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CNS > Pathology of Stroke > Flashcards

Pathology of Stroke Flashcards

1
Q

What vessels supply the cerebral cortex?

A

Internal Carotid Arteries [70%]
Vertebral Arteries [30%]
Both through circle of willis

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2
Q

Define Cerebral Perfusion Pressure

A

the difference between systemic arterial blood pressure and intracranial pressure

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3
Q

What causes Global cerebral ischemia?

A

results from a fall in cerebral perfusion pressure below threshold for autoregulation

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4
Q

What causes local cerebral ischemia?

A

arterial stenosis or occlusion

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5
Q

What cell in the CNS is most vulnerable to ischemia?

A

Neurons [pyramidal neurons in hippocampus, Purkinje cells in cerebellum]

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6
Q

What areas of the brain are vulnerable to hypotension or cardiac arrest?

A

Watershed areas, Cerebral cortex, Hippocampus

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7
Q

Describe the microscopic appearance of acute neuronal injury in Purkinje cells

A

deep eosinophilia of cytoplasm and variable degrees of nuclear disintegration

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8
Q

Describe the microscopic appearance of chronic neuronal injury

A

Neuronal loss and Gliosis [+ edema and demyelination]

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9
Q

Define TIA

A

term used to describe if symptoms resolve within 24 hours

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10
Q

Define stroke

A

an “abrupt onset” of focal or global neurological symptoms caused by ischemia or hemorrhage lasting more than 24 hours

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11
Q

What is the most common cause of cerebral infarction?

A

Atherosclerosis

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12
Q

General epidemiology of stroke

A

> 70% - cerebral infarction
~ 20% – cerebral hemorrhage
remainder is subarachnoid hemorrhage

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13
Q

What is the 3rd most common cause of mortality in the US?

A

Strokes

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14
Q

What are risk factors for strokes?

A

HTN
Lipids
DM
Environmental factors
Obesity
Impaired Cardiac function
Oral contraceptive with high estrogen content
Anti-phospholipis Abs

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15
Q

What risk factor account for 50% of hemorrhagic strokes?

A

Hypertension

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16
Q

Why is hyperlipidemia considered a risk factor and what does it affect?

A

Atheroma

carotid arteries > vertebral arteries > circle of willis

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17
Q

What is the link between DM and Strokes?

A

DM increases incidence of strokes unto 3-folds in both sexes

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18
Q

What environmental factors increased the risk for strokes?

A

Diets resulting in hyperlipidemia
High salt intake may promote HTN
Smoking

19
Q

Which cardiac condition increases the risk of stroke and why?

A

A. Fib
increased risk of embolisation

20
Q

How does Anti-phospholipid autoantibodies increase risks of strokes?

A

Associated with recurrent thrombosis

Two most relevant antibodies are anticardiolipin and lupus anticoagulant.

Thrombotic stroke and transient ischaemic attacks

21
Q

Stroke

A

Ischemic
Hemorrhagic [intracerebral or subarachnoid hemorrhage]

22
Q

Pathophysiology of Global Ischemic stroke

A

Global generalized hypoxic encephalopathy

Hypotension : Acute MI. Heart failure. Shock

23
Q

Pathophysiology of Focal Ischemic stroke

A

cerebral infarcts.
Thrombosis: underlying atherosclerosis.
Emboli.

24
Q

Describe the acute morphology of ischemic stroke

A

edema neuronal microvacuolization  pyknosis  karyorrhexis  neutrophils

25
Q

Describe the chronic morphology of ischemic stroke

A

macrophagesgliosis

26
Q

In order, list the histopathologic progression of CNS ischemic infarcts

A

Edema
‘‘red neurons”
polymorphonuclear leukocytosis
monocytes [macrophages]
Gliosis

27
Q

What type of stroke [embolic, hemorrhagic, thrombotic] hast the fastest onset?

A

Embolic stroke

28
Q

What condition causes an emboli from the heart?

A

from left atrium in AFib
Endocarditis
Cardiac surgery
prosthetic or damaged valves (rheumatic fever, calcific aortic valve disease)

29
Q

What are four possible causes of emboli?

A

Atheromatous plaques (carotid arteries)
The heart
fat emboli
Gas

30
Q

Describe gas as a possible source of emboli

A

Air or nitrogen as emboli seen in decompression sickness

31
Q

Describe fat as a possible source of emboli

A

Fat emboli as a result of trauma [stained with Oil-red O]

32
Q

What type of stroke is associated with Fat emboli?

A

multiple petechial haemorrhages in the grey and white matter

33
Q

What structures are common affected by intracerebral hemorrhage?

A

Basal Ganglia, Cerebellum

34
Q

What is the leading cause of intracerebral hemorrhage?

A

HTN

35
Q

What is the prognosis of intracerebral hemorrhage?

A

Lethal conditions but the hematoma can slowly be resorbed over months with from restitution of function

36
Q

What are causes of Subarachnoid hemorrhage?

A

Rupture of Congenital [Berry Aneurysmd]
Atherosclerotic and mycotic aneurysms
AV malformation

37
Q

What is the prognosis of Berry Aneurysms?

A

Mortality is high. Re-bleeding is common in survivors.
Resorption of blood may lead to meningeal fibrosis & hydrocephalus

38
Q

What increases the likeness of a berry aneurysms to “rupture” ?

A

probability increases with size of aneurysm + incidence acutely increases in intracranial pressure [straining at stoll, sex]

39
Q

What arteries are commonly implicated in Berry Aneurysm?

A
40
Q

What types of strokes are associated with Hypertension?

A

Intracerebral hemorrhage

Lacunar infarcts [basal ganglia]

41
Q

What is the clinical significance of Lacunar Infarcts?

A

can be silent or cause serious impairment

42
Q

What arteries are implicated in lacunar infacrts?

A

lenticulostriate arteries of internal capsule, Putamen, thalamus, pontine tegmentum, cerebellum.

43
Q

Describe the gross morphology of lacunar infarcts

A

Small often cystic infarcts

44
Q

What is a common site of hemorrhage in hypertensive patients?

A

Basal Ganglia

CNS (10 decks)

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