Pathology of Ischemic Disease of the CNS

Question 1

Strangulation with an object is termed…?

Answer 1

Ligature strangulation

Question 2

What are the different types of asphyxiation?

Answer 2

Suffocation, strangulation, chemical asphyxiation

Question 3

What artery is most prone to an embolic infarct?

Answer 3

Middle cerebral artery

Question 4

What changes may be seen in the subacute phase of ischemia?

Answer 4

Macrophage infiltration and reactive gliosis

Question 5

Pink discoloration of the skin and burns of the gastric mucosa are indicative of poisoning by what chemical?

Answer 5

Hydrogen cyanide - compete with ferric ion of cytochrome oxidase

Question 6

True/False. Embolic strokes are more common than thrombotic strokes.

Answer 6

True. They often originate from cardiac mural thrombi

Question 7

This type of stroke is often due to hypertension and leads to cavity formation in the basal ganglia.

Answer 7

Lacunar strokes

Question 8

How can positional and traumatic asphyxia be differentiated physically?

Answer 8

Both cause congestion and petechiae, Only positional asphyxia causes cyanosis

Question 9

CNS ischemia can be attributed to at least one of four factors. What are they?

Answer 9

1. Impaired O2 carring capacity
2. Inhibition of O2 (ex: CO poisoning)
3. Low PO2
4. Decrease perfusion or blocked vessels

Question 10

A patient is determined to be in the early stage of ischemia. What microscopic changes may be evident?

Answer 10

Shrink and breaking down of the cell nucleus, inflammation due to neutrophil infiltration

Question 11

Cessation of blood flow to a specific area of the brain is termed what type of ischemia?

Answer 11

Focal ischemia

Question 12

This type of asphyxiation is due to mechanical obstruction or occlusion of the external airway.

Answer 12

Strangulation - usually homicidal or suicidal in nature

Question 13

What is the difference in morphological appearance of a thrombotic vs. embolic stroke?

Answer 13

Thrombotic strokes are termed “white strokes” and present with pale areas in the brain. Embolic strokes are “red or hemorrhagic strokes”

Question 14

This type of asphyxiation is due to mechanical obstruction or occlusion of the internal airway.

Answer 14

Choking

Question 15

How may the brain appear if it experiences global ischemia?

Answer 15

Cerebral edema, widened gyri, narrow sulci, possible herniation

Question 16

An individual is found by first responders in their house. Responders note a wood-burning fireplace and redness along the person’s skin. Autopsy reveals necrosis of the globus pallidus, cerebral cortex, and hippocampus. What is the likely COD?

Answer 16

Carbon monoxide poisoning

Question 17

Hypercoagulable states, dissecting aneurysms, and illicit drug use are often attributed to (focal/generalized) strokes.

Answer 17

Focal strokes

Question 18

What is pseudo-laminar necrosis?

Answer 18

Uneven destruction of the neocortex with preservation of some areas

Question 19

Cardiac arrest, shock, hypotension, asphyxia, and hypoglycemia are examples of what type of ischemia?

Answer 19

Global ischemia

Question 20

Persons working in sewers and cesspools are most at risk for asphyxiation by what compound?

Answer 20

Hydrogen sulfide