SDL: Vasculopathology

Question 1

some conditions associated with hypotension

Answer 1

myocardial infarct, ruptured aortic aneurysm, severe GI bleeding, bleeding from trauma, septic shock

Question 2

most sensitive areas to ischemic (red) neurons

Answer 2

Sommer’s sector of hippocampus, purkinje cells

Question 3

where does laminar necrosis occur?

Answer 3

watershed infarcts at border-zone areas

Question 4

characteristics of brain death

Answer 4

absence of perfusion, reflexes, respiration

isoelectric (flat) EEG

respirator brain- in vivo autolysis of brain when patient is kept alive by mechanical ventilation (good organ donors)

Question 5

causes of a focal hypoxia/ischemia episode

Answer 5

emboli occlusion, mural thrombus or vegetations from heart following an MI, neoplastic emboli

Question 6

most emboli go to this artery

Answer 6

middle cerebral artery

Question 7

causes of hemorrhagic infarction

Answer 7

occlusion of artery is incomplete, so there is recirculation of blood

embolus- breaks up, moves distally

extrinsic compression of artery

vasospasm

reperfusion of infarct

Question 8

treatment of hemorrhagic infarct

Answer 8

IR goes to the occluded artery using a catheter, administers tPA to lyse the thrombus

Question 9

most common cause of cerebrovascular accidents

Answer 9

atherosclerosis

Question 10

what happens to the infarcted tissue the first 12-24 hours? when is it considered an infarction?

Answer 10

red neurons, eosinophilic neuronal necrosis, acute neuronal injury

24 hours

Question 11

when do neutrophils infiltrate infarcted tissue?

Answer 11

2-7 days

Question 12

what happens when macrophages remove dead tissue?

Answer 12

leaves a cavity (6-8 weeks)

Question 13

the characteristic microscopic feature of subacute infarct

Answer 13

macrophages

Question 14

intracranial hemorrhages caused by trauma

intracranial hemorrhages caused by vascular pathology (and trauma)

Answer 14

epidural and subdural hemorrhages

intracerebral and subarachnoid hemorrhages

Question 15

main causes of intracerebral hemorrhage

Answer 15

hypertension, cerebral amyloid angiopathy, vascular malformations, vasculitis (rare)

Question 16

typical site of hypertensive hemorrhage

Answer 16

single, large hemorrhage in basal ganglia and thalamus, also in the pons

Question 17

second most common cause of intracerebral hemorrhage

Answer 17

cerebral amyloid angiopathy (CAA) same amyloid as Alzheimer’s; tends to cause hemispheric hemorrhages

Question 18

localized abnormal dilation of a blood vessel

Answer 18

aneurysm

Question 19

types of aneurysms

Answer 19

saccular (berry)- spherical, involving portion of wall

atheroschlerotic (fusiform)- entire circumference of vessel

mycotic- infections, septic emboli

dissecting (rare)- through the wall of vessel

Question 20

most common cause of non-traumatic bleeding in the subarachnoid space

Answer 20

saccular aneurysm

Question 21

dissecting aneurysms typically occur

Answer 21

at the point where the internal carotid enters the cranium

Question 22

types of vascular malformations, and which kinds are associated with hemorrhage

Answer 22

arteriovenous malformation and cavernous hemangioma are associated with hemorrhage

venous malformation and capillary telangectasis are not associated with hemorrhage

Question 23

this malformation has a popcorn appearance on radiology

Answer 23

cavernous angioma

Question 24

most common type of cerebral edema, and describe when it happens

Answer 24

vasogenic: fluid in extracellular space because of disruption of blood-brain barrier in infarct, hemorrhage, tumor, or trauma

Question 25

describe what cytotoxic edema is and what causes it

Answer 25

fluid in intracellular compartment because of cellular membrane injury

hypoxia, metabolic event like ketoacidosis

Question 26

sites of brain herniation

Answer 26

cingulate (subfalcine), uncal, tonsils of cerebellum, transcalvarial

Question 27

transtentorial herniation compresses

Answer 27

occulomotor nerve, posterior cerebral artery; causes unilateral pupillary dilation and hemorrhagic infarct in occipital lobe

Question 28

what is kernohan’s notch?

Answer 28

opposite side of brain stem is compressed against tentorium in a transtentorial herniation

Question 29

duret’s hemorrhage is caused by

Answer 29

compression and pushing of brain stem in a transtentorial herniation

Question 30

what happens to midbrain in transtentorial herniation?

Answer 30

anteroposterior elongation of midbrain