NeuroPatho of Vascular Disease Flashcards
are more strokes ischemic or hemorrhagic?
ischemic is 80%`
are neurons or glial cells more susceptible to ischemic injury?
neurons…use more oxygen
what cells of cerbellum are most sensitive to infarct?
purkinje cells
name three areas of brain that are stroke vulnerable
hippocampus
neocortex
watershed regions
how long till stroke visible on CT?
6-8 hours
what are initial changes seen on CT with stroke?
blurring of gray and white matter lines
in 1-2 days post stroke what can be seen on CT?
congestion and discoloration of gray matter
over time what occurs weeks following stroke?
cavitation due to necrosis and no neuron replacement in brain
when is max swelling impact following stroke seen?
2-7 days post event with max at 7 days
at 12-24 hours post stroke, how do neurons appear?
eosinophilic cytoplasm with pyknotic nuclei
what cell starts to come into ischemic area at 1-3 days post stroke?
neutrophils start necrosis
3-5 days post stroke what type of cell do we have a lot of?
macrophages
at 1-2 weeks post stroke what cell is around?
lots of astrocytes and microglia
what appears at site of ischemia more than 2 weeks post stroke?
glial scar
what is focal ischemia of a deep penetrating vessel called?
lacunar infarct
what regions are commonly an issue with global ischemia?
watershed regions
what is difference in focal and global ischemia?
global is whole brain losing flow…like hypotension
focal is blockage of a specific vessel…thromboembolic
what is a drug that causes brain hemorrhage?
cocaine
what is most common cause of acute non traumatic intracerebral hemorrhage?
hypertension
what two vessels does acute hypertensive hemorrhage clasically occur in?
lenticulostriate branches of MCA and pontine perforators of the basilar
pontine and cerebellar hemorrhages are associated with compression of what?
the brainstem
where are lacunar infarcts located? what two things are here?
in deep cerebral nuclei…globus pallidus and putamen
what leads to infarcts being cut out in lacunar infarcts?
liquefactive necrosis
what is the most common cause of a subarachnoid hemorrhage?
ruptured berry aneurysms
what does gross brain look like in subarachnoid hemorrhage?
between arachnoid and pia so entire surface of brain red as is the sulci
where do berry aneurysms occur?
circle of willis
are more berry aneurysms found in anterior or posterior circulation of circle of willis?
much more in anterior
what portions of the circle of willis commonly allow formation of berrys?
junctions of vessels
what is special about vessel junctions that allow for berry aneurysms to form?
no media in blood vessel to prevent outpouching
what are three layers of blood vessel? which is not present in berry aneurysm?
adventitia (outside)
media
internal elastica (inside)
what are risk factors for berry aneurysms rupture?
HTN, cigs, cocaine, alcohol
what type of disorders are berry aneurysms associated with?
connective tissue disorders like ehler danlos
what can a subarachnoid hemorrhage lead to following the hemorrhage? when does it occur?
5-10 days after hemorrhage can have secondary vasospasm leading to ischemia
what is an arteriovenous malformation?
connection of artery and vein without intervening capillary
what is risk with arteriovenous malformation?
rupture into brain or subarachnoid
what is Rx for arteriovenous malformation?
embolize and surgical resection
what is a cavernous angioma?
tumor composed of small thin walled vessels
name two risk with cavernous angioma
seizure and rupture
what happens in giant cell arteritis?
pan arteritis with giant cells formin granulomas in the vessles
what vessel is common in giant cell arteritis?
temporal artery
what is Rx for giant cell arteritis?
steroids
what is change seen in primary angiitis of CNS?
focal segmental granulomatous change
what vessels seen in primary angiitis of CNS?
medium sized and small vessels of the leptomeninges and superficial cortex
what does polyarteritis nodosa cause in CNS?
focal segmental inflamm with neutros and then necrosis
