CNS trauma + Cerebrovascular diseases Flashcards by Omar Gazar

بسم الله الذي وسع كل شئ علما
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Accumulation of excess amount of fluid in brain parechyma ?

Cerebral edema

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Causes of cerebral edema?

Vasgogenic edema
Cerebral edema

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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

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Intra cellular accumulation of fluids due to cell membrane injery whether neronal microglia or endothelial called?

Cerebral Cytotoxic edema

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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

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Describe grossly the edematous brain

Brain is swollen
gyri falttened and sulci narrowed
Ventricular cavities compressed
Soft

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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

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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

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Cells affects by global cerebral ishcmeia

Pyramidal Of cortex
Pyramidal of hippocampus
Purkinje in cerebellum

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Respirator brain

Dead brain in respirator
Dilated congesetd with autolysis

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Pseudolaminar necrosis uneven distribtion of neuronal loss + gliosis and neocortex
Borderzone “ watershed “ infracts appears in ?

Global cerebral ischemia

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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

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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

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Venous occulsion in Focal ishcemis in brain

Venous occlusion =cancer=SSS thrombosis =bilatereal mulitple hge infarcts

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MNIN STROKE
Sympotoms <24 hours
by small platlet thrombi + atheroemboli

TIA
Transient ischemia attacks

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MNIN STROKE
Sympotoms <24 hours
by small platlet thrombi + atheroemboli

TIA
Transient ischemia attacks

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Acute onset Neurological defecits due to Obstructive Cerebovascular lesions causing infarction or Hge

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Slowly progeressive decrease in mental dysfunction in cerebral atherosclerois called

Muti-infact dementia

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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

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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 `

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 +++++++++++++++++++++++++++ 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 _____________ 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 _______________- Due to rupture of middle meninigeal artery or temoproparietal fracture

bETWEEN dura and arachanoid ________________ 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

الحمدلله رب العالمين