Pathology of Cerebrovascular Disease Flashcards

1
Q

Explain the blood supply to different parts of the cortex?

A
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2
Q

Do veins accompany arteries in the brain?

A

No they do not

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3
Q

What drains the dura mater?

A

Large venous sinuses

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4
Q

What is ischaemia?

A

Lack of blood flow

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5
Q

What is hypoxia?

A

Lack of oxygen

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6
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 blood supply

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7
Q

Vaugly, what is the cause of stroke?

A

Interruption of supply of oxygen and nutrients, causing damage to brain tissue

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8
Q

What can an interruption in oxygen to the brain be caused by changes in?

A

Vessel wall

Blood flow (including blood pressure)

Blood contituents

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9
Q

What changes in the vessel wall can cause an interruption of blood supply to the brain?

A

Atheroma or vasculitis

Outside pressure (strangulation)

Spinal cord compression

Compression of veins

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10
Q

What changes to blood flow can cause an interruption of oxygen delivery to the brain?

A

Decreased blood flow

Increased blood pressure bursting vessels

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11
Q

What changes to blood constituents can cause interruption to delivery of oxygen to the brain?

A

Thrombosis of arteries and rarely veins

Bleeding due to anticoagulation

Reduced platelets and clotting factors

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12
Q

In practice, what are the 3 main causes of localised interruptions of blood supply?

A

Atheroma and thrombosis of artery causing ischaemia

Thromboembolism (for example from left atrium) causing ischaemia

Ruptured aneurysm of cerebral vessel causing haemorrhage

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13
Q

What are the 2 kinds of ischaemia?

A

Transient symptoms

Longstanding symptoms

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14
Q

What are transient symptoms ischaemia?

A

Less than 24 hours

Due to reversible ischaemia (transient ischamia attack)

Tissue still viable

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15
Q

What are long standing sympotoms ischaemia?

A

More than 24 hours

Due to irreversible ischaemia

Causes localised brain death (infarct)

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16
Q

Explain the pathogenesis of ischaemic stroke?

A

Brian is very sensitive to oxygen ischaemia

Few minutes of hypoxia or anoxia will cause brain ischaemia

Can lead to infarction, it it does then damage to neurons is permanent as neurons do not regenerate

Classically wedge shaped reflecting arterial perfusion territory

17
Q

How long is required to cause brain ischaemia?

A

Few minutes of hypoxia

18
Q

What is a local area of brain death called?

A

Regional cerebral infarct

19
Q

What is seen in histology of ischaemic stroke?

A

Loss of neurons (causes clinical functional deficit)

Foamy macrophages (repair process leading to gliosis)

Gliosis is CNS equilvalent of fibrosis

20
Q

Why is the location of ischaemia important?

A

Small affected area of one part of brain may not cause too much impairment

Similar size of affected area in another part of brain may be devastating

21
Q

What artery in the brain is often blocked due to an atheroma or maybe thromboembolism from the internal carotid artery?

A

Middle cerebral artery

22
Q

What is the pathogenesis of a ruptured aneurysm causing ischaemic stroke?

A

1) Beyond carotids and vertebral arteries the cerebral arteries have thin walls
2) Weakening of wall and hypertension causes aneurysm to form
3) Wall can then rupture, especially if severe hypertension
4) Decreased blood flow distally to brain due to spasm of artery (haemorrhage)

23
Q

What are 2 common sites of ruptured vessels causing haemorrhage stroke?

A

Basal ganglia (microaneurysm forms in hypertensive patients)

Circle of Willis (berry eneurysm forms in hypertensive patients)

24
Q

Vaugly, what can cause strokes as well as local problems?

A

General problems

25
Q

What are some examples of general problems that can cause stroke?

A

Low oxygen in blood

Inadequate supply of blood

Inability to use oxygen

26
Q

What are examples of low oxygen in blood causing stroke?

A

Carbon dioxide poisoning

Near drowning

Respiratory arrest

27
Q

What does low oxygen in blood causing stroke mean?

A

Hypoxia with intact circulation of blood

28
Q

What does inadequate supply of blood causing stroke mean?

A

Flow of blood not occuring

Blood may be oxygenated or not

29
Q

What are examples of things that cause inadequate supply of blood causing stroke?

A

Cardiac arrest

Hypotension

Brain swelling (such as trauma)

30
Q

What is an example of inability to use oxygen?

A

Cyanide poisoning

This is rare

31
Q

How does hypotension lead to stroke?

A

Central parts of arteries territory is better perfused

Leads to watershed zones that are poorly perfused, which are zonal patterns of ischaemia and infarction at interface of territories

32
Q

How does cardiac arrest cause stroke?

A

Causes complete loss of perfusion and oxygen for a few minutes

Leads to laminar cortical necrosis (infarction)

33
Q

What are the different patterns of infarction?

A

Watershed infarcts

Laminar cortical necrosis

Regional infarcts