CNS: Cerebrovascular Disease

Question 1

True/false: stroke accounts for 10% of all death in UK

Answer 1

True

Question 2

Two types of cerebral infaction

Answer 2

Anaemic:

• —Focal: Large vessel disease or small vessel (eg vasculitis)
• —Global: MI, shock, sepsis

Haemorrhagic

Question 3

What are watershed infarcts?

Answer 3

The borders between individual vessel regions of the brain which are the most vulnerable to infarctions during a GLOBAL ischaemic episode.

Question 4

Define a stroke

Answer 4

It is rapidly progressive clinical symptoms of focal, and at times global, loss of cerebral function

lasting more than 24 hours or leading to death

with no apparent cause, other
than that of vascular origin

Question 5

Define a TIA

Answer 5

Acute loss of focal cerebral or ocular function <24 hrs

Question 6

What causes hemiplegia?

Answer 6

Blockage of the middle cerebral artery causing infarction of the internal capsule (white matter communicating signals to the brainstem)

Question 7

True or false: You cannot see a stroke in gross anatomy in first 6 hours (explain progression of decay)

Answer 7

True, minimal change

By 48 hours the tissue will be pale and soft with a diffuse margin

2-10days: affected area becomes gelatinous

10d-3weeks: tissue liquifies to leave a cavity

Question 8

What will histology show on area of infarction?

Answer 8

Early ischaemic changes after 12 hours: RED NEURONS, oedema

Late: Inflammatory response, many neutrophils within 48 hours. Reactive astrocytosis over next two to 3 weeks

Question 9

Type of emboli that can cause infarction

Answer 9

Cardiac mural thrombi (MI, valve disease, AF)

Thrombi from atheromas in carotids

Emboli with ventricular septal defects

Cardiac sugery

Tumour, fat (from CPR due to rib fracture) or air emboli

Infective endocarditis

Question 10

Two types of non-traumatic intracranial haemorrhage?

Answer 10

Intracerebral

Sub arach

Question 11

Causes of intracerebral haemorrhage

Answer 11

HYPERTENSION (50%!!!)

• -Large vessel disease
• -Hyaline arteriosclerosis
• -Charcot-Bouchard microaneurysm
• -Lacunar infarct
• -Slit haemorrhage

Amyloid angiopathy
Anticoagulants
Tumours
Vasculitis
AV malformation

Question 12

Two causes of sub arach haemorrhage

Answer 12

Berry aneurysm

AV malformation

Question 13

How many cases of intracerebral haemorrhage does Amyloid angiopathy cause? What is the pathology?

Answer 13

10-15%

Media of the small penetrating vessels is replaced by amyloid.

Amyloid causes weakening of the vessel walls

Question 14

How to stain for amyloid in blood vessels?

Answer 14

Congo red stain which under polarised light will show up APPLE GREEN

Question 15

Where do berry aneurysms occur?

Answer 15

40% at the join between the anterior
communicating and anterior cerebral arteries

Closely followed by aneuryms of the middle cerebral artery

Question 16

Risky diseases for berry aneurysms?

Answer 16

PKD
Neurofibromatosis
Marfans

Question 17

Types of traumatic brain injuries

Answer 17

Blunt force
Acceleration-deceleration
Missile/penetrating
Focal
Diffuse

Question 18

Which artery is affected by extradural haemorrage

Answer 18

Meningeal artery, between skull and dura

Question 19

Which blood vessels are affected by subdural haemorrage

Answer 19

Bridging veins, between dura and arachnoid mater

Question 20

Symptoms of extradural haemorrhage

Answer 20

SLOW ACCUMULATION with compensation, therefore there is a LUCID INTERAL, before compensatory exhaustion, increased ICP and death

Question 21

Symptoms of subdural haemorrhage

Answer 21

Increased risk of this haemorrhage in patients with cerebral atrophy (elderly and alcoholics)

Present with history of headache and confsion over 48 hours

Question 22

What is a diffuse axonal injury?

Answer 22

An intracerebral haemorrhage causes by deceleration forces on the head.

Patient usually unconsious upon impact, and remain disabled or in a coma

Question 23

Histology: Staining for beta-APP on a section of brain can demonstrate what kind of injury?

Answer 23

Diffuse axonal if pt survived for 2 hours