Chapter 23: Lecture Neuropathology part 1

Question 1

What is the most important (epidemiological) cerebrovascular disease?

Answer 1

Stroke

Question 2

What is the feature of a stroke?

Answer 2

ischemia

Question 3

True/false: the brain is not very sensitive to lack of O2

Answer 3

False! they are very sensitive (especially neurons)

Question 4

Because neurons are so susceptible to loss of O2, blood supply is very important. How is this organized?

Answer 4

Circle of Willis

Question 5

What are the most important causes of lack of O2?

Answer 5

– Arterial obstruction due to blood vessel wall disease (atherosclerosis, vasculitis)

– Arterial obstruction due to an (tumour) embolus

– Reduced perfusion (hypotension, heart infarct, bleeding from body)

– Reduced O2-tension (suffocation, CO intoxication)

Question 6

There are four different arteries that ‘meet’ and form the circle of Willis. What are they?

Answer 6

2 art. carotis and 2x art. vertebralis

Question 7

There are three coupled terminal arteries, what are they?

Answer 7

– 2x arteria cerebri anterior – 2x arteria cerebri media – 2x arteria cerebri posterior

Question 8

What is a hemorrhage in the brain often caused by?

Answer 8

Hypertensie

Question 9

Are the vascular territories of terminal intracranial arteries (and watershed areas) common places where a stroke could occur?

Answer 9

Yes

Question 10

True/false: it only rarely occurs that a stroke causes paresis of e.g. the face

Answer 10

False (and it can occur anywhere, paresis of organs, speech, the face…)

Question 11

What is the function of Broca’s area?

Answer 11

involved in production of speech sound (motoric)

Question 12

What is the function of Wernicke’s area?

Answer 12

involved in understanding of speech sound (somatic)

Question 13

What links the Broca’s and Wernicke’s area?

Answer 13

Arcuate fasciculus (bundle of nerve fibers)

Question 14

What will a stroke of the a. media cerebri often lead to?

Answer 14

Paresis of Broca’s or Wernicke’s area

Question 15

What are the two types of Cerebrovascular Accidents?

Answer 15

Ischaemic and hemorrhagic cerebrovascular accident

Question 16

In what artery do cerebrovascular accidents (ischemic & hemorrhagic) mostly occur?

Answer 16

A. media cerebri

Question 17

True/false: Since there is often either a ischemic or hemorrhagic cerebrovascular accident in the a. media cerebri, the area of ischemia is usually in the white matter/middle of the brain

Answer 17

False, during an ischaemic cerebrovascular incident the area of ischemia is indeed contained to the grey matter, but because an hemorrhage leads to compression, the area of ischemia spreads up to the cortex (white matter)

Question 18

Why is the ‘organization’ of the blood vessels -the capillary bed- so important?

Answer 18

When there is a malformation (such as: the capillary beds form a net (because of overgrown), or there are little to no capillary beds (only an artery remaining)) this can lead to increased blood pressure in other areas. They are really fragile and cannot hold all this pressure, which might lead to EC growth with impaired vessel maturation, leading to late AVM lesions with arterio-venous shunt without intervening capillaries

Question 19

What is the timeline of cellular consequences of ischemia? (important!) And what is the use of it?

Answer 19

1. Neuronal damage and death (‘red neurons’)
2. Loss of myelin
3. Death of glia cells
4. Loss of tissue with clearing reaction (colliquation) →influx of granulocytes and monocytes/macrophages
5. Cavitation

Under the microscope, it can be estimated how long ago the ischemia has occurred

Question 20

How are the different stages (neuronal death, loss of myelin, death of glia cells, colliquation and cavitation) recognized under the microscope?

Answer 20

Question 21

What is ischemia? A lack of…

Answer 21

a restriction in blood supply to tissues, causing a shortage of oxygen

Question 22

I’d advise to watch this video by Armando Hasudungan, it was recommended in the lecture and explains the different places of hemorrhages (oc it will also be ‘explained’ in the flashcards :))

Answer 22

https://www.youtube.com/watch?v=Kb_wzb7-rvE

Question 23

There are many different types of hemorrhages, that each present with it’s own clinical picture. They are named after their location. What are they (from out to inside)?

Answer 23

1. epidural 2. subdural 3. subarachnoidal 4. (intra)parenchymal

Question 24

Which of the different types of hemorrhages (epidural, subdural, subarachnoidal and (intra)parenchymal) are extra- and which are intra-axial?

Answer 24

Extra-axial: epidural, subdural and subarachnoidal Intra-axial: (intra)parenchymal

Question 25

What are the locations of epidural, subdural, subarachnoidal and parenchymal hemorrhages (between which two structures)?

Answer 25

Epidureal: between skull and dura (epi=outside) Subdural: between dura and arachnoid (sub=under) Subarachnoidal: between arachnoid and pia Parenchymal: in the parenchym

Question 26

Are the epidural, subdural and subarachnoidal hemorrhages arterial or venous?

Answer 26

Epidural: arterial Subdural: venous Subarachnoidal: arterial

Question 27

Are the causes of epidural, subdural and subarachnoidal hemorrhages trauma or an aneurysm?

Answer 27

Epidural: trauma Subdural: trauma Subarachnoidal: aneurysm (in young people, trauma can be in old people as well)

Question 28

What is the progression of epidural and subdural hemorrhages?

Answer 28

Clear interval (!) → progressive deterioration of consiousness → death

Question 29

How are epidural and subdural hemorrhages treated?

Answer 29

Decompression (via a hole in the skull)

Question 30

What is the (clinical) progression of subarachnoidal hemorrhages?

Answer 30

Hyperacute severe headache and sudden loss of consciousness

Question 31

How are subarachnoidal hemorrhages treated?

Answer 31

Coil/clip (on the aneurysma, a bulb is formed, by inserting coils, a thrombus cannot be formed, and thus the artery can close again, see the picture on slide 19 if you do not understand)

Question 32

What are the characteristics of intraparenchymal hemorrhage?

Answer 32

• Very severe • Bleeding inside the brain parenchyma • Brain parenchyma offers little resistance → easy spread • Fast increase of intracranial pressure • Mortality 75-80%

Question 33

What are the symptoms of intraparenchymal hemorrhages?

Answer 33

This depends on the location! (and corresponds with the function of that area!)

Question 34

Which of the following hemorrhages occurs OUTSIDE the brain parenchyma, i.e. is extra-axial: 1. Subarachnoidal 2. Subdural 3. Epidural 4. All 5. None

Answer 34

4. All