Intracranial vascular pathology

Question 1

What is the difference between infarction and ischaemia?

Answer 1

ischaemia - reduced oxygenation of tissue causing dysfunction (no tissue death)

Infarction - severely reduced oxygenation of tissue, death of tissue (also called ischaemic necrosis)

Question 2

Define shock?

Answer 2

life threatening condition where there is impairment of oxygenation in numerous organs

Question 3

What is ischaemia often referred to when in brain, myocardium, intestines and calf muscles?

Answer 3

Brain - transient ischaemic attack
Myocardium - stable angina
Intestines - intestinal angina
Calf muscle - intermittent claudication

Question 4

Define TIA?

Answer 4

temporary disturbance in brain function due to temporary interruption in blood supply to region of brain

Question 5

What are the causes of a TIA?

Answer 5

Heart - thrombus (usually due to post-MI or A-fib)

Blood vessel - atheroma-thrombus (plaque usually made of cholesterol forms)

Question 6

Are strokes/TIA’s contralateral or ipsilateral?

Answer 6

Contralateral

Question 7

At what point do the nerve fibres coming from the brain cross over?

Answer 7

decussation of pyramides

Question 8

What happens in Atrial fibrillation?

Answer 8

Area of the atria (not SAN) send out electrical impulses

these impulses cause atria to twitch causing blood to be pumped out irregularly (can cause clot)

Question 9

Where is a stroke emboli most likely to form?

Answer 9

bifurcation of carotid artery

Question 10

What is the treatment for atheromatous plaques?

Answer 10

Endarterectomy (remove atheromatous build up in endothelium)

Question 11

What can stroke be caused by other than ischaemic stroke?

Answer 11

stroke can be due to ischaemia or haemorrhage

Question 12

What develops in the brain from an older infarct?

Answer 12

cystic cavity which can be seen on dissection of the brain?

Question 13

What is vasculitis?

Answer 13

group of diseases where there is inflammation of blood vessels
(often idiopathic or autoimmune)

Question 14

Will stenosis of one of the carotid arteries cause ipsilateral or contralateral TIA/Stroke?

Answer 14

contralateral i.e. stenosis of right carotid causes symptoms on left side

Question 15

How can we assess whether cause of TIA is A-Fib or stenosis?

Answer 15

pulse will be irregularly irregular if A-fib

Question 16

Where are the common locations for intracranial haemorrhage?

Answer 16

• extradural middle meningeal
• subdural bridging veins
  (^both caused by trauma)
• subarachnoid circle of Willis
• Intracerebral

Question 17

What are the causes of intracerebral haemorrhage?

Answer 17

(also called haemorrhagic stroke)

• Hypertension (most common)
• Amyloid angiopathy
• AVM (arteriovenous malformation)

Question 18

What is cerebral amyloid angiopathy (possible cause of haemorrhagic stroke)?

Answer 18

• deposition of amyloid in cerebral BV walls

- increases risk of haemorrhage

Question 19

What staining can be used to check for amyloid?

Answer 19

• Congo red stain

- amyloid shows as red

Question 20

What is an AVM?

Answer 20

arteriovenous malformation

• congenital abnormal tangle of arteries and veins within the substance of the brain or on surface of brain
• increased risk of bleed

Question 21

What is the cause of spontaneous subarachnoid haemorrhage?

Answer 21

Berry aneurysm

- prone to spontaneous bleed

Question 22

What is a berry aneurysm?

Answer 22

• round bulging and weakening of the blood vessels in circle of Willis

Question 23

What are the symptoms of subarachnoid haemorrhage/

Answer 23

• sudden severe headache
• stiff neck
• nausea
• light sensitivity
• blurred/double vision
• stroke symptoms
• loss of consciousness

Question 24

What condition is associated with higher risk of berry aneurysm?

Answer 24

autosomal dominant polycystic kidney disease