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NEURO > Pathology of cerebrovascular disease > Flashcards

Pathology of cerebrovascular disease Flashcards

1
Q

what are the different parts of the brain

A 
frontal lobe
parietal lobe
occipital lobe
temporal lobe
cerebellum 
brain stem
spinal cord
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2
Q

what parts of the cerebrum does the anterior cerebral artery supply

A

medial and superior (excluding occipital

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3
Q

what parts of the cerebrum does the middle cerebral artery supply

A

lateral

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4
Q

what parts of the cerebrum does the posterior cerebral artery supply

A

inferior and occipital

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5
Q

what do the arteries in the cerebrum join to form

A

circle of willis

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6
Q

what are the large venous sinuses within the dura

A 
superior sagittal 
inferior sagittal 
transverse sinus
straight sinus 
sigmoid sinus 
jugular vein
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7
Q

what is the WHO definition of 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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8
Q

what can cause stroke

A

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

can be changes in:

  • vessel wall
  • blood flow (including pressure)
  • blood constituents
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9
Q

give examples of changes to the vessel walls that can cause stroke

A

abnormality of wall eg atheroma or vasculitis,

outside pressure eg strangulation, spinal cord compression, compression of veins

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10
Q

give examples of changes to the blood flow and pressure that can cause stroke

A

decreased blood flow, increased blood pressure bursting vessels

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11
Q

give examples of changes to the blood constituents that can cause stroke

A

thrombosis of arteries (rarely veins)

bleeding due to anticoagulation, reduced platelets and clotting factors

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12
Q

what are the three main causes of LOCALISED interrupted blood supply

A
  1. Atheroma + thrombosis of artery causing ischaemia
  2. Thromboembolism (for example, from left atrium) causing ischaemia
  3. Ruptured aneurysm of a cerebral vessel causing haemorrhage
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13
Q

where can atheroma + thrombosis usually occur

A

bifurcation of the internal carotid arteries

causes internal carotid artery thrombosis

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14
Q

what area does internal carotid artery thrombosis usually affect

A

ischaemia usually in the MCA territory

but can be elsewhere

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15
Q

what is ischaemia

A

a relative or absolute lack of blood supply in a tissue or organ

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16
Q

what do transient (<24hr) ischaemic symptoms indicate

A

TIA
- reversible ischaemia
= tissue still viable

17
Q

what do longstanding (>24hr) ischaemic symptoms indicate

A

Infarct
- irreversibel ischaemia
= localised brain death

18
Q

summarise the pathogenesis of stroke

A

hypoxia/anoxia
= ischaemia

prolonged ischaemia
= infarction

= permanent damage - neurons do not regenerate

19
Q

what is a localised area of brain known as

A

regional cerebral infarct

classically wedge shaped - reflects arterial perfusion territory

soft then becomes cystic then loss of brain tissue

20
Q

what is gliosis and what causes it

A

CNS equivalent to fibrosis

macrophages in the repair process

21
Q

why is the location of ischaemia more important than size

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

22
Q

briefly summarise the pathophysiology of thromboembolism

A

thrombosis

  • embolism breaks off
  • embolises to vessel
  • blocks blood supply
  • causes ischaemic stroke
23
Q

give an example of a common site of thromboembolism

A

left atrial appendage thrombosis

  • LA connected directly to outflow of left side of hear
  • thrombosis breaks off and embolises to the aorta and possibly carotid arteries
  • embolus blocks right middle cerebral artery
24
Q

what causes an aneurysm to form

A

weakening of thin cerebral artery walls and hypertension

25
Q

what can happen to the cerebral artery aneurysm if hypertension severe

A

wall can rupture

26
Q

what does rupture of the aneurysm cause

A
  1. haemorrhage
  2. decreased blood flow distally to the brain due to arterial spasm - ischaemia

= haemorrhagic stroke

27
Q

what are common sites of ruptured vessels causing haemorrhagic stroke

A

basal ganglia - microaneurysms in hypertensive patients

circle of willis - berry aneurysm in hypertensive patients

28
Q

what are the three main causes of GENERALISED interrupted blood supply

A
  1. low O2 in blood (hypoxia with intact circulation)
  2. inadequate blood supply (flow of blood not occurring)
  3. (rarely) inability to use O2 - e.g. cyanide poisoning
29
Q

what can cause low O2 in the blood

A

C02 poisoning

near drowning

respiratory arrest

30
Q

what can cause an inadequate supply of blood

A

cardiac arrest with immediate resuscitation

hypotension

brain swelling (eg trauma)

31
Q

what type of infarct can be caused by hypotension

A

watershed infarcts

32
Q

what are watershed infarcts and how do they occur

A

zonal areas of infarction at the interface of artery perfusion territories

occur when blood is oxygenated but there is a prolonged period of poor perfusion pressure in the brain

= caused by pure hypotension

33
Q

how can cardiac arrest followed by several minutes of resuscitation cause infarction

A

during those minutes – no circulation to brain and no oxygen in blood – all of brain deprived of blood flow and O2

= cortical necrosis (infarction)

34
Q

CASE: 75 year old woman with known coronary artery disease + bouts of pneumonia

what might the pneumonia cause in terms of blood supply

A

periods of poor oxygenation not adequate circulation

35
Q

CASE: woman then suffers cardiac arrest

what will this cause in terms of blood supply

A

period of no perfusion and no oxygen

36
Q

CASE: successful resuscitation then further arrest then dies

what types of infarct may be found on autopsy

A

various types

  1. Watershed - hypotension
  2. Laminar cortical necrosis (infarction) - from MI + resus
  3. Regional infarcts related to
    poor flow through
    cerebral vessels narrowed
    by atheroma

NEURO (51 decks)

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