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N - C > Pathology of Cerebra-Vascular Disease > Flashcards

Pathology of Cerebra-Vascular Disease Flashcards

1
Q

Describe the venous drainage of the brain

A

Veins do not accompany arteries

Large venous sinuses within dura

Fed by bridging veins from brain which cross the meninges to the skull

Emissary veins link to veins outside the skull

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2
Q

What is a stroke?

A

Focal neurological deficit (loss of function affecting a specific region of the central nervous system) due to disruption of its blood supply.

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3
Q

How do most strokes occur?

A

Blood vessel being blocked by a thrombus (ischaemic stroke)

Around 1 in 10 strokes arise from a ruptures blood vessel causing a haemorrhage

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4
Q

What are the major features of stroke?

A

Focal neurological deficit:

  • Sudden weakness or numbness
  • face, arm or leg, most often on one side of the body

Others:

  • Confusion, difficulty speaking/ understanding speech
  • Difficulty seeing (one or both eyes)
  • Difficulty walking, dizziness, balance/ coordination loss
  • Severe headache with no known cause
  • Unconsciousness
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5
Q

What is a transient ischaemic attack (TIA)?

A

Symptoms and signs last

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6
Q

What is a minor stroke?

A

> 24 hours but minor neurological deficit

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7
Q

What is a disabling stroke?

A

> 24 hours with persisting disability that impairs independence

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8
Q

How much cardiac output provides cerebral blood flow?

A

15%

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9
Q

How long does hypoxia or anoxia take to cause brain ischaemia?

A

Few minutes

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10
Q

What can ischaemia cause?

A

Can lead to infarction

Damage to neurones is permanent

Neurones do not regenerate

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11
Q

Why is neuronal plasticity important in the recovary from stroke?

A

Through physiotherapy, speech theraoy etc we can train other neurones to do the job of the ones that are lost

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12
Q

What is ischaemia?

A

Relative or absolute lack of oxygen in a tissue or organ

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13
Q

What is infarction?

A

Regional cell death

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14
Q

Briefly run over virchow’s triad

A

Change in vessel wall, flow, content

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15
Q

What are some of the causes of CNS ischaemia?

A

Atherosclerosis

Thrombosis

Embolism
-Arterial thromboembolism, fat)

Hypotension

  • Cardiac arrest
  • Massive blood loss

Arterial spasm following subarachnoid haemorrhage

Systemic vascular disease
-e.g. arteritis

Mechanical compression

  • Head injury-> brain swell
  • Tentorial herniation
  • Spinal cord compression

Venous obstruction

  • Mediastinal tumour
  • Dural vein thrombosis (sepsis)
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16
Q

How does the infarction of neurones compare to glial cells?

A

Neurones die fast

Supportive (glial) tissues are more robust

17
Q

What may cause global ischaemia?

A

Systemic hypotension

18
Q

What MAP puts the patient at risk of systemic hypotension?

A

MAP less than 60mmHg

19
Q

What neurones are particularly at risk in global ischaemia?

A

Superficial cortex
Hippocampus
Thalamus
Cerebellum

20
Q

What is the normal histology in a CNS infarct?

A

Loss of neurones
-causes clinical functional deficit

Foamy macrophages
-repair process leasing to gliosis

Gliosis = CNS equivalent of fibrosis

21
Q

What is haemorrhagic stroke?

A

Rupture of a small artery usually at a bifurcation leading to catastrophic haemorrhage

about 15% of strokes

22
Q

Describe intracerebral haemorrhage

A

Associated with systemic hypertension in over 50s

80% of these in basal ganglia

Also occur in brainstem, cerebellum, cerebral cortex (decreasing order)

23
Q

What causes the damage in haemorrhagic stroke?

A

Rapidly growing intracranial space occupying lesion and increased ICP

24
Q

What is a subarachnoid haemorrhage?

A

Rupture of saccular (Berry) aneurysm on circle of Willis

25
Q

What is a common presentation for interventrcular haemorrhage?

A

Hypoxia in premature infants

Babies in NICU

Poor outcome

26
Q

What are the consequences of intracranial haemorrhage?

A

Death because of rapid increase in ICP (esp subarachnoid)

Clinical features of stroke (headache esp in SAH)

Secondary infarction
-Local effect of mass lesion and ICP effect

Long term survivors lose brain tissue - cystic

N - C (35 decks)

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