56
Q

How does hypertension cause lacunar infarcts?

A

Hypertension causes arteriosclerosis which with or occlusion of vessels supplying basal ganglia, hemispheres and brainstem causes single/multiple small cavitated infarcts.

57
Q

Describe the infarcts?

A

Consists of tissue loss with scattered compound granular corpuscles surrounded by gliosis

58
Q

What do clinical effects of lacunar infarcts depend on?

A

Location of the infarct
they could be silent

59
Q

Define Acute hypertensive encephalopathy?

A

syndrome of diffuse cerebral dysfunction

60
Q

What are the signs/symptoms of acute hypertensive encephalopathy?

A

headaches, confusion, vomiting and convulsions, sometimes leading to coma

61
Q

What is acute hypertensive encephalopathy usually a part of?

A

Accelerated (malignant)phase hypertension

62
Q

Why is rapid treatment needed in acute hypertensive encephalopathy?

A

In order to reduce raised ICP

63
Q

Effects of acute hypertensive encephalopathy on the brain.

A

oedematous brain +/- tentorial or tonsillar herniation
arteriolar fibrinoid necrosis and petechiae throughout brain

64
Q

What is chronic hypertensive encephalopathy a cause of?

A

vascular (multi-infarct) dementia

65
Q

What is Vascular dementia?

A

dementia often with focal neurological defects

66
Q

What causes chronic hypertensive encephalopathy?

A

By multifocal vascular disease over long time

67
Q

Examples of multifocal vascular diseases/

A

cerebral atheroma
thrombosis or embolism from carotids or heart
cerebral hypertensive arteriolosclerosis

68
Q

Common cause extradural and subdural haemorrhage?

A

Trauma

69
Q

What are extradural and subdural haemorrhages
almost always due to?

A

Trauma

70
Q

COMPARETHE MAJOR CAUSES OF STROKE.
LIST :
Clinical presentation
30-day mortality %
Pathogenesis
Predisposing factors

A

Refer to the table in HANDOUT.

71
Q

Compare the following between a subarachnoid hemorrhage and intracerebral hemorrhage:
1.Cause
2.signs +symptoms
3.location in brain
4.Side effects of hemorrhage.

A

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Pathology (2 decks)

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