Histopathology 19: Cerebrovascular Disease And Trauma

Question 1

What are the 2 types of hydrocephalus ?

Answer 1

Non-communicating

Communicating

Question 2

What is the main cause of non-communicating hydrocephalus ?

Answer 2

The choroid plexus gets stuck in the cerebral aqueduct blocking csf flow

Question 3

What is a common cause of communicating hydrocephalus?

Answer 3

Meningitis infection- causes inflammation of the meninges which blocks csf reabsorption into the venous sinuses

Question 4

What are the 3 main types of herniation in the brain ?

Answer 4

• Subfalcine herniation
• uncal herniation (medial temporal lobe down through the tentorial notch)
• Tonsillar herniation (coning)- cerebellum is pushed through the foramen magnum

Question 5

What features can be seen on histology suggesting AVM (atrioventricular malformation) ?

Answer 5

Complex intertwining vessels

Question 6

What is the characteristic sign of Cavernous Angioma on MRI ?

Answer 6

Target sign on T2 weighted MRI

Question 7

What is a non-traumatic Intra-parenchymal haemorrhage ?

Answer 7

Haemorrhage into the brain parenchyma due to rupture of a small intraparenchymal vessels

Most commonly into the basal ganglia

Question 8

What is the most common cause of non-traumatic intra parenchymal haemorrhages ?

Answer 8

Hypertension

Question 9

With which symptoms/signs can a fissure fracture present ?

Answer 9

Otorrhoea- CSF fluid leaks out of the ears
Rhinorrhoea- CSF fluid leaks out of the nose

Battle sign and raccoon eyes

Question 10

Rotational traumatic brain injury tend to cause damage to which structures in the brain ?

Answer 10

Midline structures - corpus callosum, rostral brainstem, septum pellucidum

Question 11

Describe the features of subarachnoid haemorrhage ?

Answer 11

• Haemorrhage in the subarachnoid space.
• Caused by ‘berry’ aneurysm, hypertension, trauma, AVM - severe ‘thunder clap’ headache radiating to the occiput - associated with polycystic kidney disease, coarctation of the aorta

Question 12

Describe the features of extradural haemorrhage ?

Answer 12

• Bleed above the dura due to damage to the middle meningeal artery
• associated with severe trauma and fracture to the pterion
• subsequent lucid interval.

Question 13

Describe the features of Intracerebral haemorrhage (haemorrhage stroke) ?

Answer 13

• Caused by hypertension and arteriovenous malfor- mations.

- Hypertension may lead to either hyaline arteriosclerosis or Charcot–Bouchard aneurysms.

Question 14

Describe the features of subdural haematoma ?

Answer 14

• Bleed between the dura and arachnoid due to an acute tear in bridging veins.
• caused by trauma.
• features of raised intracranial pressure (headaches, confusion, nausea and vomiting), altered mental state
• Insidious onset usually taking 48 hours

Question 15

what are 2 types of cerebral oedema

Answer 15

VASOGENIC - disruption of the BBB

CYTOTOXIC - secondary to cellular injury (eg hypoxia. ischaemia)

Question 16

cerebral oedema on MRI

Answer 16

loss of gyri

Question 17

describe the route CFS takes

Answer 17

choroid plexus pumps out CSF
goes from lateral ventricles - intraventricular foramina - 3rd ventricle
cerebral aqueduct - 4th ventricle
medulla - central canal
subarachnoid space
CSF goes via arachnoid granulations - returns to systemic circulation

Question 18

normal ICP

Answer 18

7-15mmHg in a supine adult

increased pressure causes herniation

Question 19

features of non-traumatic intra-parenchymal haemorrhage

Answer 19

haemorrhage into the brain parenchyma due to rupture of small intraparenchymal vessels
common in basal ganglia
hypertension in 50%

presents as: severe headache, vomiting, LOC, focal neurological signs

Question 20

presentation of AV malformations

Answer 20

haemorrhage
seizures
headache
focal neurological deficits

occur under high pressure causing a massive bleed

Question 21

features of cavernous angiomas

Answer 21

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

presents as: headache, seizures, focal deficits, haemorrhage

tend to occur at lower pressure

Question 22

features of sub-arachnoid haemorrhages

Answer 22

rupture of a berry aneurysm
most in the inter-carotid bifurcation
highest risk of rupture when 6-10m in diameter
presents as: sudden onset severe headache, vomiting, LOC

Question 23

features of cerebral infarction

Answer 23

tissue death due to ischaemia
cerebral atherosclerosis = most common cause
especially affects the carotid bifurcation or the basilar artery
largest area supplied by middle CA

Question 24

types of head trauma

Answer 24

missile + non-missile
acceleration and deceleration
focal or diffuse

Question 25

what are contusions

Answer 25

when the brain collides with the internal surface of the skull
causes bruising of the surface
if this causes rupture of the pia mater = a laceration

Question 26

what is a diffuse axonal injury

Answer 26

occurs at the moment of injury
shear and tensile forces cause damage to the axons
midline structures particularly affected