Cerebrovascular Diseases & Infections Flashcards by Christian Wakim

Describe the deficits associated with the Anterior Cerebral Artery area

Upper motor neuron type weakness & Cortical type sensory loss, contralateral hemiplegia

Contralateral leg more than arm or face

Alien hand syndrome

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Describe the deficits associated with the posterior cerebral artery

contralateral homonymous hemianopia

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Describe the deficits associated with the middle cerebral artery

Most common for infarcts or ischemic events
Aphasia, Hemineglect, Hemianopia, Face-arm sensorimotor loss
Gaze preference toward lesion
Lacunes: small deep infarcts involving penetrating branches of MCA

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What are the three major categories of cerebrovascular diseases

Thrombosis
Embolism
Hemorrhage

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What are the most common cerebrovascular disorders

Global ischemia
Embolism
Hypertensive Intraparenchymal hemorrhage

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What are the two types of reduction in blood flow and their respective causes

Global ischemia: General reduction of perfusion
–cardiac arrest, shock, severe hypotension

Focal Ischemia: Localized area
– Embolic or thrombotic arterial occlusion, atherosclerosis in hypertension

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What deficits occur if the ACA-MCA watershed area infarcts

Proximal arm and leg weakness

Transcortical aphasia: language issues.

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What deficits occur if the MCA-PCA watershed area infarcts

Higher order visual processing

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What is the main cause of thrombotic occulsions

Atherosclerosis

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Which cerebral artery is most affected by embolic infarction

MCA

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If someone were to be diagnosed with shower emboli, what preceding event caused it?

long bone fracture

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What is a transient ischemic attack

a neurological deficit that is less than 24 hrs in duration caused by temporary brain ischemia

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What does a TIA mean for the future

impending Stroke.

15% will have debilitating stroke within 3 mo of that 15% 1/2 of them will have it within 48 hrs

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Describe the two types of stroke

Hemorrhagic - bleeding

Ischemic - thrombus associated; hemorrhagic conversion is secondary bleeding of ischemia

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Describe lacunar infarcts

Deep penetrating arteries produce single or multiple small <15 mm infarcts

-pure motor hemiparesis
-thalamic lacune: contralateral sensory deficits
-Basal Ganglia: hemiballismus

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Describe hypertensive encephalopathy

Malignant HTN

HTN is most common risk factor for deep brain parenchymal hemorrhages

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Chronic hypertension is associated with what disease process

Charcot-bouchard microaneurysms

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What is Cerebral Amyloid Angiopathy

Lobar Hemorrhage - same B amyloid deposits in walls of vessels producing microbleeds

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What is CADASIL

Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts & Leukoencephalopathy

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Describe CADASIL

Recurrent strokes and dementia

First detectable approx 35 y/o

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Aneurysms are the most common cause of what

Subarachnoid Hemorrhage

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Where is the most likely place to find an aneurysm in the circle of willis

Anterior Communicating and Anterior Cerebral artery connection

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In what decade of life are aneurysms most likely to rupture

in the 5th decade of life

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What percentage of people die with their first ruptured aneurysm

25-50%

What are the four groups of vascular malformations

- Arteriovenous malformations - Cavernous malformations/hemangiomas - Capillary telangiectasias - Venous Angiomas

Where in the brain vasculature are Vascular malformations most likely

MCA & posterior branches

How does tuberculosis meningitis invade the CNS

Seeding CSF from subepidural or sub-meningeal granulomas

How does Herpes simplex and Zoster invade the CNS

Produce latent infection of sensory ganglia and ascend through sensory nerves **rabies ascends through motor nerves

Why is compliment and ABX so ineffective in fighting CNS infection?

BBB does not allow those molecules in

What treatment can be used to slow or reverse cerebral edema caused by infection

corticosteroids

if someone had dense exudate located mostly in the sagittal sinus, what would be the likely etiology of their meningitis

Pneumococcal

If someone had dense exudate around the basal area of their brain, what would be the likely etiology of their meningitis

H. Influenzae

Describe the spinal tap of someone with bacterial meningitis

Cloudy Neutrophils Little glucose Increased protein

Describe the spinal tap of someone with viral meningitis

Clear lymphocytes Normal glucose Increased protein

What is the likely etiology of meningitis in a neo nate

E. Coli | Grp B Strep

What is the likely etiology of meningitis in a 3m-2 yr unvaccinated kid

H. Influenzae B

What is the likely etiology of meningitis of an adolescent/young adult

N. Meningitidis

What is the likely etiology of meningitis in the elderly

Strep pneumo & Listeria

What is the presentation and spinal tap like for someone with a brain abscess

Progressive focal neurologic deficits CSF: High WBC, High Protein, Normal Glucose

Someone comes in for brain surgery. You didnt review the chart and Putoff is your preceptor. He mentions the thick dura of the patients brain and asks what likely left this sign.

Subdural empyema. Extradural abscesses associated with osteomyelitis

Christian went to military training this summer and was packed in with 100 other sweaty anxious docs. He gets meningitis, what etiology of meningitis is he likely to get and why would kristen be mad at him?

N. Meningitidis - colonizes crowded populations. dorms barracks etc transmitted by direct contact. Kissing, sharing water bottles etc

Describe the disease process with chronic meningitis of TB

subarachnoid space fills with gelatinous exudate with obliterative endarteritis Predilection for base of the brain (arachnoiditis)

What is a tuberculoma

Well circumscribed Intraparenchymal mass; central caseous necrosis; inactive lesions calcify

Describe neurosyphillis

occurs in 10% of untreated people - -Chronic meningitis -> communicating hydrocephalus - -Paretic neurosyphilis (delusions of grandeur) - -Tabes Dorsalis (Damage to sensory nerves)

What family of viruses cause 80% of viral meningits

Enterovirus Most self limiting

Describe West Nile Virus

Polio like syndrome with paralysis CSF: colorless, increase pressure, increase protein, normal glucose Both neuronophagia and microglial nodules

What areas of the brain are affected by HSV-1

Inferior & medial temporal lobes | Orbital gyri of frontal lobes

What percent of neonates delivered to mothers with HSV-2 will develop sever encephalitis

50%

Where does CMV localize in the brain and what is the complication

Periventricular sub ependymal regions -> sever hemorrhagic necrotizing ventriculoencephalitis & choroid plexitis

What is the complication of congenital CMV

periventricular necrosis -> sever brain destruction -> microcephaly & periventricular calcification

Describe the acute phase and the post infection phase of polio

Acute: Neurophagia of the anterior horn (flaccid paralysis) Post-polio: 25-35 years. Progressive weakness with decreased muscle mass and pain (FDR)

Describe the rabies infection

1-3 month incubation Nonspecific sx (malaise, HA, Fever) with local paresthesias around wound. hydrophobia Negri bodies

What is a unique complication of HIV meningitis

IRIS (Immune reconstitution Inflammatory syndrome) After antivirals are started, immune system kicks into high gear Also increases chance of primary CNS Lymphoma

Describe Progressive multifocal leukoencephalopathy

JC Polyomavirus - asymptomatic at first but comes back with immune suppression Ill-defined destruction of white matter; subcortical area of demyelination with lipid-laden macrophages in the center

Describe subacute sclerosing panencephalitis

Paramyxovirus Rare, progressive clinical syndrome --Cognitive decline, spasticity of limbs, & seizures Children or young adults not vaxxed against measles -> widespread gliosis and myelin degeneration

if you patient has diabetes which fungal meningoencephalitis are they likely to come down with

mucormycosis

Describe toxoplasmosis infection

Opportunistic infection for HIV and pregnancy Brain abscesses develop near gray-white junction of cerebral cortex and deep gray nuclei

Describe the histo of toxoplasmosis infection

Central focus of necrosis, petechial hemorrhages surrounded by acute and chronic inflammation

Describe the spongiform changes seen in prion diseases

intracellular vacuoles in neurons and glia