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Y2 Neurology > Pathology of Cerebra-Vascular Disease > Flashcards

Pathology of Cerebra-Vascular Disease Flashcards

1
Q

what cerebral artery supplies the largest area of brain?

A

the middle cerebral artery

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2
Q

in what area of the brain does the middle cerebral artery divide into two ?

A

at the sylvain fissure

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3
Q

what area of the brain does the middle cerebral artery supply?

A

as if putting your hands on the side of your head on the outside of the brain

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4
Q

what area of the brain does the anterior cerebral artery supply?

A

mostly the medial surface anteriorly and suppling posteriorly until the parieto-occipital sulcus

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5
Q

what area of the brain does the posterior cerebral artery supply?

A

inferior of the temporal lobe and the occipital lobe posteriorly

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6
Q

do veins in the brain follow arteries?

A

no

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7
Q

between what two layers are the venous sinuses ?

A

between the dural folds

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8
Q

what do all the venous sinuses drain into ?

A

the internal jugular vein

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9
Q

what are the veins called which connect the intracranium and extrcranium ?

A

emissionary veins

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10
Q

what is the WHO definition of 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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11
Q

what are the two types of strokes?

A

ischaemic

haemorrhagic

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12
Q

what type of stroke is the most common?

A

ischaemic stroke

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13
Q

what are the major symptom of a stroke?

A

sudden weakness or numbness

often one side of the body is affected

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14
Q

other symptoms which are experienced by the stroke patient is dependant on what?

A

the area of brain affected

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15
Q

what other symptoms as well as weakness are often seen in stroke patients ?

A 
confusion 
difficulty speaking/understanding speech 
difficulty walking 
difficulty seeing 
severe headache 
unconsciousness
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16
Q

what are the three major categories of stroke /

A

Transient ischaemic attack (TIA)
Minor stroke
Disabling stroke

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17
Q

what is a TIA?

A

Symptoms and signs last <24hr

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18
Q

what is a minor stroke?

A

> 24hr but minor neurological deficit

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19
Q

what is a disabling stroke?

A

> 24hr with persisting disability that impairs independence such as Not being able to swallow

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20
Q

is the brain sensitive to changes in oxygen ?

A

yes very sensitive

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21
Q

what percentage of cardiac output does the brain get?

A

15%

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22
Q

what are the two complications of hypoxia which causes ischaemia?

A
  1. infarction

2. permanent damage to the neurones

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23
Q

what drug can be used for about 85% of stroke patients ?

A

thrombolysis

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24
Q

what are the three components of virchows triad?

A
  1. change of vessel wall
  2. change in blood composition
  3. change in flow
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25
Q

what is ischaemia ?

A

reduced or absent oxygen in a tissue or organ

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26
Q

what is Poisseuille’s law a measurement of ?

A

flow

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27
Q

what three variables are present in Poisseuille’s law

which determines flow?

A

pressure gradient x radius ^4 / 8 length

28
Q

if the pressure gradient decreases in Poisseuille’s law what happens to the flow ?

A

decreases

29
Q

if the radius decreases in Poisseuille’s law what happens to the flow ?

A

radius decreases, resistance increases, therefore flow decreases

30
Q

if the length of the vessel decreases in Poisseuille’s law what happens to the flow ?

A

length decreases, the flow will increase

31
Q

what is the mechanism called when the vessels change their radius to maintain the same cerebral blood flow ?

A

autoreguation

32
Q

give examples of the different types of flow in a vessel ?

A

stagnant
laminar
turbulent

33
Q

give 8 causes of ischaemia ?

A 
atherosclerosis 
thrombosis 
embolism 
hypotension 
arterial spasm

systemic vascular disease (arteritis)
mechanical compression
venous obstruction

34
Q

how does arterial spasm cause ischaemia ?

A

spasm causes a decrease in vessel radius therefore the blood flow to the brain is reduced

35
Q

when would arterial spasm occur in the brain?

A

after a subarachnoid haemorrhage

36
Q

give two arteries where infarction commonly occurs?

A

internal carotid artery

middle cerebral artery

37
Q

what are the two most common locations in the brain for ischaemia to occur ?

A

cerebral hemispheres

internal capsule

38
Q

what symptom is caused by infarction in the internal capsule ?

A

contralateral hemiparesis

39
Q

which cells are very vulnerable to die following ischaemia?

A

neurones

40
Q

what shape is the infarction following ischaemia?

A

wedge shaped

- reflecting the arterial perfusion territory

41
Q

what does the brain look like after an infarction?

A

soft and becomes cystic

42
Q

what is regeneration of the brain following infarction called?

A

gliosis

- equivalent of fibrosis

43
Q

state three risk factors of thrombotic stroke?

A

arteriosclerosis
smoking
diabetes

44
Q

what two conditions could be the source of an embolism causing a stroke?

A

cardiac arrhythmias

thoracic aortic aneurysm

45
Q

what is a watershed infarction ?

A

Periphery of perfusion territory of major arteries especially affected
- the borders between the artery territories

46
Q

what is the law which determines flow in a vessel?

A

Poisseuilles law

47
Q

neurones in which part of the brain are most sensitive to hypotensive events?

A

superficial cortex, hippocampus, thalamus, cerebellum

48
Q

what three things would be seen in the histology of an infarct ?

A

loss of neurones
foamy macrophages
gliosis

49
Q

what do foamy macrophages do?

A

they are involved in the repair process leading to gliosis

50
Q

what is the definition of a haemorrhagic stroke ?

A

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

51
Q

are hemorrhagic strokes more common than ischaemic strokes?

A

no

52
Q

in which location do haemorrhagic strokes usually occur ?

A

at bifurcations of arteries

53
Q

state some risk factors of hemorrhagic stroke ?

A

systemic HT

over 50yrs

54
Q

what is a common location effected by haemorrhagic strokes?

A

basal ganglia

then

  • brain stem
  • cerebellum
  • cerebral cortex
55
Q

what is the aneurysm called which is seen in subarachnoid haemorrhages ?

A

saccular (Berry) aneurysm

56
Q

which part of the circle of willis is most commonly affected by a subarachnoid haemorrhage ?

A

the anterior part

  • internal carotid
  • anterior communicating
  • middle cerebral
57
Q

what size are most aneurysms for SAH?

A

<10mm

58
Q

in which age range are inter ventricular haemorrhages most common?

A

in babies and infants

59
Q

what is the prognosis of interventicular haemorrhages ?

A

very poor outcome

60
Q

what causes inter ventricular haemorrhages ?

A

hypoxia in premature infants

61
Q

after an intracranial haemorrhage what changes occur in the brain tissue?

A

the tissue can become cystic

62
Q

what are the complications of intracranial haemorrhages?

A

rapid increase of ICP

death

63
Q

what is a stroke ?

A

stroke is a neurological deficit caused by disruption of blood supply

64
Q

what is the appearance of an ischaemic stroke ?

A

wedge shaped infarction

- usually the middle cerebral artery

65
Q

what area of the arteries are commonly affected by haemorrhagic strokes ?

A

the bifurcation

66
Q

state some causes of ischaemic strokes?

A 
atherosclerosis 
thrombosis 
embolism 
hypotension 
arterial spasm 
systemic vascular disease
67
Q

state some causes of haemorrhagic strokes ?

A

aneurysm
trauma
hypertension

Y2 Neurology (52 decks)

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