CNS trauma + Cerebrovascular diseases Flashcards
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Accumulation of excess amount of fluid in brain parechyma ?
Cerebral edema
Causes of cerebral edema?
Vasgogenic edema
Cerebral edema
Desrbie vasogenic edema ?
There is damage in the endothelium of cerebral blood vessels increasing BBB permaebility causing accumulaiton of fluid extracellulear casuing vasogenic edema means edema due to Vessel damage
Intra cellular accumulation of fluids due to cell membrane injery whether neronal microglia or endothelial called?
Cerebral Cytotoxic edema
Compare between vasgoenic and cytotoxic edema in locality
Vasogenic : localized adjacent to inflamation or tumors
Or Generalized
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Cytotoxic edema :
In generalized hypoxic or ischemic injury
Describe grossly the edematous brain
Brain is swollen
gyri falttened and sulci narrowed
Ventricular cavities compressed
Soft
List brain hypoxia causes
Functional : alic2
Altitides low partial pressure of oxygen
Low carrying capacity in Anemia
Carbon dioxide posino9ng
Cyanind Poison causing Less usage of Oxygen in the cells
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Ischemia due to obstruction + Hypotension
Types of cerebral ischemia
Global Cerebral ischemia
occure when there is genralidzed perfusion reduction as cardiac arrest and shock
end with complete recovery in mild cases but in severe death or severly impairments
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Focal cerebral ischemia to loaclized arrea affecting
large vessles emboli or throbosis
Small vessles: Vasculitis
Cells affects by global cerebral ishcmeia
Pyramidal Of cortex
Pyramidal of hippocampus
Purkinje in cerebellum
Respirator brain
Dead brain in respirator
Dilated congesetd with autolysis
Pseudolaminar necrosis uneven distribtion of neuronal loss + gliosis and neocortex
Borderzone “ watershed “ infracts appears in ?
Global cerebral ischemia
Focal cerebral ishcmia severity depends on ?
caused by?
Collateral circulation
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Arterial occlusion due to :
Thrombosis of Caroid or cerebral areteris due to atherosclerosis or arhteritsi
Embolic Occlusion : Derived from heart mural thrombosis comlicating MI. AF. or endocarditis
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Venous occlusion =cancer=SSS thrombosis =bilatereal mulitple hge infarcts
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Non occuliscce compression of cerebral arteris from outside causing infarction
Lacunar infarcts
Small infarcts in the deep non cortical white matter or brainstem
Due to ?
Occulstion of Penetraing branches of cerebral arteries
may occur in basal ganglia
caudate and putamen
Venous occulsion in Focal ishcemis in brain
Venous occlusion =cancer=SSS thrombosis =bilatereal mulitple hge infarcts
MNIN STROKE
Sympotoms <24 hours
by small platlet thrombi + atheroemboli
TIA
Transient ischemia attacks
MNIN STROKE
Sympotoms <24 hours
by small platlet thrombi + atheroemboli
TIA
Transient ischemia attacks
Acute onset Neurological defecits due to Obstructive Cerebovascular lesions causing infarction or Hge
Slowly progeressive decrease in mental dysfunction in cerebral atherosclerois called
Muti-infact dementia
Cerebral infactcion causes and casues !
Causes liqufacting necoriss of brain tissue
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Causes :
Arterial occlusion due to atherocslcerosis with thrombosis of internal caroid cerebral vertebral or basialr artery
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Embolism from left side of Heart
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Venous thrombosis :
Associated with prenancy and contraceptive
infaction gorossly describe !
In beginign Hge
then liqufactive necorsis with cyst
Infaction micro describe
After 6 hours the cytoplsam become eosiophilic
during 24 hours: Neurophlic infiltrates
after one day MQ begins to infiltrate !
Multiple saccular dilatation on arteries in circle of willis which rupture casues subarachnoid Hge?
Berry Congenital aneyrusm
Congential berry casues ?
Congenital weakness of media at side of bidurcation
Weakness of internal elastic lamina
Abnormalitis of Collagen types
Polycystic kideny disease is associated with which aneyrusm ?
Berry aneyrusm
Commonest aneyrsm in middle CEREBRAL Artery ?
Berry due to weakened wall due to mild infection
Intenral caroid and basilar commonest aneysum ?
Atheroscletoic aneyrusm due to cerebral atherocsclerosis
Aneyrsum in small vessles less than 300um diamtere ?
Charcot bouchaed micro aneyrusms by HTN
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LENITCULOSTIATE Artireirs aneyrsm
Charcot bouchard microanyrusm
Mention effects of cerebral aneyrusms
=Increasing ICP
=RUPTURE CAUSING Subarahcnoid Hge
==Hydrocephalus
It can be laibel to thrombosis and calcification
cOMMENEST SITE Of arteriovenous malformation
Middle cerebral artery
Cavenous malofrmation or cavnernous angioma
Blood filled sinusoids
Capillary telangectasia
Dilated capillaries in normal brain tissue without symptoms
Spontanoeus non traumatic Hge
aCCOUNTS FOR 10-20% STROKES
more common in males
Location in Basal ganglia thalmus cerebral cerebellum pons
Causes?
HTN
Casuing
charcot bouchaed microaneyrsm and its rupture causing Hge
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also
Beryy aneysm
Aretovenous and caneronus malfomration
Neoplasm
vascultits
Sopntaucnosu non traumatic Hge mROPHOLGY ?
[Peticheal Hge”
Massive Hge
Effects of Spontanous non traumatic Hge
Hemiplegia
Increased Intracranial tension
causgin tentorial herniation
Types of traumatic head injuries
Parenchymal injuries :
concussion
contusion
Diffuse axonal injuries
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Traumatic vascular injury
Hge and Hematoma
Concussion
`Trauma with movment of brain back and forth ,causing
altered mental status and loss of Consciousness
-Temporary resp arrest
-Amensia
-Neurological recovery is complete
Contusion
Direct parenchymal injury
Coup injury cerebral injry at same side of imapct
Contrecoup injury cerebral injuet at opposite site of impact
Diffuxe axonal injury
Injury to white matter with axonal swelling due to acceleation and deceleration
locations:
Corpus callosum ,
Preventricular white matter , Hippocampus.
Cerebral and cerebellar peduncles
Traumatic vascular injury
epidural and subdural heamtoma
Traumatic intreacerebral and subarachnoid Hges
Epidural heamtoma
between skull and dura
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Due to rupture of middle meninigeal artery or temoproparietal fracture
bETWEEN dura and arachanoid
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tear of bridging veins deain brain to dural sinusses
sUBDURAL HHEAMTOMA
Risk factors for subdural hematoma ?
Brain atrophy
Anticoagulant
Shaking -whiplash
Talk and die syndrome
In Lucid Interval before loss of conscousness epidural hematoma
Transtentorial henriation occures in ?
Epidural hematoma
Slow venous bleeding +
delayed onset of fradually incrasing headache and confusion
In subdural heamtoma
Biconvex shape not crossing suture line in Head CT?
ePIDURAL hematoma
Subdural heamtoma in CT
crescent shaped hge crossing suter lines
Gyri apre preserved
Cannot cross falx tentorium
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