hypoxia, ischemia, and stroke

Question 1

HIE

Answer 1

hypoxic-ischemic encephalopathy
basically hypoxia of whole brain
initially a grey matter process

Question 2

steps of energy crisis

Answer 2

energy failure -> depolarization -> glutamate discharge -> opening of NMDA, AMPA Rs -> Ca influx -> apoptosis

Question 3

reperfusion injury

Answer 3

free radiacal damage, lactic acid damage, cerebral edema

monocytes to area

Question 4

first damage

Answer 4

cell membranes compromised, metabolism ceases, neurons die (grey more then white)

Question 5

after 4-5 min of ischemia

Answer 5

irrecersible hippocampal, neocortical, striatal, and prukinje cell death

Question 6

> 5 min of ischemia

Answer 6

thalamic and brain stem damage

spinal cord resistant to hypoxia

Question 7

red neurons

Answer 7

appears w/in hour os reperfusion

Question 8

which cells of hippocampus die first?

Answer 8

CA1

most likely explanation is that these cells produce more glutamate

Question 9

which layers of neocortex die first?

Answer 9

3
5
6
most likely explanation is that these cells produce more glutamate

Question 10

cerebral infarction

Answer 10

focal brain necrosis d/t complete and prolonged ischemia focally affecting all tissue elecments, neurons, glia, and vessels

Question 11

penumbra

Answer 11

area of brain that has not yet become necrotic d/t ischemia, if O2 is delivered in time neurons can be saved

Question 12

hemorrhagic infarct

Answer 12

NOT an actual hemorrhage

is lesion d/t to reperfusion injury

Question 13

bland infarct

Answer 13

no reperfussion just swelling and disintegration

Question 14

thalmus blood supply>

Answer 14

thalamoperforator aa from PCA

Question 15

caudate nucleus blood supply

Answer 15

lenticulstriate aa (from MCA)

Question 16

globus pallidus blood supply

Answer 16

anterior choroidal aa

Question 17

putamen blood supply

Answer 17

brr of ACA

Question 18

man in barrel syndrome

Answer 18

d/t death of watershed areas

produces proximal arm and leg weakness

Question 19

watershed regions

Answer 19

ACA-MCA
MCA-PCA
zones, can occur with severe hypovolemia

Question 20

ischemic stroke gross

Answer 20

48hrs- edema and loss of gray-white matter jnx
2-10 days- gelantinous and friable w/distinct necrotic borders
3wks- liqufaction and cyst formation

Question 21

ischemia stroke microscopic

Answer 21

24hrs- red neurons
48hrs- neutrophils
1-2 wks- gliosis by astocytes
2-3wks- microglial cells predominate and neovascularization with granulation tissue 
months- cyst cavity w/gliotic lining

Question 22

10% of ischemic stokes

Answer 22

have hemorrhagic conversion/evolution

maybe d/t restored luminal patency of occluded vessel or reperfusion injury

Question 23

lateral medullary syndrome

Answer 23

aka PICA or wallenberg syndrome
loss of pain and temp sensation on c/l side of body and i/l side of face (this is Dx for condition)
ataxia
horner syndrome
nystagmus and vertigo
nausea and vomiting (fatal gastroenteritis syndrome)

Question 24

TIA

Answer 24

clinical presentation <10min

emergency- full work up

Question 25

what are the major causes of hemorrhagic strokes?

Answer 25

HTN, anticoagulants, bleeding disorders, cerebreal amyloid depostion, ruputured aneurysms, AV malformations, trauma

Question 26

pure motor stroke

Answer 26

contralateral pons or internal capsule lacune

Question 27

pure sensory stroke

Answer 27

contralateral thalamus lacune

Question 28

MCA syndrome

Answer 28

``` hemiparesis (face & arms >> legs) aphasia sensory loss hemianopia eye deviation ```

Question 29

ACA syndrome

Answer 29

lower extremity weakness sensory loss incontinence

Question 30

PCA syndrome

Answer 30

homonymous hemianopia | sensory loss

Question 31

PICA syndrome

Answer 31

ataxia horner syndrome ipsilateral loss of face sensation contralateral loss of pain and temp sensation

Question 32

arterial aneurysms

Answer 32

``` aka saccular or berry aneurysms subarachnoid (high pressure) hemorrhage majority in circle of wilisi at first bifurcation of MCA W>M risk factors: smoking, alcohol ```

Question 33

berry aneurysms associated with

Answer 33

polycystic kidney disease marfans and other CT diseases coarctation of aorta NFI

Question 34

sturge weber syndrome

Answer 34

rare sporadic neurocutaneous sydrome meningeal and ipsilateral cutaneous angiomatosis port wine stain on face if severe enough will see calcifications of vessels

Question 35

symptoms of sturge-weber

Answer 35

``` seizures developmental delay TIAs hemiparesis HAs glaucoma ```

Question 36

HTN encephalopathy

Answer 36

``` severe HA nausea, vomiting papilledema visual disturbances seizures confusion coma ```

Question 37

cerebral amyloid angiopathy

Answer 37

almost all pts with alzheimers have some degree of amyloid deposition stains with congo red usually deposition is in small vessles rarely d/t neoplasm, but usually idiopathic can cause ischemic or hemorrhagic lesions cause dementia it is associated with ApoE phenotypes