histopath - cerebrovascular path Flashcards
Define stroke
> 24hours
- focal/global loss of cerebral function
- inadequate vascular perfusion
Most common site for cerebral thrombosis
- Carotid bifurcation
2. Basilar artery
Most common site for cerebral embolus
Middle cerebral artery
Typical site of embolism in TIA?
ophthalmic branch of internal carotid
Ix in TIA to attempt to confirm Dx?
Carotid USS
Initial management of TIA
Aspirin + dipyridamole +/- carotid endarterectomy
If <3h since stroke, what is the management
thrombolytics + aspirin +/- dipyridamole
Cause of global cerebral ischemia
Failure of systemic circulation eg HF
3 non-traumatic forms of cerebral haemorrhage?
- Intraparenchymal haemorrhage
- Subarachnoid haemorrhage
- Arteriovenous malformations
Main RF for intraparenchymal haemorrhage
Hypertension
Most common site of intraparenchymal haemorrhage
Basal Ganglia
RFs for subarachnoid haemorrhage
PCKD
Ehlers Danlos
Aortic Coarctation
Most common cause + site of subarachnoid haemorrhage
Carotid bifurcation
Tx of subarachnoid haemorrhage from rupture berry aneurysms?
coil - stops blood flow through weak vessel area
coup
where impact occurs
Contracoup
opposite side to where impact occurred
Contusion - tends to affect which lobes?
Frontal and temporal
Viral causes of meningitis in a neonate? give 4
Echovirus
Coxsackie
HIV
Mumps
Indolent, childhood brain tumour
Pilocytic astrocytoma
Tumour in the ventricles, leading to hydrocephalus
Ependymoma
neurofibromatosis type 2 is associated with which brain tumour?
Meningioma
2 main types of cerebral oedema
- Vasogenic (leak)
- Cytotoxic (2ndary to vessel injury)
How does cerebral oedema resolve itself? i.e. where does the fluid go - state 3 ways
1) into blood via AQP4 in foot processes
2) into subarachnoid CSF
3) into ventricles
Normal CSF flow in da brain
Choroid plexus –> lateral vent –> 3rd vent –> 4th vent –> spinal cord OR subarach space
2 types of hydrocephalus
1) Communicating (problem with CSF resorption into venous sinuses)
2) Non-communicating (obstruction to CSF flow)
Presentation of cerebral arteriovenous malformation
Headache, seizure, haemorrhage, focal signs
Wtf is a cavernous angioma
Collection of large weak capillaries with no parenchyma between them
Average age of presentation of a cavernous angioma? how do they present?
> 50yo with headache/haemorrhage/focal neuro Sx
