Pathology of Cerebrovascular Disease

Question 1

what supplies the brainstem and cerebellum with blood?

Answer 1

vertebral and basilar arteries

Question 2

definition of a stroke

Answer 2

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

Question 3

cause of a stroke

Answer 3

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

Question 4

the interruption of supply of oxygen is cuased by what?

Answer 4

Vessel wall
Blood flow (including blood pressure)
Blood constituents

Question 5

what are the 3 main causes of localised interpted blood supply?

Answer 5

Atheroma + thrombosis of artery causing ischaemia
Thromboembolism (for example, from left atrium) causing ischaemia
Ruptured aneurysm of a cerebral vessel causing haemorrhage

Question 6

what is an infarct?

Answer 6

Longstanding symptoms (>24 hours)– due to irreversible ischaemia causing localised brain death = infarct

Question 7

can neurones regenerate?

Answer 7

no

Question 8

what would an infarct look like on histology?

Answer 8

Loss of neurones - causes clinical functional deficit
Foamy macrophages –repair process leading to gliosis
Gliosis is CNS equivalent of fibrosis

Question 9

what are the two common sites of ruptured vessels causing hemorrhagic stroke?

Answer 9

Basal ganglia – microaneurysms form in hypertensive patients

Circle of Willis – Berry aneurysm forms in hypertensive patient

Question 10

what are the generalised interrupted blood supply or hypoxia causes?

Answer 10

Low O2 in blood (hypoxia with intact circulation of blood)

Inadequate supply of blood (flow of blood not occurring) – blood may be oxygenated or not

Rarely: Inability to use O2 – eg cyanide poisoning

Question 11

what are three examples of brain injury caused by generalised interrupted blood supply or hypoxia?

Answer 11

Hypotension- watershed infarction
Cardiac arrest-cortical infarction
Complex case- complex pattern