Neuro Patho Flashcards by chioma Amako

One of the sensitive areas for hypoxia injury is?

Hippocampus

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

True

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

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

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What is this microscopic change?

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What is this microscopic change?

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

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What’s this image?

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What enzyme converts Hypoxanthine/xanthine to auric acid?

Xanthine Oxidase

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

True

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

Free Radicals (Superoxides)

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Left Middle Cerebral Arteries Infracts: Images

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Right Middle Cerebral Arteries Infract

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Anterior Cerebral Artery (ACA) infract

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Posterior Cerebral Artery Infarct(PCA)

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

67%; 33%

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

Intracerebral Hemorrhage
(adults develops Lobar hemorrhage)

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

subarachnoid Hemorrhage

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

Watershed Infract- Few Centimeters lateral to the inter hemispheric fissure

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Neurons which are most susceptible to ischemic injury?

CA1 pyramidal neurons of hippocampus

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Shrunken nuclei and eosinophilia cytoplasm lacking Nis bodies are characteristics of

Irreversible Ischemic Injury

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

TIA: Transient Ischemic Attack

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

Lobar Hemorrhage

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

Basal Ganglia hemorrhage

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

Ruptured Berry Aneurysm (Sacular aneurysm)

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Ruptured A-V malformation

SAH often in Children (aged 10-30years)

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Non-shunting vascular malformation (popcorn or mulberry appearance)

CNS cavernous hemangioma

Two types of types of Intracerebral Hemorrhage?

Lobar Hemorrhage and Ganglionic Hemorrhages

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

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

Complication of SAH (Non-traumatic Subarachnoid Hemorrhage)

Rebleeding Arterial Vasospasm Hydrocephalus Hyponatremia

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?

Secondary Normal Hydrocephalus

Aneurysmal subarachnoid Hemorrhage- Why does berry aneurysm develop?

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 3. Neurofibromatosis 1

Associated Conditions of Aneurysmal Subarachnoid Hemorrhage

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

Lecture question

Posterior Communicating Artery - 3rd nerve damage

What artery is Aneurysm most common?

Posterior Communicating Artery

**Hypertensive Brain Hemorrhage** Chronic hypertension —-> —————-of small penetrating arteries—-> ———- or formation of ———- and then rupture ( microaneurysms/Charcot Bouchard aneurysms); Hyaline arteriolosclerosis; Focal Damage)

Where is the common location for Hypertensive Brain Hemorrhage?

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 )

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

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

True

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

Multiple Infract Dementia (MID)

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

Hypertension Hyperlipidemia Diabetes Advanced age

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

Multiple Infract Dementia

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

Lobar; Ganglionic

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

Lobar Hemorrhage

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

Ganglionic Hemorrhaged

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?

Arteriorvenous Malformation

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

Cavervenous Malformations (CMs)

Gross: Popcorn or mulberry appearance with engorged purplish clusters

Cavernous Malformation

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

Cavernous Malformations

What are the watershed areas?

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

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

Stroke

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.

Watershed Stroke

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

Watershed Stroke

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

Global Cerebral Ischemia

What type of stroke is this?

Global Cerebral Ischemia

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

Ischemic Stoke -Clinical Sequelae and Radiologic Features

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

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

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

Which neurotransmitter is responsible for Ischemic Stroke?

Glutamate

Type of edema that first develop in ischemia stroke is?

Cytotoxic Edema

Cascade of Cerebral Ischemia

Timeline for a brain infract based on gross and microscopic changes

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.

TIA -transient Ischemic Attack .

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?

Lacunar infaract

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

Subarachnoid hemorrhage

Socrative