Intracranial Vascular Pathology ( non-traumatic ) Flashcards
What are the Causes of intracranial vascular pathologies
1- Atrial fibrillation 2- atherosclerosis/ thrombosis / embolism 3- vasculitis 4- hypertension 5- amyloid 6- arteriovenous malformation 7- berry aneurysm
Explain Ischaemia vs infarction
Ischaemia : diminished oxygenation of tissue/organs causing dysfunction - but no death of tissue ( reversible )
Infarction : severly/prolonged diminished oxygenation of tissue/organ - there is necrosis and death of cells
What is shock
a life threatening condition where there is impairment of oxygenation of numerous organs
What is another term used for infarction
Ischaemic necrosis
Will all infarction have ischaemia first
If sudden or complete blockage happens there will only be ischaemia for a few minutes and then infarction
What is another term for ischaemic stroke
Cerebral infarct
If there is ischaemia in the myocardium what is it called
Stable angina
What is ischaemia of the intestines
intestinal angina ( mesenteric ischaemia )
What is ischaemia of calf muscles
Intermittent claudication
What is a TIA
temporary disturbance in Brian function due to a temporary interruption in blood supply to a region of brain.
15% of patients with TIA can get a stroke within next 3 months
Causes of TIA
1- Heart : thrombus, Afib , post MI
2- Atherosclerosis ( atheroma plaque can travel to Brian )
Why does TIA in right side of Brian affect left side of body
Nerve fibres cross over at decussation of pyramids, work contralateral
What is Atrial fibrillation and how can it cause a stroke
When areas in the heart other than the sinus node send out electrical impulses. Causing atria to twitch irregularly. Blood won’t be pumped out effectively which could cause a a blood clot to form. Clot could travel to brain and cause stroke
How can a previous MI cause TIA or stroke
Due to MI heart doesn’t contract properly due to fibrous scar tissue. Thrombus can develop and travel up to brain.
What could histologically needle shaped crystals in the artery wall mean
Cholesterol built up in blood vessel wall
What is an carotid endarterectomy
Operation to remove the atheromatous build up in the endothelium in the carotid
Define stroke
Irreversible necrosis of Brian tissue due to ischaemia or haemorrhage
Define ischaemic stroke
Irreversible necrosis of Brian tissue due insufficient oxygen
What happens when a infarct has been in the brain for weeks
Immune system removes the inflammatory tissue and brain tissue. Cystic cavity is left behind.
Completed stroke
Stroke that has stabilized. Infarction is now a cystic cavity.
What is vasculitis
Group of diseases where there is inflammation of blood vessels. idiopathic or autoimmune
What is CNS vasculitis
Vasculitis affecting cerebral blood vessels only or part of systemic vasculitis.
How does vasculitis present histologically
Inflammatory cells in the vessel wall and lumen is blocked with cells ( not white lumen )
77 year old man has 15 minute of slurred speech and drooping of right side of face, Symptoms have resolved but has had 2 similar episodes in past 3 months. ECG is normal. Which underlying pathology is most likely
1- Berry aneurysm 2- Left carotid artery stenosis 3- right carotid artery stenosis 4- A fib 5- Right middle cerebral artery stenosis
Left Carotid artery Stenosis
77 year old man has 15 minute of slurred speech and drooping of right side of face, Symptoms have resolved but has had 2 similar episodes in past 3 months. pulse is irregular irregular . Which underlying pathology is most likely 1- Berry aneurysm 2- Left carotid artery stenosis 3- right carotid artery stenosis 4- A fib 5- Right middle cerebral artery stenosis
A fibrillation
Which haemorrhage is venous not arterial
Subdural haemorrhage
Haemorrhages are most commonly due to ? less commonly ?
Most common : Hypertension
Less common : amyloid antipathy and AVM
What is Amyloid
abnormal protein that accumulates in tissues and causes wearing in blood vessel walls, in a wide variety of clinical settings , ex: Alzheimer
What is cerebral amyloid antipathy
Deposition of amyloid in cerebral blood vessel walls = increase haemorrhage risk
Congo red stain can detect what
Detects amyloid , colour changes from red to green when polarizer is used ( like glow in dark )
57 y man dies suddenly.
Autopsy findings: large right sided intracerebral haemorrhage. Histology of cerebral blood vessels show Congo Red positive protein depositions blood vessel walls
Which diagnosis is most likely
Cerebral amyloid angiopathy
What is Arteriovenous malformation
Congenital abnormal tangle of arteries and veins within the brain or on the surface of brain = risk of bleeding
Spontaneous SAH causes
Berry aneurysms : round bulging and weakening of blood vessel usually found in circle of Willis = prone to spontaneous bleed - SAH
Incidence of berry aneurysm risk is increased if patient has which disease
Autosomal dominant polycystic kidney disease
49 y man attend Emergency with thunderclap headache and history of Autosomal dominant polycystic kidney disease what is most likely diagnosis
SAH
