Friday - Krafts - cerebrovascular disorders

Question 1

Difference between thrombus and embolus

Answer 1

thrombus - the clot stays where it was made

embolus - the clot is made and moves somewhere new

Question 2

What is global cerebral ischemia caused by

mild Sx
severe Sx
What do you see upon gross disection

Answer 2

Hypotension

mild: transient confusion

Severe: persistent vegetative state or brain death

gross disection: hazy grey-white demarcation (grey and white matter are not as distinct in color)

Question 3

Watershed infarcts are a result of what type of ischemia

where do they occur

Answer 3

global cerebral ischemia (caused by low BP)

occur away from large cerebral arteries. usually between middle and anterior cerebral

Question 4

laminar necrosis

Answer 4

see necrosis in weird layered patterns. there may be some layers in between the necrosis that are alive because vessles in the meninges are keeping them alive

Question 5

Two causes of focal cerebral ischemia

Answer 5

ischemic (pale) infarcts. more common. usually due to thrombi (atherosclerosis). can (depending on patient) give TPA to break up clot.

hemorrhagic (red) infarcts. usually due to emboli from heart + reperfusion

Question 6

timeline of gross appearance of ischemic infarcts

also hemorrhagic infarcts

Answer 6

ischemic -

day 1-2 white, wet, swollen
day 2-10 gelatinous, outlines of visible infarct
day 10-21 liquefaction and cavitation

hemorrhagic -

punctate hemorrhages or big hematomas
eventual resolution and cavitation

Question 7

timeline of microscopic appearance of ischemic and hemorrhagic infarcts

Answer 7

hemorrhagic looks the same as ischemic, just with extravasated blood

12hr - red neurons, edema, swollen astrocytes
12-48hr - lots of neutrophils
2-3 days - less neutrophils, more macrophages

1 week - gliosis
1-2 weeks - even more macrophages
after 2 weeks: dense gliosis and new capillaries

Question 8

one main cause of lacunar infarcts

what are they?

Answer 8

hypertension

the deep vessels of the brain (the ones that supply basal ganglia, deep white matter, brainstem) develope arteriolar sclerosis and make little lakes (lacunar) infarcts

Question 9

slit hemorrhages

caused by
what is seen microscopically

Answer 9

caused by hypertension

little hemorrhages, microscopically, see hemosiderin-laden macrophages, gliosis

Question 10

acute hypertensive encephalopathy

caused by
Sx

Answer 10

caused by malignant hypertension (bp nearing the 300/200)

Sx: confusion, convulsions, coma
swollen brain with petechiae and fibrinoid necrosis of arterioles

Question 11

parenchymal hemorrhage

age group
mortality
due to

Answer 11

peak age 60, high mortalithy

usually due to rupture of a small intraparenchymal vessel, can be ganglionic or lobar

cause: hypertension

Question 12

tiny, “cute” aneurysms

two main causes

Answer 12

charcot-bouchard microaneurysms

hypertension and parenchymal hemorrhage

Question 13

most common cause of subarachnoid hemorrhage

Answer 13

rupture of berry aneurysm

Question 14

Berry aneurysm:

what about the size of it is important

Answer 14

grows slowly

with >1cm, 50% risk of bleeding per year