CNS trauma/Cerebrovascular disease Norton

Question 1

what essentials does the brain need

Answer 1

glucose and oxygen

Question 2

what is functional HYPOXIA

Answer 2

low inspired partial pressure

Question 3

what is ischemia

Answer 3

• obstruction

- reduced perfusion pressure ( hypotension)

Question 4

survival of brain tissue depends on what 2 things

Answer 4

• COLLATERAL circulation
• duration of ischemia
• how much the blood flow reduced

Question 5

what causes global cerebral ischemia

Answer 5

hypotension
hypoperfusion
low-flow state

Question 6

in global cerebral ischemia which neurons are most sensitive to ischemia and hypoglycemia

Answer 6

large pyramidal neurons
hippocampus
purkinje cells of cerebellum

Question 7

In severe cases, survivors of global cerebral ischemia with severe imparimnets, absent reflexes, absent respiratory drive will what EEG

Answer 7

flat EEG

Question 8

what does the brain look like for global cerebral ischemia

Answer 8

brain is swollen

gyri widened

Question 9

under the microscope what does global cerebral ischemia look like for early, subacute, repair?

Answer 9

early: red neurons
subacute: liquefactive necrosis, macrophages
repair: gliosis

Question 10

under the microscope what does global cerebral ischemia look like generally

Answer 10

pseudolaminar necrosis

border zone infarcts ( watershed0

Question 11

what is pseudolaminar necrosis

Answer 11

uneven destruction /preservation of cortex

Question 12

what is the most common location for border zone infarcts

Answer 12

b/w anterior and middle cerebral arteries

Question 13

what causes focal cerebral ishcemia

Answer 13

obstruction of local blood flow

-embolism, thrombosis

Question 14

how can focal cerebral ischemia be modified

Answer 14

collateral flow

Question 15

what parts of the brain does not have collateral flow

Answer 15

thalamus
basal ganglia
deep white matter

Question 16

what are two things that can cause thrombosis for focal cerebal ischemia

Answer 16

atherosclerosis

arteritis

Question 17

what is the most common area impacted by embolism

Answer 17

middle cerebral artery

Question 18

what does the gross non-hemorrhagic morphology look like for focal cerebral ischemia

Answer 18

pale soft
boundary infarct distinct
liquefactive necrosis

Question 19

what does the microscopic non-hemorrhagic morphology look like for focal cerebral ischemia

Answer 19

red neurons
microglia
astrocytes enlarged

Question 20

morphology of focal cerebral ischemia hemorrhagic resembles what

Answer 20

non-hemorrhagic plus bleeding and resorption

Question 21

focal cerebral ischemia can also be assoicated with what other occulsion

Answer 21

venous occlusion of superior sagittal sinus

Question 22

what do lacunar infarcts affect

Answer 22

deep penetrating arterties/arterioles
basal ganglia
hemispheric white matter
brain stem

Question 23

what can CAUSE lacunar infarcts

Answer 23

arteriolosclerosis

lacunes (singe or multiple small cavity infarcts)

Question 24

what are some results of lacunar infarcts

Answer 24

lacunes (singe or multiple small cavity infarcts)
macrophages
gliosis

Question 25

what is slit hemorrhages

Answer 25

small hemorrhages which are resorbed

Question 26

what is the result of slit hemorrhage

Answer 26

slit-like cavity with brownish discoloration

Question 27

what are ACUTE symptoms for hypertensive encephalopathy

Answer 27

``` headache confusion vomiting convulsions sometimes coma ```

Question 28

when and why should hypertensive encephalopathy be treated

Answer 28

urgently to reduce increased ICP

Question 29

over what time period does hypertensive encephalopathy occur

Answer 29

OVER MONTHS

Question 30

infarcts occur in what part of the brain for hypertensive encephalopathy

Answer 30

gray and white matter

Question 31

hypertensive encephalopathy is also called what

Answer 31

- vascular or multi-infarct dementia | - syndrome of dementia, gait abnormalities, pseudobulbar signs, neurologic deficits

Question 32

Binswanger disease

Answer 32

predominantly involves white matter for hypertensive encephalopathy

Question 33

where can an intracranial hemorrhage occur

Answer 33

ANY SITE

Question 34

what is intracerebral hemorrhage

Answer 34

spontaneous (non-traumatic) rupture of intraparenchymal vessel

Question 35

what is the most common cause of intracerebral hemorrhage

Answer 35

HYPERTESNION

Question 36

Charcot-Bouchard

Answer 36

aneurysms- most commonly in basal ganglia

Question 37

when due to hypertension where does intracerebral hemorrhage occur

Answer 37

putamen, thalamus, pons | rarely cerebral hemisphere

Question 38

when due to hypertension intracerebral hemorrhage the extruded blood compresses what and if you're old what does it compress

Answer 38

parenchyma | CAVITY

Question 39

what can cause lobar hemorrhage for intracerebral hemorrhage

Answer 39

hemorrhagic diathesis neoplasms drug abuse, infections amyloid angiopathy ( alzheimer's)

Question 40

what can cause subarachnoid hemorrhage

Answer 40

rupture of Berry aneurysm

Question 41

what is another name for berry aneurysms

Answer 41

saccular aneurysm | "congenital aneurysm"

Question 42

what is the most common intracranial aneurysm

Answer 42

berry aneurysms

Question 43

90% of berry aneurysms are located in what part of ciruclation

Answer 43

anterior circulation

Question 44

what causes berry aneurysms? what increases risk

Answer 44

``` unknown - Ehlers-Danlos smoking hypertension marfans ```

Question 45

are Berry aneurysms identifiable in new borns

Answer 45

no

Question 46

explain the wall of the berry aneurysm

Answer 46

- muscular and intimal not apart of wall | - hylinzed intima, adventitia part of wall

Question 47

where does the vessel rupture for berry aneurysm

Answer 47

APEX

Question 48

what are signs and symptoms for berry aneurysm

Answer 48

sudden, excruciating headache | rapid loss of consciousness

Question 49

what happens in first rupture of berry aneurysm

Answer 49

25-50% die | -rebleeding in survivors is common

Question 50

what is the clinical feature for acute berry aneurysms

Answer 50

vasospasm from irritation of vessels by blood

Question 51

what is the late sequelae for berry aneurysm

Answer 51

meningeal fibrosis and scarring | obstruction to CSF flow and reabsorption

Question 52

when are arteriovenuous malformations detected and how

Answer 52

10-30 years seizure disorder intracerebral hemorrhage subdural hemmorrhage

Question 53

what is the most common malformed artery

Answer 53

middle cerebral artery

Question 54

what is cavernous hemangioma

Answer 54

greatly distended, loosely organized vascular channels | - no intervening neural tissue

Question 55

where does cavernous hemangioma usually occur

Answer 55

cerebellum pons subcortical region

Question 56

where does capillary telangiectasia occur

Answer 56

pons

Question 57

what is the difference between capillary telangiectasia and cavernous hemangioma

Answer 57

intervening neural tissue on capillary telangiectasia