CNS trauma/Cerebrovascular disease Norton Flashcards
what essentials does the brain need
glucose and oxygen
what is functional HYPOXIA
low inspired partial pressure
what is ischemia
- obstruction
- reduced perfusion pressure ( hypotension)
survival of brain tissue depends on what 2 things
- COLLATERAL circulation
- duration of ischemia
- how much the blood flow reduced
what causes global cerebral ischemia
hypotension
hypoperfusion
low-flow state
in global cerebral ischemia which neurons are most sensitive to ischemia and hypoglycemia
large pyramidal neurons
hippocampus
purkinje cells of cerebellum
In severe cases, survivors of global cerebral ischemia with severe imparimnets, absent reflexes, absent respiratory drive will what EEG
flat EEG
what does the brain look like for global cerebral ischemia
brain is swollen
gyri widened
under the microscope what does global cerebral ischemia look like for early, subacute, repair?
early: red neurons
subacute: liquefactive necrosis, macrophages
repair: gliosis
under the microscope what does global cerebral ischemia look like generally
pseudolaminar necrosis
border zone infarcts ( watershed0
what is pseudolaminar necrosis
uneven destruction /preservation of cortex
what is the most common location for border zone infarcts
b/w anterior and middle cerebral arteries
what causes focal cerebral ishcemia
obstruction of local blood flow
-embolism, thrombosis
how can focal cerebral ischemia be modified
collateral flow
what parts of the brain does not have collateral flow
thalamus
basal ganglia
deep white matter
what are two things that can cause thrombosis for focal cerebal ischemia
atherosclerosis
arteritis
what is the most common area impacted by embolism
middle cerebral artery
what does the gross non-hemorrhagic morphology look like for focal cerebral ischemia
pale soft
boundary infarct distinct
liquefactive necrosis
what does the microscopic non-hemorrhagic morphology look like for focal cerebral ischemia
red neurons
microglia
astrocytes enlarged
morphology of focal cerebral ischemia hemorrhagic resembles what
non-hemorrhagic plus bleeding and resorption
focal cerebral ischemia can also be assoicated with what other occulsion
venous occlusion of superior sagittal sinus
what do lacunar infarcts affect
deep penetrating arterties/arterioles
basal ganglia
hemispheric white matter
brain stem
what can CAUSE lacunar infarcts
arteriolosclerosis
lacunes (singe or multiple small cavity infarcts)
what are some results of lacunar infarcts
lacunes (singe or multiple small cavity infarcts)
macrophages
gliosis
what is slit hemorrhages
small hemorrhages which are resorbed
what is the result of slit hemorrhage
slit-like cavity with brownish discoloration
what are ACUTE symptoms for hypertensive encephalopathy
headache confusion vomiting convulsions sometimes coma
when and why should hypertensive encephalopathy be treated
urgently to reduce increased ICP
over what time period does hypertensive encephalopathy occur
OVER MONTHS
infarcts occur in what part of the brain for hypertensive encephalopathy
gray and white matter
hypertensive encephalopathy is also called what
- vascular or multi-infarct dementia
- syndrome of dementia, gait abnormalities, pseudobulbar signs, neurologic deficits
Binswanger disease
predominantly involves white matter for hypertensive encephalopathy
where can an intracranial hemorrhage occur
ANY SITE
what is intracerebral hemorrhage
spontaneous (non-traumatic) rupture of intraparenchymal vessel
what is the most common cause of intracerebral hemorrhage
HYPERTESNION
Charcot-Bouchard
aneurysms- most commonly in basal ganglia
when due to hypertension where does intracerebral hemorrhage occur
putamen, thalamus, pons
rarely cerebral hemisphere
when due to hypertension intracerebral hemorrhage the extruded blood compresses what and if you’re old what does it compress
parenchyma
CAVITY
what can cause lobar hemorrhage for intracerebral hemorrhage
hemorrhagic diathesis
neoplasms
drug abuse, infections
amyloid angiopathy ( alzheimer’s)
what can cause subarachnoid hemorrhage
rupture of Berry aneurysm
what is another name for berry aneurysms
saccular aneurysm
“congenital aneurysm”
what is the most common intracranial aneurysm
berry aneurysms
90% of berry aneurysms are located in what part of ciruclation
anterior circulation
what causes berry aneurysms? what increases risk
unknown - Ehlers-Danlos smoking hypertension marfans
are Berry aneurysms identifiable in new borns
no
explain the wall of the berry aneurysm
- muscular and intimal not apart of wall
- hylinzed intima, adventitia part of wall
where does the vessel rupture for berry aneurysm
APEX
what are signs and symptoms for berry aneurysm
sudden, excruciating headache
rapid loss of consciousness
what happens in first rupture of berry aneurysm
25-50% die
-rebleeding in survivors is common
what is the clinical feature for acute berry aneurysms
vasospasm from irritation of vessels by blood
what is the late sequelae for berry aneurysm
meningeal fibrosis and scarring
obstruction to CSF flow and reabsorption
when are arteriovenuous malformations detected and how
10-30 years
seizure disorder
intracerebral hemorrhage
subdural hemmorrhage
what is the most common malformed artery
middle cerebral artery
what is cavernous hemangioma
greatly distended, loosely organized vascular channels
- no intervening neural tissue
where does cavernous hemangioma usually occur
cerebellum
pons
subcortical region
where does capillary telangiectasia occur
pons
what is the difference between capillary telangiectasia and cavernous hemangioma
intervening neural tissue on capillary telangiectasia
