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8 PATH 2 > LECTURE FINAL COPY > Flashcards

LECTURE FINAL COPY Flashcards

1
Q

CEREBROVASCULAR DISEASE

A

NEW TOPIC

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2
Q

Under normal circumstances, the brain receives _____

A

15% of the cardiac output and utilized fought 20% of the oxygen consumed by the body

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3
Q

What is the most sensitive hypoxic organ?

A

The brain

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4
Q

What are the 3 major categories of cerebrovascular disease?

A
  1. Parenchymal injuries
  2. Infarcts (ischemic stroke)
  3. Hemorrhage’s (hemorrhagic stroke)
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5
Q

What are “Parenchymal injuries” associated with cerebrovascular disease?

A

Parenchymal injuries associated with a generalized with a generalized reduction in blood flow, including global hypoxia - ischemic encephalopathy

  • LEAST COMMON
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6
Q

What are “Infarcts” associated with cerebrovascular disease?

A

Infarcts (ischemic stroke) caused by local vascular obstruction

  • zone of NECROSIS due to oxygen deficiency
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7
Q

How common is “Infarcts (ischemic stroke)” in cerebrovascular disease?

A

Makes up 80% of all CVD (MC)

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8
Q

What are hemorrhages (hemorrhagic stroke) associated with cerebrovascular disease?

A

Within the brain parenchyme or subarachnoid space

  • Makes up 15% of all CVD
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9
Q

What is a hemorrhage?

A

An escape of blood from a ruptured vessel

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10
Q

What is ischemia?

A

A restriction of blood supply to tissue causing a shortage of oxygen and glucose

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11
Q

What is an infarct?

A

Tissue death (necrosis) due to lack of oxygen

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12
Q

When does Ischemic stroke occur?

A

When an artery to the brain is blocked

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13
Q

What are the 2 types of ischemic stroke?

A

Lacunar infarction and thrombosis of cerebral arteries

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14
Q

Lacunar infarction makes up ____

A

8-9% of all ischemic infarction

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15
Q

Lacunar infarction is associated with ?

A

Hyaline arteriosclerosis **

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16
Q

What happens during Lacunar infarction?

A

Dramatic narrowing of the lumen of arterioles = reduced blood flow to the brain

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17
Q

What does Lacunar infarction affect?

A

MIDBRAIN

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18
Q

What type of infarction do people have subtle manifestations and don’t realize they have it?

A

Lacunar infarction

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19
Q

Thrombosis of cerebral arteries is due to ______

A

Atherosclerosis

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20
Q

What is thrombosis of cerebral arteries associated with?

A

Atheroma accumulate in the walls - activation of the platelet plug, thrombus formation, necrosis of tissue

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21
Q

In thrombosis of cerebral arteries, what happens if the thrombus breaks off?

A

If thrombus tears and becomes an embolism, it goes with blood flow to vessels who have small lumen - leads to development of thromboembolism

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22
Q

What are the most common areas of atheroma ?

A
  1. Bifurcation of the CC artery
  2. Bifurcation of the internal carotid artery
  3. Middle cerebral artery
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23
Q

Where is the bifurcation of the common carotid artery?

A

Divided into int/ext at the level of C5

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24
Q

Where is the bifurcation of the internal carotid artery?

A

Divided into ant/middle cerebral artery

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25
Q

What is the most vulnerable area for ischemic stroke (atheroma)?

A

Middle cerebral artery ***

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26
Q

Liquefaction necrosis results from?

A

Cerebrovascular disease

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27
Q

What is liquefactive necrosis?

A

Replacement of damaged brain by neuralgia = GLIOSIS

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28
Q

What are the sources of thromboemboli in the brain?

A

Left sided heart failure

  • mitral stenosis
  • subacute bacterial endocarditis
  • MI
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29
Q

What is Transient Ischemic Attack (TIA)?

A

Sequelae of thrombosis - resolution

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30
Q

What happens in Transient Ischemic Attack (TIA)?

A

Development of temporary ischemic stroke - patient develops manifestations of stroke and loss of motor function/speech/eyesight

(UNILATERAL)**

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31
Q

What is the duration of Transient Ischemic Attack (TIA)?

A

Lasts several minutes and the symptoms go away

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32
Q

What is a major symptom of TIA?

A

Loss of vision explained by Involvment of opthalmic artery

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33
Q

What is important diagnosis in TIA associated with the opthalmic artery thrombosis?

A

Aka AMAUROSIS FUGAX

  • Temporary unilateral loss of vision
  • Similar symptoms
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34
Q

What is the treatment of opthalmic artery thrombosis (aka AMAUROSIS FUGAX) associated with TIA?

A

Anticoagulant

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35
Q

Hemorrhagic stroke subcategory:

A

Intracerebral aka parenchymal aka hypertensive (long term)

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36
Q

What is intracerebral/parenchymal/hypertensive Hemorrhagic Stroke associated with?

A

Hyaline arteriosclerosis

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37
Q

What is the mechanism of injury with intracerebral/parenchymal/hypertensive - Hemorrhagic stroke?

A

In the case of long term hypertension, development of hyaline arteriosclerosis, replacement of normal vascular wall with hyaline tissue weakening of the vascular wall

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38
Q

What does intracerebral aka parenchymal aka hypertensive - Hemorrhagic Stroke lead to?

A

Death of parenchyme

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39
Q

What is the most dangerous part of high BP?

A

Hemorrhagic stroke

  • Intracerebral aka parenchymal aka hypertensive
  • Sudden increase or decrease of BP
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40
Q

What is the development sequence of hemorrhagic stroke?

A
  1. Dramatic pressure into adjacent tissue which results in
    compression of walls in ventricle and formations of
    non-communicating hydrocephalus
  2. Development of poisoning of brain tissue by blood
    ▪ Because blood gets outside of the vessels- poisonous for the
    nervous tissue
  3. Pressure atrophy of brain tissue
    ▪ Usually results in death
    ▪ If survival, there is scar tissue formation
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41
Q

What happens from subarachnoid hemorrhagic stroke?

A

Rupture of multiple aneurysms that develop within several cerebral arteries (circle of Willis)

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42
Q

What is an aneurysm?

A

Pouching of vascular wall

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43
Q

Where does subarachnoid hemorrhagic stroke go?

A

Goes into subarachnoid space (not cerebral tissue)

  • Does not result in death of neural tissue, just blood in the subarachnoid space
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44
Q

What is the etiology of subarachnoid hemorrhagic stroke?

A

Hypertension may be involved, but it is genetic

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45
Q

What is the way in which subarachnoid hemorrhagic strokes occur?

A

The middle layer of arteries are weakened and eventually leads to destruction of the elastic fibers and slow formation of pouching

  • usually occurs in bifurcations
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46
Q

When does a subarachnoid hemorrhage occur

A

Usually before 50 y.o.

47
Q

What are the 2 examples of subarachnoid hemorrhage?

A
  1. Berry aneurysm

2. Congenital giant aneurysm

48
Q

Aka of Berry Aneurysm :

A

Saccular Aneurysm

49
Q

What does Berry Aneurysm cause?

A

Papilledema

  • Berry A. Is most vulnerable to rupture (> 1cm)
50
Q

Congenital Giant Aneurysm aka

A

Giant Aneurysm

Diameter = > 1cm, up to 5 cm

51
Q

What are the symptoms of congenital Giant aneurysm ?

A

Similar to space occupying lesions (headache, papilledema, nausea, vomiting )

  • MUST BE REMOVED
52
Q

Aneurysms are most vulnerable to rupture between _____

A

4-7 mm

53
Q

CNS TRAUMA

A

NEW TOPIC

54
Q

What is the major factor of CNS trauma ?

A

Car accidents

55
Q

What is a hematoma?

A

Collection of blood outside of the vessels

56
Q

What are the 3 major categories of CNS trauma?

A
  1. Epidural hematoma
  2. Subdural Hematoma
  3. Brain Traumatic Injury (parenchyme)
57
Q

Know your layers ->

A

(Superficial to deep)

  • Dura mater
  • Arachnoid mater
  • Pia mater
58
Q

What is an epidural hematoma?

A

Normally no space between the skull and dura > in this case, arterial hemorrhage pushes against the dura and creates space at the expense of the cranial fossa

59
Q

What artery does blood leak from in an epidural hematoma?

A

Meninges arteries - middle meningeal artery

60
Q

Will you have increased hydrostatic P in epidural hematoma?

A

YES

  • Along with compression of brain tissue
61
Q

What swells during epidural hematoma?

A

Swelling of white matter - accumulation of fluid around axons

  • loss of brain function
  • prevents/diminishes neural activity
62
Q

What happens to the brain during Epidural Hematoma?

A

Shift of brain to the other side fo skull

  • Noncommunicating hydrocephalus is possible
63
Q

What are the types of Herniations that can occur during Epidural hematoma ? **

A
  1. Subfalcine Herniation
  2. Transtentorial (Uncal, uncinate) herniation
  3. Cerebellar Tonsilar Herniation
64
Q

What happens during Subfalcine herniation?

A
  • Compression of the anterior cerebral artery

- Compression of the cingulate gyrus against the fall Cerebri

65
Q

What results from a Transtentorial (Uncal, uncinate) herniation?

A

Compression of free margin of temporal lobe against tentorium cerebelli

66
Q

What gets compressed during Transtentorial (Uncal, uncinate) herniation ?

A

Compression of CN III =

Palsy of CN III **

67
Q

What are the results of Transtentorial (Uncal/uncinate) herniation?

A
  • Paralysis of sphincter papilla muscle responsible for narrowing pupil
  • Ipsilateral pupil dilation
  • Results in permanent dilation of pupil on the same side of herniation
68
Q

What is ipsilateral pupil dilation?

A

Mydriasis aka Blown Pupil

69
Q

What herniation is more serious, Subfalcine or Transtentorial?

A

Transtentorial

70
Q

What is the most serious herniation associated with Epidural hematoma?

A

Cerebellar Tonsilar Herniation

71
Q

What happens during Cerebellar Tonsilar Herniation ?

A

Herniations of cerebellar tonsils and brainstem into foramen magnum (can result in death)

72
Q

What gets compressed during Cerebellar Tonsilar herniation

A
  • Midbrain

- Cardiovascular and respiratory centers compressed = can lead to parathesis/ cardiopulmonary arrest

73
Q

What can cerebellar Tonsilar herniation lead to?

A

Secondary brainstem hemorrhage

  • aka duret hemorrhage
  • develops in pons
  • arterial hematoma
74
Q

What is a severe consequence of cerebellar Tonsilar herniation ?

A

Lost consciousness in 15-25 min and die within 45 min

75
Q

Where is the most dangerous place for an epidural hematoma?

A

Temporal bone

76
Q

Why is the temporal bone the most dangerous place for an epidural hematoma?

A

Middle meningeal artery (largest of meningeal arteries)

77
Q

What is the sequence of Epidural Hematoma?

A
  1. Trauma
  2. Break of skull
  3. Cuts meningeal A.
  4. Increases hydrostatic P.
  5. Convexity
  6. Swelling
  7. Death (highly likely)
78
Q

What is affected in Subdural hematoma?

A

Superior cerebral veins

79
Q

Aka of superior cerebral veins =

A

Bridging veins

  • carries blood from the brain to superior sagittal sinus to be drained: major blood collector of brain
80
Q

What does Subdural hematoma result from?

A

Results from rupture of bridging veins due to sudden change of head velocity

81
Q

What is the MOI in Subdural hematoma?

A

Trauma to head, law of inertia, the brain still has room to move when skull is impacted, creates tearing/shearing force

82
Q

What happens during a Subdural hematoma?

A

Leakage fo blood in Subdural space

  • venous hematoma
83
Q

What exactly happens with a Subdural hematoma, what causes damage?

A

Direct contact of blood with the brain - leads to dysfunction and atrophy of the brain tissue

84
Q

When will you see signs and symptoms for Subdural hematoma?

A

24-48 hours and a 2nd trauma could be fatal (why athletes who experience this trauma should continue playing)

85
Q

What are the 2 types of Subdural hematoma?

A
  1. Acute

2. Chronic

86
Q

What happens with acute Subdural hematoma?

A

Sudden change of head velocity that develops in the normal brain (normal people falling)

87
Q

What happens with Chronic Subdural hematoma?

A

Usually develops in elderly people with brain atrophy

  • typical with Alzheimer’s , Parkinson’s, and Huntington’s
88
Q

What are the things associated with brain traumatic parenchymal injury?

A
  • concussion
  • Diffuse Axonal injury
  • contusion
  • laceration (aka traumatic brain hemorrhage)
  • Basilar skull fracture
89
Q

What happens during a brain traumatic parenchymal injury?

A

Damage of brain in different degree and severity

  • MC cause of post traumatic dementia
90
Q

What is brain traumatic parenchymal injury associated with?

A

Concussion

91
Q

What is concussion clinical syndrome?

A

Characterized by immediate and transient loss of neurological function secondary to mechanical forces

92
Q

What is concussion characterized by?

A

2 factors: loss of consciousness and amnesia

93
Q

What is amnesia?

A

Temporary loss of memory of events prior to, during, and after they occur

94
Q

What system is affected with concussion associated with brain traumatic parenchymal injury ?

A

Reticular Activating System (temporary function loss of RAS with concussion)

  • Set of neurons which connect various parts of the brain with one another and negatively effected by trauma
95
Q

What is the most common cause of post traumatic dementia?

A

Diffuse Axonal injury

96
Q

What happens during diffuse Axonal injury ?

A

Elongation of white matter - stretching

  • may result in tear of white matter structures
97
Q

Where does diffuse Axonal injury normally occur?

A

In posterior portions of brainstem and cervical spine

98
Q

What is the MOI with diffuse Axonal injury?

A

Acceleration-deceleration trauma

(Car accident whiplash*)

  • Shaken baby syndrome
99
Q

What do you see within Diffuse Axonal injury?

A

Subinclusions found in area of axon tear, due to accumulation of proteins (micro tears in white matter), amyloid protein precursor-Axonal spheroids

  • aka AXONAL SWELLING
100
Q

What disease would you see with Diffuse Axonal injury ?

A

Alzheimer’s disease

101
Q

What happens with contusion?

A

Hemorrhage’s in the Superficial brain parenchyma caused by blunt trauma - anatomical damage to brain tissue

(More serious than concussion )

102
Q

What are the 2 types of contusions?

A

Coup and contra coup

103
Q

What is coup contusion characterized by?

A

Damage of brain underneath area of impact

  • mobile impact force on immobile head
104
Q

What is contra coup contusion characterized by?

A

Damage of brain on opposite side of impact

  • Mobile head runs into immobile object (person runs into wall)
105
Q

What is laceration aka

A

Traumatic brain hemorrhage

106
Q

What happens during laceration?

A

Tear of brain tissue (and therefore blood vessels)

** DONT CONFUSE WITH STROKE

107
Q

What are the 2 types of hemorrhage associate with laceration?

A
  1. Traumatic Subarachnoid hemorrhage

2. Intracerebral/parenchymal hemorrhage

108
Q

What happens during traumatic subarachnoid hemorrhage?

A

Leakage of blood in subarachnoid space as a result of trauma - develops in superficial areas

109
Q

What happens during intracerebral/parenchymal hemorrhage?

A

Leakage of blood in brain tissue as a result of trauma

110
Q

What happens with a basilar skull fracture?

A

Fracture of orbital plates of frontal bone or greater wing of sphenoid development of bilateral periorbital hemorrhage (bruising of both eyes) and rhinorrhea (runny nose for no reason)

  • Raccoon sign
111
Q

What are the 2 types of fracture associated with Basilar skull fracture?

A

Fracture of orbital plates of frontal bone or greater wing of sphenoid

Fracture of pyramid of temporal bone or anterior aspect of the occipital bone

112
Q

What happens during the 2nd type of fracture during basilar skull fracture?

A

Fracture of pyramid of temporal bone or anterior aspect of the occipital bone - development of battle sign (bruising behind ear)

  • leakage of CSF from ear > otorrhea
113
Q

What can happen as a result of basilar skull fracture?

A

Development of an infection of the CNS - antibiotics would be prescribed

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