Cerebrovascular Diseases Flashcards
What are three things that can go wrong and cause cerebrovascular diseases?
Thrombosis - clot that stays and gets bigger
Embolism - clot that forms and moves (also made up of fat or cholesterol)
Hemorrhage - bleed, rupture
Stroke applies to all three
What is the third leading cause of death in the US?
Cerebrovascular diseases
What is global cerebral ischemia?
- global ischemia
- caused by hypotension
- outcome: mild-transient confusion, severe-persistent vegetative state or brain death
- watershed infarcts, laminar necrosis, or diffuse necrosis
What areas are particular suspectable to hypoxia?
Areas at edges of vascular supply (watershed infarcts)
Anterior and middle cerebral artery boarder
Watershed infarct is associated with hypotension
What is laminar necrosis?
Damage in just one area, kinda random
Vessels in meningitis supply brain is one explanation
What do you see with patients who have been on a respirator for a long time?
Global ischemia
Liquifacting necrosis - liquid
When does hazy gray-white demarcation happen?
Global Ischemia
Cannot tell gray apart from white (the boarder)
What is focal ischemia?
-Obstruction of blood flow to focal spot
Two ways:
- ischemic (pale) infarcts - thrombosis, often arise from artherosclerotic plaques (looks for pale). More common
- hemorrhagic (red) - was something plugging but then it was re opened and blood flushed in. Due to emboli and reperfusion, often arises from the heart
TSIs are often the harbingers
What does streptokinase do?
Synthetic way that breaks clots
Used in pale infarcts
Would kill a person with red infarcts
What do ischemic infarcts look like?
2days: white, wet, swollen
2-10days: gelatinous, outlines are visible
10-21days: liquefaction and cavitation
What do hemorrhagic infarcts look like?
Punctuate of big
Red
Eventually resolution and cavitation
What are the microscopic changes of focal infarcts in order?
- Red neurons,edema, swollen astrocytes
- Lots of neutrophils
- Less neutrophils, macrophages
- Gliosis
- More macrophages
- Dense gliosis and new capillaries
Hemorrhagic looks the same but with blood cells
Where do you see lacunar infarcts?
Hypertensive cerebrovascular disease
What is a lacunar infarct?
A tiny blood vessel that travels to the deep areas of the brain becomes occluded
See macrophages and gliosis
Develop arteriole sclerosis
Have little holes
Have necrosis
What is a slit hemorrhage?
In hypertension
Vessel is perforated and there are slits
Macrophages and gliosis
See some hemosiderin and lipid laden
No necrosis
