Patho Lab 1

Question 0

Basal ganglia hemorrhage

Answer 0

1) Putamen in particular
2) Non-traumatic and caused by hypertension that leads to arteriosclerosis (Damages and weakens small penetrating artery)
3) Blood collection -> Midline shift -> Secondary edema -> Herniation

Question 1

Germinal matrix hemorrhage?

Answer 1

1) Intraventricular hemorrhage (Complication of prematurity
2) Arise in subependymal region (Germinal matrix very susceptible)
3) 28 weeks gestational age newborn

Question 2

Basal ganglia hemorrhage may cause?

Answer 2

Stroke

Question 3

Epidural hematoma

Answer 3

1) Results in blood clot on external surface of dura

2) Trauma -> Rupture of middle meningeal artery

Question 4

What causes subdural hematoma?

Answer 4

1) Trauma with tearing of bridging veins

2) Particularly with cerebral atrophy (exposes bridging veins)

Question 5

Bilateral chronic subdural hematoma

Answer 5

1) Blood clots are brown to tan because of organisation
2) Form more slowly and insidiously than clots from arterial hemorrhage
3) Most common in trauma in the very young and elderly

Question 6

Berry aneurysm

Answer 6

1) Cerebral arterial circulation
2) Most common region is btw ant. communicating and ant. cerebral
3) Trifurcation of middle cerebral & bifurcation of int. carotid with post. communicating
4) Vertebral-basilar aneurysm <10%
5) Multiple aneurysms 20-30% cases

Question 7

Ruptured berry aneurysm may cause?

Answer 7

Subarachnoid hemorrhage

Question 8

Leakage of blood from aneurysm causes?

Ruptured aneurysm?

Answer 8

Headache -> Severe headache

Question 9

Multiple aneurysms

Answer 9

1) Congenital

2) Defect presents from birth but take years to form so ruptured aneurysms usually occur in young and middle aged

Question 10

Subarachnoid hemorrhage from ruptured aneurysm causes?

Answer 10

1) Vasospasm -> Cerebral anoxia
2) Sudden onset of excruciating headache
3) Mortality rate initial rupture 25-50%

Question 11

Diffuse subarachnoid hemorrhage

Answer 11

1) Extend from base of the brain to lateral surface of frontal & temporal
2) No blood beneath dura

Question 12

Lacunar infarcts in basal ganglia, deep white matter, brain stem (pons) caused by?

Answer 12

Arteriolar sclerosis caused by chronic hypertension

Question 13

Arterial thrombosis and embolism may cause?

Answer 13

Acute cerebral infarct

Question 14

Acute watershed infarction

Answer 14

1) Bilaterally symmetric dark discoloured area

2) Relative or absolute hypoperfusion of the brain

Question 15

Remote watershed infarction

Answer 15

1) Subacute

2) Not bilateral

Question 16

Thrombosis in internal carotid artery

Answer 16

Arterial thrombosis is far more common than venous (100:1)

Question 17

Thromboembolus of cerebral artery

Answer 17

1) Particularly in middle cerebral artery and its distribution
2) Heart is the common source (Mural thrombus in the left atrium)

Question 18

Subacute infarct

Answer 18

1) Liquefactive necrosis with formation of cystic spaces

2) Intermediate infarct

Question 19

Hemorrhagic infarction

Answer 19

1) Caused by arterial embolus
2) Acutely edematous infarcted tissue may produce mass effect
3) Decrease size of lateral ventricle
4) Midline shifted to contralateral side of lesion

Question 20

Acute infarction with anoxic injury

Answer 20

1) Red neurons (Hypoxia)

2) Hippocampus and purkinje cells (Red cytoplasm, indistinct cytoplasmic borders, karyolysis) are highly susceptible

Question 21

Subacute (intermediate) infarct

Answer 21

1) Edema with obscured structural lining
2) Swelling that shifts midline to the side
3) Liquefactive necrosis with formation of cystic spaces

Question 22

How cystic spaces are formed?

Answer 22

Resolution of liquefactive necrosis (remote infarct) by influx of blood monocytes to become tissue macrophages over weeks leads to cystic spaces formation

Question 23

Remote cerebral infarction causes?

Answer 23

1) Wallerian degeneration (decreased descending corticospinal tracts)
2) Cerebral peduncle of midbrain is reduced unilaterally

Question 24

Cerebral edema

Answer 24

1) Shift of midline to the side
2) Multiple metastases may be the cause
3) Widened gyri with flattened surface and narrowed sulci

Question 25

Herniation of uncus of the hippocampus through tentorium and herniation of cerebellar tonsils through foramen magnum caused by?

Answer 25

Acute brain swelling

Question 26

Duret hemorrhages (Pons)

Answer 26

1) End result of herniation

E.g. Uncal herniation from edema

Question 27

Pseudolaminar necrosis

Answer 27

1) Persistent vegetative state

2) Cortical ribbon is very thin (loss of cortex)