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MHD- Neuro > Neuropathy of Cerebrovascular Disease > Flashcards

Neuropathy of Cerebrovascular Disease Flashcards

1
Q

What is the oxygen reserve capacity of the brain?

A

NONE-ZO.

NO BLOOD U DED (after 6-8 minutes)

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2
Q

Put the following cells in order of their sensitivity to ischemia: astrocytes, oligodendrocytes, neurons, endothelial cells

A

Neurons > oligodendrocytes > endothelial cells, astrocytes

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3
Q

Which neurons are particularly susceptible to ischemic damage?

A

Pyramidal cells in the CA1 region of the hippocampus

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4
Q

Which cells in the cerebellum are particularly susceptible to ischemic damage?

A

Purkinje cells

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5
Q

What is the definition of a stroke?

A

Abrupt onset of focal or global neurological symptoms caused by ischemia or hemorrhage

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6
Q

What are the two types of cerebrovascular disease?

A

Cerebral ischema: 85% (can be global or focal)

Intracranial hemorrhage: 15%

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7
Q

What causes an intraparenchymal hemorrhage?

A

HTN, amyloid

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8
Q

What causes a subarachnoid hemorrhage?

A

Saccular aneurysms, AVM

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9
Q

Name 4 causes of global cerebral ischemia

A

1) Low perfusion (due to atherosclerosis)
2) Acute decrease in blood flow (cardiogenic shock)
3) Chronic hypoxia (anemia)
4) Repeated episodes of hypoglycemia (insulinoma)

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10
Q

What are the consequences of mild global ischemia?

A

No permanent damage

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11
Q

What are the consequences of severe global ischemia?

A

diffuse damage –> vegetative state

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12
Q

What are the consequences of moderate global ischemia?

A

Damage to watershed areas and selectively vulnerable regions

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13
Q

What microscopic changes occur in the first 6 hours of ischemia to the brain?

A

None

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14
Q

When do “red dead neurons” appear following infarction and what are their characteristics?

A

Cytoplasmic eosinophilia
Loss of Nissl substance
Dark pyknotic nuclei

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15
Q

What is laminar necrosis?

A

Selective vulnerability of the pyramidal neurons of layers 3 and 5 leads to laminar necrosis (specific layers of the cortex die)

This only occurs if the patient survives longer than 3 days…

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16
Q

In adult brains, big neurons, neurons in cortical layers 3 and 5, CA1 of the hippocampus and purkinje cells of the cerebellum are selectively vulnerable to ischemic damage. Which cells are vulnerable in the infant brain?

A

Subiculum, thalamus, and pontine nuclei

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17
Q

WHat is the most common cause of thrombotic focal ischemia in the brain?

A

atherosclerosis

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18
Q

Where does atherosclerotic plaque build up/rupture most often occur in the brain?

A

The junction of the bifurcation of the internal carotid arteries and the MCA

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19
Q

WHat is the most common cause of embolisms to the brain?

A

Cardioembolic- atrial fibrillation is the most common cause

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20
Q

Where in the vasculature do cardioembolic plaques tend to lodge?

A

The MCA

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21
Q

Name three small vessel diseases that can affect the brain

A

Diabetes, atherosclerosis, vascultits

22
Q

Infarction of which arteries leads to lacunar strokes?

A

Lenticulostriate vessels

23
Q

Ischemia to the internal capsule leads to what type of stroke (as in what type of information is disrupted)

A

Pure motor stroke

24
Q

Ischemia to the thalamus leads to what type of stroke (as in what type of information is disrupted)?

A

Pure sensory stroke

25
Q

Following ischemic damage in the MCA territory of the brain, dominant hemisphere infarct and non-dominant infarct are associated with different symptoms. Differentiate between dominant and non-dominant hemispheric symptoms.

A

Dominant hemisphere infarct is often associated expressive aphasia (inability to produce language) whereas non-dominant infarct is associated with neglect syndrome

26
Q

What gross changes are seen following an acute infarct (6-48 hours)

A

pale, soft, swollen, indistinct border, blurred grey/white junction

27
Q

Which areas of the brain are susceptible to lacunar infarct?

A

basal ganglia, thalamus, pons and subcortical white matter

28
Q

What are two major causes of lacunar infarcts?

A

HTN, Small Vessel Disease

29
Q

What is the most common cause of a hemorrhagic cerebral infarction?

A

Embolism – it is secondarily hemorrhagic following reperfusion

30
Q

What is the cause of intracranial hemorrhages above the arachnoid (epidural and subdural hematomas)

A

Trauma

31
Q

What is the cause of intracranial hemorrhages below the arachnoid (subarachnoid)?

A

Underlying cerebral vascular disease

32
Q

What causes a subarachnoid hemorrhage?

A

Aneurysms

33
Q

What causes an intraparenchymal hemorrhage?

A

Hypertension

34
Q

Name 4 common locations of a hypertensive hemorrhage.

A

putamen, pons, thalamus, cerebellum

35
Q

What are Charcot-Bouchard aneurysms?

A

Aneurysms associated with chronic HTN. They affect small blood vessels (such as in the basal ganglia and thalamus)

36
Q

Resolution of an intraparenchymal hemorrhage?

A

Resolution leaves a small cystic space with macrophages containing hemosiderin

37
Q

Where do most saccular (berry) aneurysms occur?

A

In the anterior circle of willis

38
Q

In what population does intraventricular hemorrhages occur?

A

Common in premature infants (and instantly fatal)

Very rare in adults

39
Q

Where is the site of rupture of an intraventricular hemorrhage?

A

In the germinal matrix located beneath the ependyma which easily ruptures into the ventricles

40
Q

Where does a Duret hemorrhage occur?

A

In the pons

41
Q

A duret hemorrhage is secondary to what event?

A

Secondary to compression from herniation of the medial temporal lobe that leads to stretching and ischemia of perforating arterioles

Compression can result from a variety of mass lesions producing herniation:
hemorrhages, inflammation, neoplasms

42
Q

What is a lethal complication of an epidural hematoma?

A

Herniation

43
Q

What causes a subdural hematoma?

A

Tearing of bridging veins between dura and arachnoid

44
Q

What is the difference between an epidural and subdural bleed on CT?

A

Epidural: lens shaped bleed
Subdural: crescent shaped bleed

45
Q

What is a lethal complication of a subdural bleed?

A

Herniation

46
Q

What is a deadly consequence of a tonsillar herniation?

A

Compression of the brainstem and cardiopulmonary arrest

47
Q

What is a subfalcine herniation?

A

Displacement of the cingulate gyrus under the falx cerebri

48
Q

What structure is compressed by a subfalcine herniation

A

The ACA

Compression of the ACA leads to infarction

49
Q

What is an uncal herniation?

A

Displacement of the uncus (of the median temporal lobe) under the tentorium cerebelli

50
Q

What structures are compressed by an uncal herniation?

A

CN III –> Down and out eye + dilated pupil

Compression of PCA leads to occipital lobe infarct (contralateral homonymous hemianopsia)

Rupture of the paramedian artery –> Duret hemorrhages

51
Q

What are the microscopic changes that occur 1-2 weeks post infarct?

A

Reactive gliosis and vascular proliferation

MHD- Neuro (19 decks)

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