Neuro 70: Pathology of cerebral vasc disease

Question 1

How does the healing of a cerebral infarct differ from an infarct that occurs elsewhere in the body?

Answer 1

• cerebral infacts do not result in collagenous scars
• instead the necrotic issue is removed –> cavity is left behind
• the cavity is surrounded by gliosis

Question 2

What is the most common dirrect cause of death following a stroke?

Answer 2

• herniation of the brainstem
• during the first several days after an infarct there is swelling due to edema that can cause compression or herniation of important structures
• *so initial tx of stroke is to reduce this swelling!

Question 3

What are 4 factors that can contribute to a pt having an infarction?

Answer 3

1. decreased oxygen of the blood - Hbopathy, hypoxia
2. decreased perfusion - hypotension, stasis, increased intracranial P
   - could also be from carotid stenosis –> dont need total occlusion to get and infarct!
3. hypercoaguable state - pregnancy, oral contraceptives, antiphospholipid antibody syndrome
4. HTN

Question 4

Histology of an acute cerebral infarct

Answer 4

• nuclei will have ground glass appearence
• cytoplasm shrinks
• cell becomes esinophilic
• nackground becomes vacuole-ated & fluffy looking = edema

Question 5

Histology of the early organization following an acute infarct

Answer 5

• see lots of macrophages that come in from the peripheral blood
• see endothelial cells begin to grow in the damaged areas

Question 6

What is seen 4 days after a cerebellar infarct

Answer 6

• the affected area is well demarcated

- the defective area is swollen and fragile –> begins to fall appart and crack

Question 7

What is see 2-3 weeks histologically after an acute cerebellar infarct

Answer 7

• sea of macriohages that fill up the area where the brain tissue was previously
• see neovascularization and capillaries

Question 8

What is seen in the early cavitation stage of healing from an acute infarct?

Answer 8

• about 2 mnths after the infarct
• macrophages begin to leave
• the infarcted area begins to collapse, leaving behind the neovascularzation –> see lots of tiny vessels

Question 9

What is left 3 weeks after an acute infarct has been healing?

Answer 9

• there is a cavity with thin-walled blood vessels within it
• trabecular looking

Question 10

3 most common locations for primary thrombosic occlusions to occur?

Answer 10

1. Basilar a.
2. Vertebral a.
3. Internal carotid a.

Question 11

3 most common locations for embolic occlusions?

Answer 11

1. Middle cerebral artery –> sort of like a continuation of the internal carotid, so thats why a lot of emboli will end up here!
2. Anterior cerebral artery
3. Posterior cerebral artery

Question 12

What makes the lenticulostriate arteries more vulnerabel to infarcts?

Answer 12

-b/c they are skinny vessels that come off at right angles !

Question 13

Lacunar infarcts

Answer 13

• typcially seen in pts with HTN
• the compensation to normotension will cause distal areas to become ischemic –> causes tiny infarcts
• there can be early swelling around these lesions that causes the compression and dysfunction of the surrounding tissue –> so the sx can be more severe than expeted
• recovery is uaully good and the sx often go away after 3mnths when the swelling reduces

Question 14

Granular atrophy

Answer 14

• secondary to multiple small infarcts that are the result of poor profusion to distal vasculature
• seen in pts with poor control of their HTN

Question 15

Leukoaraiosis

Answer 15

• areas in the white matter of decreased density
• shows up on CT as an UBO (unidentified bright object)
• associated HTN
• can cause cognitive impairment

Question 16

HTN

Answer 16

• most important cause of both infarction and spontaneous hemorrhage
• causes both atherosclerosis and changes in smaller vessels of the brain

Question 17

MIliary microaneurysms

Answer 17

• AKA Charcot-Bouchard aneurysms
• microscopic swellings of the small perforating arteries in the brain
• usually seen in HTN pts –> but occassionally in normotensive elderly pts
• the rupture of these small vessels can cause HTN intracerebral hemorrhages
• most commonly seen in lenticulostirate arteries
• the hemorrhages are seen (in decreaseing order) in the deep grey matter –> pons –> cerebellum –> and a few in the cerebral hemispheres

Question 18

Infarct v. hemorrhage: TIA hx

Answer 18

• Infarct = hx of TIA

- hemorrhage = NO hx of TIA

Question 19

Onset of infarct v. hemorrhage

Answer 19

• infarct = onset @ rest

- hemorrhage = onset during activity

Question 20

Pain w/ infarct v. hemorrhage?

Answer 20

• infarct = minimal discomfort

- hemorrhage = headache (often severe)

Question 21

Deficits w/ infarct v. hemorrhage?

Answer 21

• infarct = sudden onset of focal deficit w/out change in consciousness or mental status
• hemorrhage = rapidly evolving neurological deficit w/ altered mental status/conciousness

Question 22

HTN and infarct v. hemorrhage?

Answer 22

• infarct = moderate HTN (occasionally normotensive)

- hemorrhage = severe HTN (occasionally moderate)

Question 23

CSF in infarct v. hemorrhage?

Answer 23

• infarct = clear

- hemorrhage = bloody

Question 24

Amyloid angiopathy

Answer 24

• amyloid deposits in the walls of the vessels in the CNS

- use congo red stain or polarized light to see the amyloid material

Question 25

Duret Hemorrhages

Answer 25

• hemorrhages in the ventral and paramediam portions of the midbrain and the pons
• associated with brainstem herniation & raised ICP
• can be caused by acute hematoma

Question 26

Where are berry aneurysms typically seen? + what do they typically have associated with them?

Answer 26

• in the branch points of arteries
• usually in the anterior portion of the circulation
• AKA saccular or congenital aneurysms
• polycystic kidney is usually associated!!!

Question 27

What is the most common cause of spontaneous (non-traumatic) subarachnoid hemorrhage?

Answer 27

-rupture of a berry aneurysm