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cAS3 > Neuro Patho > Flashcards

Neuro Patho Flashcards

1
Q

One of the sensitive areas for hypoxia injury is?

A

Hippocampus

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2
Q

True or False: Vasogenic edema is from the loss of the blood brain barrier with ischemic injury

A

True

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3
Q

Brain Infract: Day 1(Macrophage/Red neurons/liquefactive), Week 1(Macrophage/Red neurons/liquefactive), 1month (Macrophage/Red neurons/liquefactive)

A

Day1: Red Neuron, 1week: Macrophage, 1month: Liquifactive

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4
Q

What is this microscopic change?

A
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5
Q

What is this microscopic change?

A

Foamy Macrophages at the right which are cleaning up the lipid debris from the liquefactive necrosis

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6
Q

What’s this image?

A
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7
Q

What enzyme converts Hypoxanthine/xanthine to auric acid?

A

Xanthine Oxidase

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8
Q

True or false: Hupoxanthine and Xanthine begins to accumulate in the cell in the absence of Oxygen or Low Oxygen (Hypoxia)?

A

True

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9
Q

In the presence of Oxygen, Hypoxanthine and Xanthine are converted into Uric acids- what another product does this process form?

A

Free Radicals (Superoxides)

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10
Q

Left Middle Cerebral Arteries Infracts: Images

A
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11
Q

Right Middle Cerebral Arteries Infract

A
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12
Q

Anterior Cerebral Artery (ACA) infract

A
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13
Q

Posterior Cerebral Artery Infarct(PCA)

A
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14
Q

Intracerebral hemorrhage accounts for ———-percentage of hemorrhagic strokes; Subarachnoid hemorrhage accounts for ——-hemorrhagic strokes?

A

67%; 33%

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15
Q

———results from Hypertension (most common) Cerebral Amyloid Angiopathy (elderly); Ruptured Antreriovenus malformations (A-V) in Children?

A

Intracerebral Hemorrhage
(adults develops Lobar hemorrhage)

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16
Q

———- results from ruptured Berry Aneurysm (in adults) Ruptured Anteriovenous (A-V) Malfunction in Children

A

subarachnoid Hemorrhage

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17
Q

What Infract Zone between ACA-MCA distribution is at greatest risk?

A

Watershed Infract- Few Centimeters lateral to the inter hemispheric fissure

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18
Q

Neurons which are most susceptible to ischemic injury?

A

CA1 pyramidal neurons of hippocampus

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19
Q

Shrunken nuclei and eosinophilia cytoplasm lacking Nis bodies are characteristics of

A

Irreversible Ischemic Injury

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20
Q

Temporary, focal cerebral ischemia that results neurologic deficits lasting <24 (usually < 1hr) hint: Aunt in Spanish

A

TIA: Transient Ischemic Attack

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21
Q

Spontaneous ICH (Intracerebral hemorrhage) in elderly due to cerebral amyloid angiopathy

A

Lobar Hemorrhage

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22
Q

What type of hemorrhage damages and weakens the small penetrating arteries due to chronic hypertension?

A

Basal Ganglia hemorrhage

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23
Q

What rupture causes subarachnoid Hemorrhage in adults with complaints “Worst headache of my life” (Severe headache)

A

Ruptured Berry Aneurysm (Sacular aneurysm)

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24
Q

Ruptured A-V malformation

A

SAH often in Children (aged 10-30years)

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25
Q

Non-shunting vascular malformation (popcorn or mulberry appearance)

A

CNS cavernous hemangioma

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26
Q

Two types of types of Intracerebral Hemorrhage?

A

Lobar Hemorrhage and Ganglionic Hemorrhages

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27
Q

Most common cause of Non-traumatic Subarachnoid Hemorrhage characterized with excruciating headaches, loss of consciousness, neck stiffness and vomiting, absence of focal neurological symptoms?

A

Rupture of a Saccular aneurysm aka Ruptured Berry Aneurysm (in adult), F:M= 3:2; Fifth decade of life

A-V Malfunction in Children

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28
Q

Complication of SAH (Non-traumatic Subarachnoid Hemorrhage)

A

Rebleeding
Arterial Vasospasm
Hydrocephalus
Hyponatremia

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29
Q

43 y/o male presents to the emergency department with urinary incontinence, dementia, gait instability, suffers Subarachnoid hemorrhage 10years ago what type of hydrocephalus is this?

A

Secondary Normal Hydrocephalus

30
Q

Aneurysmal subarachnoid Hemorrhage- Why does berry aneurysm develop?

A

Development is due to weakness in the arterial wall- lacks an internal laminate and thin media

Associated conditions of SAH
1. Autosomal dominant (polycystic kidney)
2. Connective tissue disorders:
- Ehler- Danlos syndrome
- Marfan syndrome

  1. Neurofibromatosis 1
31
Q

Associated Conditions of Aneurysmal Subarachnoid Hemorrhage

A
  1. autosomal Dominant polycystic Kidney
  2. Connective tissues disorders
    - Ehlers- Danlos Syndrome
    -Marfan Syndrome
  3. Neurofibromatosis 1
32
Q

Lecture question

A

Posterior Communicating Artery - 3rd nerve damage

33
Q

What artery is Aneurysm most common?

A

Posterior Communicating Artery

34
Q

Hypertensive Brain Hemorrhage
Chronic hypertension —-> —————-of small penetrating arteries—-> ———- or formation of ———- and then rupture

( microaneurysms/Charcot Bouchard aneurysms); Hyaline arteriolosclerosis; Focal Damage)

A
35
Q

Where is the common location for Hypertensive Brain Hemorrhage?

A

Basal Ganglia- Putamen or Caudate (Lenticulostriate arteries, branches of MCA)

Others:
Thalamus - (Thamogeniculate arteries branches of PCA
Pons- (paramedian branches of Basilar artery)
Cerebellum (penetrating branches of PICA, AICA, and SCA )

36
Q

——- is the most common site of hypertensive Intracerebral Hemorrhage (ICH) 80%

A
37
Q

Lower hemorrhage can extend to subarachnoid hemorrhage and ganglionic to Intraventricular hemorrhage (True or False)

A

True

38
Q

A SMALL VESSEL disease, common cause of memory loss in elderly

A

Multiple Infract Dementia (MID)

39
Q

What are the risk factors of MID (Multi-infarct Dementia)

A

Hypertension
Hyperlipidemia
Diabetes
Advanced age

40
Q

What disease?
-progressive headache, nausea, vomiting
- non-localizing neurologic symptoms (confusion and short-term memory loss)
- dementia, gait abnormalities, pseudobulbar signs
-STEPwise progression

A

Multiple Infract Dementia

41
Q

Can extend into Subarachnoid space ———(Ganglionic/ Lobar Hemorrhages) can extend into ventricular system (Ganglionic/ Lobar Hemorrhages)

A

Lobar; Ganglionic

42
Q

Seen in elderly > 60years, cerebral amyloid angiopathy, location (Occupital: hemianopsia, Lt temporal: Aphasia and Delirium, Parietal: Hemisensory loss, frontal: Arm weakness)

Recurrent and may extend to subarachnoid space

A

Lobar Hemorrhage

43
Q

Damages and weakens the small penetrating arteries (e.g Charcot Bouchard aneurysm rupture due to chronic hypertension), located in deep brain structure ( Basal ganglia) may extend into ventricular system

A

Ganglionic Hemorrhaged

44
Q

Cluster of dilated vessels (bag of worms), M>F, 10-30yrs, location: usually supratentorial, presents: seizure, focal neurologic deficit, hemorrhage (ICH/SAH), territory of MCA and PCA, congestive heart failure (CHF)in Children… WHAT MALFOMATION IN THE BRAIN IS THIS?

A

Arteriorvenous Malformation

45
Q

Also known as CNS Cavernous hemangioma, mean age 30 to 40 years, caused by NON-shunting vascular malformation in the brain and spinal cord; common location: Cerebrum at supratentorial compartment. Clinical Presentations: Intrecerebral hemorrhage, SEIZURES, and progressive neurologic deficits, pons and cerebellum hemorrhage and progressive neurologic deficits

A

Cavervenous Malformations (CMs)

46
Q

Gross: Popcorn or mulberry appearance with engorged purplish clusters

A

Cavernous Malformation

47
Q

Microscopic: Dilated Capillaries with an endothelial lining and thin adventurism (no elastic fibers or smooth muscle). usually no intervening brain tissue between the channels of lesion

A

Cavernous Malformations

48
Q

What are the watershed areas?

A

Areas that receive dual blood supply from the branching ends of two large arteries- they are vulnerable to ischemic injury due to their reduced blood supply

49
Q

Ranks No. 5 among all causes of fealty in the U.S?

A

Stroke

50
Q

Systemic hypoperfusion (e.g Cardiac arrest, severe hypotension) results in ——— , this infarct is located between areas supplied by the ACA, MCA, PCA because of low baseline perfusion.

A

Watershed Stroke

51
Q

Zone between the anterior and middle cerebral artery distribution is at greatest risk of ———— few centimeters lateral to the inter hemispheric fissure

A

Watershed Stroke

52
Q

A decrease in cerebral blood flow to zero which causes death of brain tissue within 4-10mins

A

Global Cerebral Ischemia

53
Q

What type of stroke is this?

A

Global Cerebral Ischemia

54
Q

Distinguish embolus and thrombotic stokes in terms of etiology, morphology, radiologic features, clinical sequalae and treatment

A
55
Q

Ischemic Stoke -Clinical Sequelae and Radiologic Features

A
56
Q

The ischemic but reversible dysfunctional tissue surrounding a core area of infraction

A

Ischemic Penumbra and saving the ischemic penumbra is the GOAL of Revascularization therapies. IV rtPA is approved in the 3-4.5hrs widow in Europe and Canada but is still only approved 0-3hrs in the U.S.

Occlusion of MCA, intracranial ICA, and basilar artery often fail to open with IV rtPA alone, ENDOVASCULAR STROKE THERAPY is proven to be effective

57
Q

Indication and contraindication for intravenous Reombinant Tissue Plamingogen Activator (RtPA) for Acute Ischemic Stroke (AIS)

A
58
Q

Which neurotransmitter is responsible for Ischemic Stroke?

A

Glutamate

59
Q

Type of edema that first develop in ischemia stroke is?

A

Cytotoxic Edema

60
Q

Cascade of Cerebral Ischemia

A
61
Q

Timeline for a brain infract based on gross and microscopic changes

A
62
Q

A 90 year old woman attends the Clinic following an episode o weakness that affects her right side; she is unable to stand or use her arm. She is quite and worries that the symptoms may return. On questioning, the episode seems to have lasted around 4 hrs.

A

TIA -transient Ischemic Attack .

63
Q

A 72 year old diabetic woman with renal disease admitted to the emergency department with a high hemipanesis affecting he’s right arm and leg; sensation is normal on the right and left what type of infarct is this?

A

Lacunar infaract

64
Q

A 54 year old man presents with onset of severe headache. On examination you notice a neck stiffness and lumbar puncture is performed which reveals a yellow colored supernatant after centrifugation of the CSF

A

Subarachnoid hemorrhage

65
Q

Socrative

A

Abusive head injury

66
Q

Socrative

A

Concussion

67
Q

Socrative

A

Inferior frontal lobe

68
Q

Socrative

A

Subdural

69
Q

Socrative

A

Left MCA

70
Q

Socrative questions

A

C. Subarachnoid hemorrhage

71
Q

Socrative

A

A. shock

72
Q

Socrative question

A

D- Charcot-Bouchard Aneurysm

cAS3 (17 decks)

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