L2

Question 1

There are three main pathogenic mechanisms for Cerebrovascular diseases ?

Answer 1

• Thrombotic occlusion
• Embolic occlusion
• Vascular rupture

Question 2

brain may be deprived of oxygen by two general mechanisms:

Answer 2

A. Functional hypoxia
B. Ischemia

Question 3

causes of functional hypoxia are

Answer 3

1. Low partial pressure of oxygen at high altitude
2. Severe anemia
3. Carbon monoxide poisoning
4. Cyanide poisoning

Question 4

Ischemia of brain occur due to:

Answer 4

tissue hypoperfusion, which can be caused by hypotension, vascular obstruction, or both

It’s can be ( transient or permanent)

Question 5

Global Cerebral Ischemia:

Answer 5

ischemic-hypoxic injury severe systemic hypotension (systolic pressures below 50 mm Hg)
as in cardiac arrest and shock.

Question 6

most susceptible neurons in global cerebral ischemia are ?

Answer 6

pyramidal cells of the hippocampus
neocortex and Purkinje cells of the cerebellum.

Question 7

1-swollen with wide gyri and narrowed sulci.
2- The cut surface shows poor demarcation between gray and white matter.

Answer 7

Global Cerebral Ischemia

Question 8

Microscopic Appearance in global cerebral haemorrhage

Answer 8

• Early changes
(12 to 24 hours after the injury)
acute neuronal cell change (red neurons)

• Subacute changes
(24 hours to 2 weeks)
Necrosis of tissue, Influx of macrophages
Vascular proliferation, Reactive gliosis

• Repair
(after 2 weeks)
Removal of all necrotic tissue.
Gliosis

Question 9

Morphology in Global Cerebral Ischemia

Answer 9

1-Border zone (“watershed”) infarcts occur in regions of the brain and spinal cord most distal portions of arterial territories
2- seen after hypotensive episodes.
3- In the cerebral hemispheres, the border zone between the anterior and the middle cerebral artery distributions is at greatest risk.
4-Damage produces a wedge-shaped band of necrosis lateral to the interhemispheric fissure.

Question 10

Focal Cerebral Ischemia

Answer 10

Cerebral arterial occlusion leads first to:
focal ischemia and then to infarction in the distribution of the compromised vessel

Little or no any collateral flow to structures such as :
- thalamus,
- basal ganglia
- deep white matter (which are supplied by deep penetrating vessels)
so they are more susceptible to Focal Cerebral Ischemia

Question 11

are a frequent source of emboli in brain ?

Answer 11

Cardiac mural thrombi

Question 12

is most frequently affected by embolic infarction?
In FCI

Answer 12

The territory of the (((middle cerebral artery))))
a direct extension of the internal carotid artery,

Question 13

• Emboli tend to lodge where vessels (branch )or in areas
of (stenosis) usually caused by :

Answer 13

atherosclerosis.

Question 14

Emboli of venous origin may cross over to the
arterial circulation through ?

FCI

Answer 14

a patent foramen ovale
and lodge in the brain (paradoxical embolism)
which include thromboemboli from deep leg veins and fat emboli (usually following bone trauma).

Question 15

Thrombotic occlusions causing cerebral
infarctions usually are superimposed on?

Answer 15

atherosclerotic plaques.

Question 16

• Common sites of Thrombotic Occlusions are ?

Answer 16

carotid bifurcation
origin of the middle cerebral artery
either end of the basilar artery

Question 17

1- results from acute vascular occlusions
2- macroscopic appearance of a evolves over time
3-During the first 6 hours, the tissue is unchanged in appearance,
but by 48 hours, the tissue becomes pale, soft, and swollen
4-From days 2 to 10, the injured brain turns gelatinous and friable.
5-From day 10 to week 3, the tissue -liquefies- eventually leaving a fluid-filled cavity.

Answer 17

Non-Hemorrhagic infarct

Question 18

1-occurs due to reperfusion of ischemic tissue, either through collaterals or after dissolution of emboli.
2- manifest as multiple, sometimes confluent, petechial hemorrhages

Answer 18

Hemorrhagic infarct

Question 19

Hemorrhages within the brain are caused by?

Answer 19

• Hypertension
• Arteriovenous malformations
• cavernous malformations
• Tumors

Question 20

Subarachnoid hemorrhages most commonly are
caused by ?

Answer 20

ruptured aneurysms

(but also occur with
other vascular malformations)

Question 21

Subdural or epidural hemorrhages usually are
associated with ?

Answer 21

trauma

Question 22

Most hemorrhages are due to ?

Answer 22

rupture of a small
intraparenchymal vessel.

Question 23

accounts for roughly 15% of deaths among
individuals with chronic hypertension?

Answer 23

Primary Brain Parenchymal Hemorrhage

Question 24

Hypertensive intra - parenchymal hemorrhages typically occur in the?

Answer 24

• Basal ganglia
• Thalamus
• Pons
• Cerebellum

Question 25

Cerebral Amyloid Angiopathy:

Answer 25

1-**amyloidogenic** peptides deposit in the walls of **medium- and small-caliber** meningeal and cortical vessels. 2-amyloid confers a rigid,**pipelike** appearance and stains with **Congo red** 3-weakens vessel walls and increases the risk of hemorrhages 4-associated hemorrhages often occur in the lobes of the cerebral cortex (**lobar hemorrhages**).

Question 26

most frequent cause of clinically significant **nontraumatic subarachnoid** hemorrhage is rupture of a ?

Answer 26

**saccular (berry) aneurysm** most Other causes of Subarachnoid Hemorrhage include • Vascular malformation • Trauma • Rupture of an **intracerebral hemorrhage into the ventricular system** • Coagulopathies • Tumors

Question 27

Rupture of aneurysm can occur at any time, but in about one third of cases it is associated with ?

Answer 27

acute **increases in intracranial pressure** as with **straining at stool** or sexual orgasm >>>patient is stricken with **sudden, excruciating**headache (classically described as “the **worst headache I’ve ever had”) and rapidly loses consciousness**

Question 28

-90% of saccular aneurysms occur in the ?

Answer 28

anterior circulation near major arterial branch points.

Question 29

atherosclerotic aneurysms frequently are fusiform and most commonly involve the?

Answer 29

**basilar artery** الانواع الثانيه مثل الاول anterior circulation

Question 30

Saccular aneurysms Due to defects in ?

Answer 30

the vessel media.

Question 31

There is an increased risk of aneurysms in patients with?

Answer 31

autosomal (dominant ) **polycystic kidney disease**

Question 32

• Aneurysms larger than……… in diameter have a roughly 50% risk of bleeding per year.

Answer 32

1 cm

Question 33

Healing and the meningeal fibrosis and scarring sometimes obstruct CSF flow or disrupt CSF resorption, leading to ?

Answer 33

hydrocephalus.

Question 34

Nonsaccular aneurysms usually manifest as?

Answer 34

**cerebral infarction** due to vascular occlusion >>instead of subarachnoid hemorrhage.

Question 35

Vascular malformations of the brain are classified into four principal types based on the nature of the abnormal vessels:

Answer 35

• Arteriovenous malformations (AVMs) • Cavernous malformations • Capillary telangiectasias • Venous angiomas.

Question 36

most common (most dangerous) type of vascular malformation of the brain ?

Answer 36

Arteriovenous Malformations

Question 37

1-Associated with seizures, an intracerebral hemorrhage, or a subarachnoid hemorrhage. 2-resemble a **tangled** network of wormlike vascular channels.

Answer 37

Arteriovenous Malformations

Question 38

Hypertensive Cerebrovascular Disease

Answer 38

1-causes **hyaline arteriolar sclerosis** of the deep penetrating arteries and arterioles that supply the: -basal ganglia -hemispheric white matter -**brain stem**

Question 39

pathologic brain processes which are related to hypertension are?

Answer 39

• Lacunes or lacunar infarcts • Rupture of the small-caliber penetrating vessels • Acute hypertensive encephalopathy

Question 40

1-are small cavitary **infarcts** just a few millimeters in size 2-found most commonly in the deep **gray matter** (basal ganglia and thalamus) internal capsule, the deep **white matter**, and the pons. 3-caused by occlusion of a **single** penetrating branch of a large cerebral artery 4-Depending on their location

Answer 40

Lacunar Infarcts

Question 41

-slitlike cavity (slit hemorrhage) surrounded by brownish discoloration?

Answer 41

Rupture of the small-caliber penetrating vessels

Question 42

1-sudden sustained rises- in diastolic blood pressure to greater than 130 mm Hg. 2–increased intracranial pressure and global cerebral dysfunction (headaches, confusion, vomiting, convulsions, and coma). 3-Postmortem examination show brain edema, with or without transtentorial or tonsillar herniation. 4-Petechiae and -fibrinoid necrosis- of arterioles in the gray and white matter

Answer 42

Acute Hypertensive Encephalopathy

Question 43

Infectious arteritis of small and large vessels is more often caused by ?

Answer 43

opportunistic infections (such as aspergillosis, herpes zoster, or CMV)

Question 44

present with a diffuse encephalopathy, often with cognitive dysfunction?

Answer 44

Vasculitis

Question 45

diseases constitute a major cause of mortality (death) and neurologic morbidity (disease).

Answer 45

Cerebrovascular Diseases