Intracranial Vascular Pathology ( non-traumatic )

Question 1

What are the Causes of intracranial vascular pathologies

Answer 1

1- Atrial fibrillation 
2- atherosclerosis/ thrombosis / embolism 
3- vasculitis 
4- hypertension 
5- amyloid 
6- arteriovenous malformation 
7- berry aneurysm

Question 2

Explain Ischaemia vs infarction

Answer 2

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

Question 3

What is shock

Answer 3

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

Question 4

What is another term used for infarction

Answer 4

Ischaemic necrosis

Question 5

Will all infarction have ischaemia first

Answer 5

If sudden or complete blockage happens there will only be ischaemia for a few minutes and then infarction

Question 6

What is another term for ischaemic stroke

Answer 6

Cerebral infarct

Question 7

If there is ischaemia in the myocardium what is it called

Answer 7

Stable angina

Question 8

What is ischaemia of the intestines

Answer 8

intestinal angina ( mesenteric ischaemia )

Question 9

What is ischaemia of calf muscles

Answer 9

Intermittent claudication

Question 10

What is a TIA

Answer 10

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

Question 11

Causes of TIA

Answer 11

1- Heart : thrombus, Afib , post MI

2- Atherosclerosis ( atheroma plaque can travel to Brian )

Question 12

Why does TIA in right side of Brian affect left side of body

Answer 12

Nerve fibres cross over at decussation of pyramids, work contralateral

Question 13

What is Atrial fibrillation and how can it cause a stroke

Answer 13

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

Question 14

How can a previous MI cause TIA or stroke

Answer 14

Due to MI heart doesn’t contract properly due to fibrous scar tissue. Thrombus can develop and travel up to brain.

Question 15

What could histologically needle shaped crystals in the artery wall mean

Answer 15

Cholesterol built up in blood vessel wall

Question 16

What is an carotid endarterectomy

Answer 16

Operation to remove the atheromatous build up in the endothelium in the carotid

Question 17

Define stroke

Answer 17

Irreversible necrosis of Brian tissue due to ischaemia or haemorrhage

Question 18

Define ischaemic stroke

Answer 18

Irreversible necrosis of Brian tissue due insufficient oxygen

Question 19

What happens when a infarct has been in the brain for weeks

Answer 19

Immune system removes the inflammatory tissue and brain tissue. Cystic cavity is left behind.

Question 20

Completed stroke

Answer 20

Stroke that has stabilized. Infarction is now a cystic cavity.

Question 21

What is vasculitis

Answer 21

Group of diseases where there is inflammation of blood vessels. idiopathic or autoimmune

Question 22

What is CNS vasculitis

Answer 22

Vasculitis affecting cerebral blood vessels only or part of systemic vasculitis.

Question 23

How does vasculitis present histologically

Answer 23

Inflammatory cells in the vessel wall and lumen is blocked with cells ( not white lumen )

Question 24

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

Answer 24

Left Carotid artery Stenosis

Question 25

``` 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 ```

Answer 25

A fibrillation

Question 26

Which haemorrhage is venous not arterial

Answer 26

Subdural haemorrhage

Question 27

Haemorrhages are most commonly due to ? less commonly ?

Answer 27

Most common : Hypertension | Less common : amyloid antipathy and AVM

Question 28

What is Amyloid

Answer 28

abnormal protein that accumulates in tissues and causes wearing in blood vessel walls, in a wide variety of clinical settings , ex: Alzheimer

Question 29

What is cerebral amyloid antipathy

Answer 29

Deposition of amyloid in cerebral blood vessel walls = increase haemorrhage risk

Question 30

Congo red stain can detect what

Answer 30

Detects amyloid , colour changes from red to green when polarizer is used ( like glow in dark )

Question 31

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

Answer 31

Cerebral amyloid angiopathy

Question 32

What is Arteriovenous malformation

Answer 32

Congenital abnormal tangle of arteries and veins within the brain or on the surface of brain = risk of bleeding

Question 33

Spontaneous SAH causes

Answer 33

Berry aneurysms : round bulging and weakening of blood vessel usually found in circle of Willis = prone to spontaneous bleed - SAH

Question 34

Incidence of berry aneurysm risk is increased if patient has which disease

Answer 34

Autosomal dominant polycystic kidney disease

Question 35

49 y man attend Emergency with thunderclap headache and history of Autosomal dominant polycystic kidney disease what is most likely diagnosis

Answer 35

SAH