Pathology of Cerebra-Vascular Disease

Question 1

what cerebral artery supplies the largest area of brain?

Answer 1

the middle cerebral artery

Question 2

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

Answer 2

at the sylvain fissure

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

inferior of the temporal lobe and the occipital lobe posteriorly

Question 6

do veins in the brain follow arteries?

Answer 6

no

Question 7

between what two layers are the venous sinuses ?

Answer 7

between the dural folds

Question 8

what do all the venous sinuses drain into ?

Answer 8

the internal jugular vein

Question 9

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

Answer 9

emissionary veins

Question 10

what is the WHO definition of a stroke?

Answer 10

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

Question 11

what are the two types of strokes?

Answer 11

ischaemic

haemorrhagic

Question 12

what type of stroke is the most common?

Answer 12

ischaemic stroke

Question 13

what are the major symptom of a stroke?

Answer 13

sudden weakness or numbness

often one side of the body is affected

Question 14

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

Answer 14

the area of brain affected

Question 15

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

Answer 15

confusion 
difficulty speaking/understanding speech 
difficulty walking 
difficulty seeing 
severe headache 
unconsciousness

Question 16

what are the three major categories of stroke /

Answer 16

Transient ischaemic attack (TIA)
Minor stroke
Disabling stroke

Question 17

what is a TIA?

Answer 17

Symptoms and signs last <24hr

Question 18

what is a minor stroke?

Answer 18

> 24hr but minor neurological deficit

Question 19

what is a disabling stroke?

Answer 19

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

Question 20

is the brain sensitive to changes in oxygen ?

Answer 20

yes very sensitive

Question 21

what percentage of cardiac output does the brain get?

Answer 21

15%

Question 22

what are the two complications of hypoxia which causes ischaemia?

Answer 22

1. infarction

2. permanent damage to the neurones

Question 23

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

Answer 23

thrombolysis

Question 24

what are the three components of virchows triad?

Answer 24

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

Question 25

what is ischaemia ?

Answer 25

reduced or absent oxygen in a tissue or organ

Question 26

what is Poisseuille’s law a measurement of ?

Answer 26

flow

Question 27

what three variables are present in Poisseuille’s law | which determines flow?

Answer 27

pressure gradient x radius ^4 / 8 length

Question 28

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

Answer 28

decreases

Question 29

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

Answer 29

radius decreases, resistance increases, therefore flow decreases

Question 30

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

Answer 30

length decreases, the flow will increase

Question 31

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

Answer 31

autoreguation

Question 32

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

Answer 32

stagnant laminar turbulent

Question 33

give 8 causes of ischaemia ?

Answer 33

``` atherosclerosis thrombosis embolism hypotension arterial spasm ``` systemic vascular disease (arteritis) mechanical compression venous obstruction

Question 34

how does arterial spasm cause ischaemia ?

Answer 34

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

Question 35

when would arterial spasm occur in the brain?

Answer 35

after a subarachnoid haemorrhage

Question 36

give two arteries where infarction commonly occurs?

Answer 36

internal carotid artery | middle cerebral artery

Question 37

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

Answer 37

cerebral hemispheres | internal capsule

Question 38

what symptom is caused by infarction in the internal capsule ?

Answer 38

contralateral hemiparesis

Question 39

which cells are very vulnerable to die following ischaemia?

Answer 39

neurones

Question 40

what shape is the infarction following ischaemia?

Answer 40

wedge shaped | - reflecting the arterial perfusion territory

Question 41

what does the brain look like after an infarction?

Answer 41

soft and becomes cystic

Question 42

what is regeneration of the brain following infarction called?

Answer 42

gliosis | - equivalent of fibrosis

Question 43

state three risk factors of thrombotic stroke?

Answer 43

arteriosclerosis smoking diabetes

Question 44

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

Answer 44

cardiac arrhythmias | thoracic aortic aneurysm

Question 45

what is a watershed infarction ?

Answer 45

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

Question 46

what is the law which determines flow in a vessel?

Answer 46

Poisseuilles law

Question 47

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

Answer 47

superficial cortex, hippocampus, thalamus, cerebellum

Question 48

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

Answer 48

loss of neurones foamy macrophages gliosis

Question 49

what do foamy macrophages do?

Answer 49

they are involved in the repair process leading to gliosis

Question 50

what is the definition of a haemorrhagic stroke ?

Answer 50

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

Question 51

are hemorrhagic strokes more common than ischaemic strokes?

Answer 51

no

Question 52

in which location do haemorrhagic strokes usually occur ?

Answer 52

at bifurcations of arteries

Question 53

state some risk factors of hemorrhagic stroke ?

Answer 53

systemic HT | over 50yrs

Question 54

what is a common location effected by haemorrhagic strokes?

Answer 54

basal ganglia then - brain stem - cerebellum - cerebral cortex

Question 55

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

Answer 55

saccular (Berry) aneurysm

Question 56

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

Answer 56

the anterior part - internal carotid - anterior communicating - middle cerebral

Question 57

what size are most aneurysms for SAH?

Answer 57

<10mm

Question 58

in which age range are inter ventricular haemorrhages most common?

Answer 58

in babies and infants

Question 59

what is the prognosis of interventicular haemorrhages ?

Answer 59

very poor outcome

Question 60

what causes inter ventricular haemorrhages ?

Answer 60

hypoxia in premature infants

Question 61

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

Answer 61

the tissue can become cystic

Question 62

what are the complications of intracranial haemorrhages?

Answer 62

rapid increase of ICP | death

Question 63

what is a stroke ?

Answer 63

stroke is a neurological deficit caused by disruption of blood supply

Question 64

what is the appearance of an ischaemic stroke ?

Answer 64

wedge shaped infarction | - usually the middle cerebral artery

Question 65

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

Answer 65

the bifurcation

Question 66

state some causes of ischaemic strokes?

Answer 66

``` atherosclerosis thrombosis embolism hypotension arterial spasm systemic vascular disease ```

Question 67

state some causes of haemorrhagic strokes ?

Answer 67

aneurysm trauma hypertension