Pathology of Cerebrovascular Disease

Question 1

Do veins travel with arteries in the brain?

Answer 1

No they are not in tandem

Question 2

What are the main venous structures in the brain?

Answer 2

Large venous sinuses within the dura

Question 3

How are the venous sinuses fed and how do these vessels travel?

Answer 3

By bridging veins from the brain, they cross the meninges from the brain towards the skull

Question 4

How are veins linked to those outside the skull?

Answer 4

Emissary veins

Question 5

What is the Who definition of stroke?

Answer 5

Focal neurological deficit due to disruption of its blood supply

Question 6

What is the most common cause of stroke?

Answer 6

Ischaemic stroke - vessel blocked by thrombus

Question 7

What percentage of strokes are haemorrhagic due to a ruptured vessel?

Answer 7

10%

Question 8

What are the major features of stroke?

Answer 8

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

Other -
Confusion/speech difficulties
Difficulty seeing
Headache

Question 9

What are the three major categories of stroke?

Answer 9

TIA - last 24 hours but minor neuro deficit

Disabling stroke - >24 hours with persisting disability that impairs independence

Question 10

What portion of the CO is dedicated to the cerebral blood flow?

Answer 10

15%

Question 11

Are neurons in the brain able to regenerate after damage|?

Answer 11

No

Question 12

How many strokes have the potential for thrombolysis?

Answer 12

85%

Question 13

What is Virchow’s triad of occlusion?

Answer 13

Change in vessel wall
‘’ flow
‘’ content

Question 14

Give some causes of CNS ischaemia

Answer 14

Atherosclerosis
Thrombosis
Embolism
Hypotension - MI, massive blood loss
Arterial spasm following subarachnoid haemorrhage
Systemic vascular disease e.g. arteritis 
Mechanical compression 
Venous obstruction

Question 15

What artery is most commonly blocked causing a regional infarction?

Answer 15

Middle cerebral artery

Question 16

What is acute cerebral cortex ischaemia?

Answer 16

Ischaemia affecting the cerebral hemispheres and the internal capsule. There is contralateral hemiparesis or other signs
May result in loss of brain tissue and cyst

Question 17

What is useful when determining whether the ischaemia is thrombotic or embolic?

Answer 17

Whether there are pro-thrombotic underlying features like arteriosclerosis, smoking, diabetes

Whether there is a probable source of embolus like cardiac arrhythmia or thoracic aortic aneurysm

Consider whether there is one singe large embolus or multiple smaller infarcts

Question 18

What is watershed infarction?

Answer 18

When a particular artery is occluded, the perfusion territory of the artery is particularly affected creating zonal patterns of ischaemia and infarction

Question 19

Outline the pathogenesis of haemorrhagic stroke?

Answer 19

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

Question 20

What proportion of stokes are haemorrhagic?

Answer 20

15%

Question 21

Where are the vast majority of intracerebral haemorrhage?

Answer 21

Basal ganglia - 80%

Question 22

Describe the process of subarachnoid haemorrhage

Answer 22

Rupture of saccular (Berry) aneurysm on circle of Willis
Usually a branching point of the anterior part of the circle - internal carotid, anterior communicating, middle cerebral most common

Question 23

What are the three arteries most commonly the location of a Berry aneurysm?

Answer 23

Internal carotid
Anterior communicating
Middle cerebral

Question 24

What are the consequences of intracranial haemorrhage?

Answer 24

Death due to rapid increase in intracranial pressure - especially sub arachnoid