Lecture 67 - Neuropathology and Treatment

Question 1

The earliest changes at the tissue level during stroke can be seen within _____hrs of stroke onset. These are Acute ________ necrosis of neurons and ______ of Neuropil (pale parenchyma on staining.)

Answer 1

12 hrs

Acute Eosinophilic Necrosis of neurons

Question 2

About 48 hrs after stroke onset, Polymorphonuclear cells will be present.

3-4 days post-stroke, ______ begin to react and _______ (aka gitter cells) appear.

Answer 2

Astrocytes

Macrophages

Question 3

After a week post-stroke, there are some _________ that survive toward the edges of the lesion –> they become hypertrophic (termed gemistocytes at this point), with _____ filling their cytoplasm. After a few weeks, cystic changes may be evident.

Answer 3

Astrocytes

GFAP

Question 4

TIA is defined as a brief episode of neurological dysfunction caused by focal brain ischemia with clinical symptoms lasting less than _____ hr(s) AND without evidence of acute brain infarction.

Answer 4

1hr

Question 5

Carotid Endarterectomy and Carotid Stenting are only useful in cases of > ____-____% stenosis. If performed, they reduce the risk of recurrent stroke by up to _____%.

Answer 5

60-70%

50%

Question 6

Embolic strokes initially cause Ischemic damage, but it may lead to _______. So, before starting patient on Heparin, must repeat CT in about ____ hrs.

Answer 6

Hemorrhage

72 hrs

Question 7

What is the difference between prophylactic therapy used for patients who have had Embolic vs Thrombotic strokes?

Answer 7

Embolic –> Anticoagulation (i.e. Warfarin - inhibits Vit K synth; Apixaban+Rivaroxaban - inhibit Factor Xa; Dabigatran - directly inhibits Thrombin)

Thrombotic –> Antiplatelet (i.e. Aspirin, Clopidogrel, etc…)

Question 8

Patients who have Embolic stroke also tend to exhibit preceeding TIAs. How do patients with TIAs from Embolic disease present differently from patients with TIAs from Thrombotic disease?

Answer 8

Remember that pieces of Emboli can break off and end up in different brain regions –> TIAs from Embolic disease will likely cause disabling deficits from different brain regions. Thrombotic disease TIAs will likely cause disabling deficits from the same brain region.

Question 9

Lacunar stroke patients are treated with ______ (antiplatelet or anticoagulant?), and if the LDL > ______, they get a high intensity Statin as well.

Answer 9

Antiplatelet

LDL > 70

Question 10

Hemorrhagic stroke is most common in brain areas with deep penetrating arteries, as they are most susceptiple to Hypertensive damage. Specifically, they tend to form a particular type of aneurysm that then ruptures, causing the hemorrhage. What are these aneurysms called?

Answer 10

Charcot-Bouchard aneurysms

Question 11

_______ hemorrhage, most commonly caused by trauma (most common non-traumatic cause is ruptured aneurysm, specifically Saccular or “Berry” aneurysms), may present with meningeal symptoms (i.e. stiff neck) and increased ICP symptoms (e.g. papilledema). They tend to form in branch points of the ______ (Anterior, Middle, or Posterior?) circulation.

Answer 11

Subarachnoid hemorrhage

Question 12

Arteriovenous Malformations (AVMs) typically occur in _______ (young or old?) people.

Answer 12

Young

Question 13

Beta Amyloid appears ______ ______ in color under Polarized light when stained with Congo Red. Remember that Beta Amyloid build up can cause Hemorrhagic stroke in _______ regions of the brain, which is not the typical location for Hemorrhagic stroke (remember they occur most often in deep brain from ruptured aneurysm in small vessels).

Answer 13

Apple Green (birefringence)

Cortical (Lobar)