Histo: Cerebrovascular disease and Trauma Pt.2

Question 1

How are arteriovenous malformations treated?

Answer 1

• Surgery
• Embolisation
• Radiosurgery

Question 2

Define cavernous angioma.

Answer 2

Well-defined malformative lesion composed of closely-packed vessels with no parenchyma interposed between vascular spaces

NOTE: it is similar to an arteriovenous malformation but there is no brain substance wrapped up amongst the vessels
NOTE: these tend to bleed at lower pressure causing recurrent small bleeds

Question 3

Describe the appearance of cavernous angiomas on MRI.

Answer 3

Shows target sign

Question 4

What causes subarachnoid haemorrhages?

Answer 4

Rupture of a berry aneurysm (present in 1% of population)

NOTE: berry aneurysms are congenital

Question 5

Where are berry aneurysms typically found?

Answer 5

Base of brain (circle of Willis)

• 80% at the internal carotid bifurcation
• 20% within the vertebro-basillar circulation

NOTE: highest risk of rupture if diameter of 6-10 mm

Question 6

What are the common presenting clinical features of SAH

Answer 6

• Sudden onset (thunderclap) headache, vomiting, loss of consciousness
• May also have symptoms of meningeal irritation (neck stiffness, photophobia)
• Warning leak a few days to weeks prior causing transient severe headache

Question 7

How are cerebral aneursyms treated

Answer 7

Endovascular coiling

Question 8

What is the most common cause of cerebral infarctions?

Answer 8

Cerebral atherosclerosis

Question 9

Where is atherosclerosis most commonly found within the cerebral vasculature?

Answer 9

Extracranial
- Carotid bifurcation

Intracranial
- MCA
- Basilar artery
- Internal carotid

Question 10

Which part of the cerebral vascular tends to be affected by infarcts resulting from emboli?

Answer 10

Middle cerebral artery branches

Question 11

List some differences between infarctions and haemorrhagic strokes.

Answer 11

Infarction

• Tissue necrosis
• Rarely haemorrhagic
• Permanent damage in the affected area
• No recovery

Haemorrhage

• Dissection of parenchyma
• Fewer macrophages
• Limited tissue damage
• Partial recovery

Question 12

What is the biggest cause of death in people < 45 years?

Answer 12

Trauma

Question 13

Describe how traumatic brain injury can be classified.

Answer 13

Non-missile and missile (e.g. shrapnel)

Acceleration/deceleration, rotational

Focal or diffuse

Causes: RTA, falls, assault

Question 14

What are the consequences of base of skull fractures?

Answer 14

• The fracture may pass through the middle ear or anterior cranial fossa
• It can cause CSF otorrhoea or rhinorrhoea
• Increased risk of infection

Question 15

What are some clinical signs of base of skull fractures

Answer 15

Battle sign
Raccoon eyes

Question 16

With regards to brain injury, what is a contusion and what is a laceration?

Answer 16

Contusion - collison of brain with skull causing surface bruising
Laceration - tearing of the pia mater

Question 17

What is the term used to describe rebound injury to the opposite side of the brain?

Answer 17

Contrecoup injury

Question 18

What is diffuse axonal injury?

Answer 18

• Occurs at the moment of injury
• Shear and tensile forces causes damage to the axons
• This is the most common non-bleed related cause of coma

Question 19

What areas of the brain are commonly affected by diffuse axonal injury

Answer 19

• Midline structures are particularly affected (e.g. corpus callosum, rostral brainstem, septum pellucidum)
• Some people suffer cognitive and behavioural changes further down the line