Neuropathology of Cerebrovascular Disease

Question 1

What is the source of anterior flow in the brain?

Answer 1

Internal Carotid ~70% of CBF

Question 2

What is the source of posterior flow in the brain?

Answer 2

Vertebral Arteries 30% of CBF

Question 3

What is the order of cells in the CNS from most to least sensitive to ischemia?

Answer 3

neurons > oligodendrocytes > endothelial cells > astrocytes

Question 4

What changes appear 6-12 hours after global cerebral ischemia?

Answer 4

Red Neurons

Question 5

What are areas that are very vulnerable to ischemia?

Answer 5

-􏰀 Pyramidal neurons in cerebral cortex (layers 3, 5 and 6) – leads to LAMINAR NECROSIS
-􏰀 Pyramidal neurons of hippocampus (long term memory)
􏰀- Purkinje cells of cerebellum

Question 6

What artery feeds the lateral areas of the brain?

Answer 6

MCA

Question 7

What artery feeds the superio-medial area of the brain?

Answer 7

ACA

Question 8

What artery feeds the inferio-medial area of the brain?

Answer 8

PCA

Question 9

What are the main causes of small vessel disease in the CNS?

Answer 9

• HTN
• Diabetes
• Vasculitis

Question 10

What is the cause of thrombotic strokes?

Answer 10

Rupture of atherosclerotic plaque

Question 11

What is the cause of embolic strokes?

Answer 11

Cardioembolism often from atrial fibrillation

Question 12

What vessels does lacunar stroke affect?

Answer 12

Lenticulostriate Vessels

Question 13

What is the most common artery involved in embolic infarct?

Answer 13

MCA

Question 14

What can be seen with lacunar strokes?

Answer 14

Arterial Hyalinosis from Hyaline Arteriolosclerosis as a result of HTN

Question 15

Hypertensive Hemorrhage

Answer 15

‐ Circumscribed hematoma surrounded by brain tissue

‐ Hemorrhage may extend into the subarachnoid space or to the ventricles

Question 16

Subarachnoid Hemorrhage

Answer 16

Bleeding into subarachnoid space

Question 17

What is the most common cause of subarachnoid hemorrhage?

Answer 17

Berry Aneurysm

Question 18

What are the associations of Berry aneurysms?

Answer 18

• Female
• AD Polycystic Kidney Disease
• Ehrler-Danos
• Marfan’s Syndrome

Question 19

Where are most Berry aneurysms found?

Answer 19

Anterior Communicating Artery in the Circle of Willis

Question 20

Intraventricular Hemorrhage

Answer 20

Rare in adults but common in premature infants with massive intraventricular hemorrhages being instantaneously fatal

Question 21

Duret Hemorrhage

Answer 21

They are small lineal areas of bleeding in the midbrain and upper pons of the brainstem. They are caused by a traumatic downward displacement of the brainstem.

Question 22

Epidural Hematoma

Answer 22

Blood between dura and the skull - often due to rupture of the middle meningeal artery

Question 23

Subdural Hematoma

Answer 23

Blood underneath the dura covering brain surface - due to tearing of bridging veins

Question 24

What can tonsillar herniation lead to the compression of?

Answer 24

Compression of the brainstem which can lead to cardiopulmonary arrest

Question 25

What can subfalcine herniation lead to the compression of?

Answer 25

Compression of ACA leads to infarction

Question 26

What can uncal herniation lead to the compression of?

Answer 26

• CN III - eye will go down and out and dilate
• PCA which causes occipital lobe infarction
• Rupture of the paramedian arteries leading to Duret hemorrhages

Question 27

Tonsillar Herniation

Answer 27

Downward displacement of cerebellar tonsils into foramen magnum

Question 28

Subfalcine Herniation

Answer 28

Displacement of the cingulate gyrus under falx cerebri

Question 29

Uncal Herniation

Answer 29

Displacement of the uncus of the temporal lobe under the tentorium cerebelli