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Pathology > Hi - Cerebrovascular Disease / Trauma > Flashcards

Hi - Cerebrovascular Disease / Trauma Flashcards

1
Q

Define stroke

A

> 24hours
- focal/global loss of cerebral function
- inadequate vascular perfusion

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2
Q

Most common site for cerebral thrombosis

A
  1. Carotid bifurcation
  2. Basilar artery
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3
Q

Most common site for cerebral embolus

A

Middle cerebral artery

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4
Q

Typical site of embolism in TIA?

A

ophthalmic branch of internal carotid

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5
Q

Ix in TIA to attempt to confirm Dx?

A

Carotid USS

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6
Q

Initial management of TIA

A

Aspirin + dipyridamole +/- carotid endarterectomy

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7
Q

If <3h since stroke, what is the management

A

thrombolytics + aspirin +/- dipyridamole

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8
Q

Cause of global cerebral ischemia

A

Failure of systemic circulation eg HF

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9
Q

3 non-traumatic forms of cerebral haemorrhage?

A
  • Intraparenchymal haemorrhage
  • Subarachnoid haemorrhage
  • Arteriovenous malformations
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10
Q

Main RF for intraparenchymal haemorrhage

A

Hypertension

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11
Q

Most common site of intraparenchymal haemorrhage

A

Basal Ganglia

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12
Q

RFs for subarachnoid haemorrhage

A

PCKD
Ehlers Danlos
Aortic Coarctation

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13
Q

Most common cause + site of subarachnoid haemorrhage

A

Rupture of berry aneurysm
80% Carotid bifurcation, 20% vertebro-basillar circulation

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14
Q

Tx of subarachnoid haemorrhage from rupture berry aneurysms?

A

coil - stops blood flow through weak vessel area

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15
Q

what is coup

A

where impact occurs

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16
Q

what is contracoup

A

opposite side to where impact occurred

17
Q

Contusion - tends to affect which lobes?

A

Frontal and temporal

18
Q

2 main types of cerebral oedema & definitions

A
  • Vasogenic (disruption of BBB)
  • Cytotoxic (2ndary to cellular injury eg hypoxia)
19
Q

How does cerebral oedema resolve itself? i.e. where does the fluid go - state 3 ways

A

1) into blood via AQP4 in foot processes
2) into subarachnoid CSF
3) into ventricles

20
Q

Normal CSF flow in the brain

A

Choroid plexus –> lateral vent –> 3rd vent –> 4th vent –> spinal cord OR subarach space

21
Q

2 types of hydrocephalus

A

1) Communicating (problem with CSF resorption into venous sinuses)
2) Non-communicating (obstruction to CSF flow)

22
Q

What is a cavernous angioma

A

Collection of large weak capillaries with no parenchyma between them, making a cavity

23
Q

Average age of presentation of a cavernous angioma? how do they present?

A

> 50yo with headache/haemorrhage/focal neuro Sx

24
Q

apperance of cerebral oedema at post mortem

A

swollen brain with no visible sulci, enlarged gyri
arachnoid tight over parenchyma

25
Q

Tx of hydrocephalus in neonates

A

Catheterise ventricle to drain CSF

26
Q

Normal ICP

A

7-15mmHg

27
Q

Where does the brain herniate when raised ICP (3)

A

Subfalcine - under falx cerebri between superior cortex
Transtentorial / uncal - medial temporal lobe goes into posterior fossa
Tonsillar - brainstem through foramen magnem

28
Q

What is an AVM

A

Blood passes quikcly from artery to vein through engorged capillaries. Decreases perfusion to tissue around it

29
Q

How do AVMs present

A

2-5th decade
Haemorrhage - massive bleeding due to high pressure
Seizure, headache, focal neuro signs

30
Q

How does presentation of AVM and cavernous angioma differ?

A

AVM is high pressure so massive quick bleed, CA is low pressure so slow / recurrent bleeds

31
Q

What diameter of berry anueyrsm is a risk?

A

6-10mm

32
Q

Causes of infarct stroke

A

cerebral atherosclerosis is main one
HTN
Smoking
DM

33
Q

Where do stroke emboli vs thrombus come from?

A

Emboli from MCA branches
Thrombus from carotid bifurcation

34
Q

Contrast histology of infarct vs haemorrhagic stroke

A

Infarct - tissue necrosis, permenant, no recovery
Haemorrhage - fewer macrophages, limited tissue damage with some recovery

35
Q

Prognoses of TBI

A

19% vegetative
31% good recovery

36
Q

2 types of TBI

A

Missle and non missle

37
Q

Signs of skull base fracture

A

Ottorrhoea / rhinorrhoea - CSF through ear/nose
Battle’s sign - haematoma below ear

38
Q

What is diffuse axonal injury

A

Tearing of axons due to shear/tensile forces that occur at moment of injury

39
Q

What brain area is vulnerable to diffuse axonal injury

A

Midline structures eg corpus callosum

Pathology (87 decks)

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