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Neuro > Cerebrovascular diseases > Flashcards

Cerebrovascular diseases Flashcards

1
Q

List the mechanisms by which hypoxia (deprivation of O2) can occur by

A

low level of oxygen in blood
low blood flow to tissue-ischemia
oxygen utilization by tissue is impaired

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2
Q

What is the definition of ischemia?

A

low blood flow

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3
Q

When does global ischemia to the brain occur?

A

systolic BP <50

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4
Q

When does focal ischemia in the brain occur?

A

during obstruction of local blood supply, leads to infarction

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5
Q

What area of the brain does global ischemia impact first?

A

borderzone/watershed areas

low flow areas between anterior, middle and posterior cerebral arteries

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6
Q

List the cell types in decreasing order of oxygen deprivation sensitivity

A

neurons, oligodendrocytes, astrocytes

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7
Q

List the brain regions in decreasing order of oxygen deprivation sensitivity

A

hippocampus (CA1 sector-sommer sector)
Lamina 3 & 5 of cerebral cortex (laminar necrosis)
purkinje cells in cerebellum

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8
Q

What role does glutamate play during ischemic/hypoxic injury?

A

when present in excess is neurotoxic, is commonly present in excess during ischemic/hypoxic injury

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9
Q

What determines the selective vulnerability of different cells/regions?

A

variable O2/energy requirements of different neurons and neuronal populations

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10
Q

What histologic changes occur to acutely hypoxic/ischemic neurons?

A

“red is dead”
pyknotic cells with shrunken and dark nucleus, no nucleolus visible
red cytoplas w/ no missl substance visible

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11
Q

What are the outcomes of severe global ischemia?

A

widespread neuronal death, irrespective or regional vulnerability
leads to persistent vegetative states and/or brain death

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12
Q

How is brain death defined?

A

diffuse cortical injury with brainstem injury (absent reflexes and respiratory drive)

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13
Q

What are the findings of severe global ischemia (respirator brain) on autopsy?

A

swollen brain, slit like ventricles, herniation

collapsed vessels due to swelling

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14
Q

What are the 3 major causes of focal ischemia?

A

thrombosis (atherosclerosis)
emobli
lacunar infarcts/slit hemorrhages

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15
Q

Where does thrombosis/atherosclerosis most commonly cause focal ischemia?

A

carotid bifurcation
origin of MCA
origin or end of basilar artery

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16
Q

What type of infarct do emboli commonly cause?

A

hemorrhagic infarct

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17
Q

What are cardiac sources of emboli?

A

mural thrombi

endocarditis (bacterial or marantic emboli)

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18
Q

What are non cardiac sources of emoli?

A

atheromas

fat, neoplasms, air

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19
Q

Which vessel is most commonly affected by emboli?

A

MCA

20
Q

What causes lacunar infarcts/slit hemorrhages?

A

hyaline arteriolosclerosis caused by hypertension and diabetes mellitus

21
Q

What are lacunes?

A

small stroked in subcortical brain structures that may be hemorrhagic

22
Q

What are uncommon causes of brain infarction?

A 
vasculitis
arterial dissection of carotid arteries
coagulation disorders
microvasculopathy
amyloid angiopathy
drug abuse
23
Q

What are the characteristics of primary angiitis (vasculitis) of the CNS?

A

involves multiple small/medium sized meningeal and parenchymal vessels
chronic inflammation, fibrinoid necrosis, multinucleated giant cells, wall destruction

24
Q

What does acute infarct look like on gross examination?

A

soft, swollen, grey-white distinction blurred

up to 48 hrs post infarct

25
Q

What does subacute infarction look like on gross examination?

A

liquefactive necrosis

2-3 wk post infarct

26
Q

What does chronic infarction look like on gross examination?

A

cavitated, all dead tissue removed

several months post infarct

27
Q

What does acute infarct look like on microscopic exam?

A

red neurons, pallor

possibly neutrophils

28
Q

What does subacute (organizing) infarct look like on microscopic exam?

A

macrophages, necrotic tissue, reactive astrocytes, vascular proliferation

29
Q

What does chronic infarct look like on microscopic exam?

A

cavilty with glial scar

30
Q

What are the signs and symptoms of vascular dementia?

A

pattern of damage
samll areas of infarct/multiple lacunar infarcts
diffuse white matter disease
infarct occur in areas important for cognition/memory

31
Q

What does cerebral venous thrombosis cause? Where?

A

hemorrhagic infarcts

superior sagital and/or lateral sinuses (results in parasagitall hemorrhagic infacts)

32
Q

What are some causes of central venous thrombosis?

A

infection, injury, neoplasm, surgery, pregnancy OCPs, hematologic abnormalities, dehydration, malignancy

33
Q

What are causes of intracerebral hemorrhage?

A

hypertension (MCC)
vascular malformations
amyloid angiopathy

34
Q

What are key features of HTN induced ICH?

A

abrupt onset of severe neurologic dysfunction when hematoma is large
putamen, thalamus, pons, cerebellum commonly affected
hyaline arteriolosclerosis

35
Q

What is the most common type of vascular malformation?

A

arteriovenous malformation: tangled network of vessels with AV shunt

36
Q

What are other, less common types of vascular malformations?

A

capillary telangiectasia
cavernous angioma
venous angioma

37
Q

What are causes of lobar hemorrhage?

A 
neoplasms
drug abuse
vasculitis
hemorrhagic diathesis
amyloid angiopathy
38
Q

What are common causes of subarachnoid hemorrhage?

A

trauma

aneurisms

39
Q

What are 3 common types of CNS aneurisms

A

saccular (berry)
mycotic (fungus)
fusiform/atherosclerotic

40
Q

What are key features of saccular/berry aneurism?

A

“the worst head ache i’ve ever had” (w/rupture)
increased risk w/ HTN, smoking, AVM, etc
increased risk of rupture as size increases
not present at birth, but hte defect in the media is congenital and the aneurism develops over time
usually occurs at branch points in the anterior circulation (ant communicating and anterior cerebral junction most common location)

41
Q

What is a stroke?

A

a sudden failure of brain function due to diminished blood flow to a part of the brain, or due to bleeding inside the brain

42
Q

What are 5 major signs of a stroke?

A 
hemineglect
vision loss
loss of speech or comprehension
numbness on one side
weakness on one side
43
Q

What does complete lack of blood flow result in?

A

cortical laminar necrosis

44
Q

What does low blood flow result in?

A

watershed injury

45
Q

What causes arteriovenous malformations?

A

atherosclerosis
congenital
prone to develop in cocain users
more common in HTN patients

Neuro (14 decks)

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