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Pathoma LAH > Neuro: 17.4: Cerebrovascular Disease > Flashcards

Neuro: 17.4: Cerebrovascular Disease Flashcards

1
Q

Why are Berry aneurisms susceptible to rupture?

A

they lack a media layer

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2
Q

What is the most common site of an intracerebral hemorrhage?

A

the basal ganglia

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3
Q

Name 3 ways that an ischemic stroke can develop.

A
  1. thrombus
  2. embolus
  3. lacunar
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4
Q

Name 3 highly vulnerable areas of the brain because of their location in a watershed area.

A
  1. pyramidal neurons of cortex layers 3,5, and 6
  2. pyramidal neurons of the hippocampus
  3. purkinje layer of the cerebellum
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5
Q

Which race has an increased risk of Berry aneurisms?

A

blacks

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6
Q

What happens in severe global cerebral ischemia? What is the outcome?

A
  • diffuse necrosis of the brain
  • death or a chronic vegetative state
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7
Q

What is a Berry aneurism?

A

a thin-walled, saccular out pouching of a BV that lacks a media layer

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8
Q

Dx?

  • a bleed on the bottom of the brain
A

a subarachnoid hemorrhage

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9
Q

Which BV feeds the surface of the cerebral cortex?

A

the middle cerebral artery

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10
Q

How does an intracerebral hemorrhage present?

A
  • HA
  • n/v
  • coma
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11
Q

What will a lumbar puncture show in subarachnoid hemorrhage?

A

xanthochromia

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12
Q

From which artery do the lenticulostriate vessels branch off of?

A

the middle cerebral artery

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13
Q

What is Hemiballismus?

A
  • a mvmt disorder characterized by a sudden, wild flailing of 1 arm +/- the ipsilateral leg
  • *** “Half of body ballistic”
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14
Q

Where do atherosclerotic plaques usually develop?

A

at arterial branch points

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15
Q

What is another name for a Berry aneurism?

A

Saccular aneurism

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16
Q

What is a subarachnoid hemorrhage?

A

bleeding into the subarachnoid space

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17
Q

If the focal neurologic deficits last less than 24 hours, then it’s called a _________.

A

transient ischemic attack (TIA)

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18
Q

Why does an embolic stroke cause hemorrhagic infarcts, but a thrombotic stroke causes a pale infarct?

A
  • embolus can be lysed by body –> blood returns
  • thrombus can’t be lysed –> pallor
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19
Q

Where do lacunar strokes most often occur?

A

in the lenticulostriate vessels of the deep brain

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20
Q

What causes intracerebral hemorrhage?

A

rupture of Charcot-Bouchard microaneurisms

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21
Q

Where do Berry aneurisms most frequently occur?

A

in the anterior Circle of Willis (branch points of the anterior communicating artery)

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22
Q

What are horizontal lines of necrosis in the brain cortex layers called?

A

cortical laminar necrosis

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23
Q

What are the macrophages of the brain?

A

microglia

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24
Q

This is a thin-walled, saccular out pouching of a BV that lacks a media layer.

A

a Berry aneurism

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25
What happens microscopically from time 0 up to 1 day post-ischemic event?
red neurons present
26
How long can neurons survive ischemia before undergoing necrosis?
3-5 mins
27
Which BV feeds the deep structures of the brain, including the basal ganglia?
the lenticulostriate vessels
28
If the focal neurologic deficits last more than 24 hours, then it's called a \_\_\_\_\_\_\_\_\_.
ischemic stroke
29
What does gliosis refer to?
reactive astrocytes lining the cystic space with CT
30
Which conditions are Berry aneurisms associated with?
* Marfans * ADPKD * Ehlers-Danlos * coarctation of the aorta
31
What is intracerebral hemorrhage?
bleeding into the brain parenchyma
32
What is a Charcot-Bouchard microaneurism? How do they occur?
* microaneurisms of the lenticulostriate vessels * HTN --\> hyaline arteriosclerosis --\> weakening of BV wall
33
Name 4 general causes (and their underlying pathology) resulting in global cerebral ischemia.
1. low perfusion (atherosclerosis) 2. acute decrease in blood flow (shock) 3. chronic hypoxia (anemia) 4. repeated episodes of hypoglycemia (insulinoma)
34
Where does a thromboembolus causing an ischemic stroke most commonly occur in the brain?
the middle cerebral artery
35
How does a subarachnoid hemorrhage present?
* a sudden headache ("the worse HA of my life") * nuchal rigidity
36
What happens in moderate global cerebral ischemia? What is the outcome? Give an example.
* infarcts to watershed areas * damage to highly vulnerable regions * ex: pyramidal neurons of cortex layers 3,5, and 6
37
Dx? * a bleed in the parenchyma of the brain
an intracerebral hemorrhage
38
What happens microscopically from time 1 day up to 1 week post-ischemic event?
inflammatory cells present (neutrophils, microglial cells)
39
What does a lacunar stroke involve?
the small BVs in the brain that undergo hyaline arteriolosclerosis
40
Intracerebral hemorrhage is a complication of \_\_\_\_\_.
HTN
41
What lesions characteristically causes Hemiballismus?
a lesion of the contralateral subthalamic nucleus (eg, lacunar stroke)
42
What happens to the BVs in hyaline arteriolosclerosis?
the lumen is narrowed by fibrosis
43
What is xanthochromia? What causes it?
* a yellow tinge to the CSF in a lumbar puncture * bilirubin breakdown products
44
Where is the hippocampus located? What is its function?
* in the temporal lobe * to transfer info to long-term memory
45
What is a mvmt disorder characterized by sudden, wild flailing of 1 arm +/- the ipsilateral leg?
Hemiballismus
46
The rupture of Charcot-Bouchard microaneurisms causes \_\_\_\_\_\_.
intracerebral hemorrhage
47
A lesion of the contralateral subthalamic nucleus (eg, lacunar stroke) causes what movement disorder?
Hemiballismus
48
What will the ischemic infarction look like due to embolus?
a hemorrhagic infarct in the periphery of the cortex
49
What is the most common source of a thromboembolus causing an ischemic infarct in the brain?
the L heart (A-fib)
50
What happens microscopically from time 1 week to 1 month post-ischemic event?
granulation-like tissue --\> cystic space formation with gliosis and astrocytes
51
What will the ischemic infarction look like due to thrombosis?
a pale infarct in the periphery of the cortex
52
What is the end result of liquefactive necrosis in the brain?
a fluid-filled cystic space surrounded by gliosis
53
What are the 2 major causes of cerebrovascular disease? Which is more common?
1. more common = ischemia 2. hemorrhage
54
What happens in mild global cerebral ischemia? What is the outcome? Give an example.
* transient confusion * complete recovery * ex: an insulinoma
55
What is a watershed area of circulation?
an area fed by the very end of a circulation
56
What are the 3 layers of a BV wall?
* intima (inner) * media (middle) * adventitia (outer)
57
What are the 2 types of ischemic cerebrovascular disease that can occur?
1. focal 2. global
58
What are the 2 types of hemorrhagic cerebrovascular disease that can occur?
1. intracerebral 2. subarachnoid
59
What is cortical laminar necrosis?
horizontal lines of necrosis in the brain cortex layers
60
What causes hyaline arteriolosclerosis?
* HTN * diabetes
61
What is one of the earliest findings on microscopy of an ischemic stroke? When does this present?
* red neurons * 12 hours post-event
62
What is the most common cause of a subarachnoid hemorrhage?
rupture of a Berry aneurism
63
What kind of necrosis is seen in an ischemic stroke?
liquefactive

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