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NS Pathology > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke تعريف

A

Acute neurological dysfunction occurring as a result of a vascular process, causing death or lasting damage

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2
Q

TRANSIENT ISCHEMIC ATTACK (TIA)

A

Transient episode of neurologic dysfunction caused by focal brain ischemia, lasting
between few minutes to 24 hrs, without acute infarction & without loss of consciousness.» high risk of developing stroke

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3
Q

Global Hypoxic/Ischemic encephalopathy due to

A

generalized decrease in cerebral blood flow

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4
Q

Features of global hypoxia: Selective Vulnerability of neurons in certain locations:

A

• Pyramidal cells in hippocampus
• Purkinje cells of the cerebellum
• Neurons in basal ganglia
• Cortical neurons especially in arterial boundary zones

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5
Q

Watershed (Borderzone) infarcts include:

A
  1. Boundary between anterior & middle cerebral arteries (Cerebral Convexities)
  2. Boundary between superior & posteriorcerebellar arteries (Posterior cerebellum)
  3. Necrosis few centimeters lateral to interhemispheric fissure.
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6
Q

Acute Global Hypoxic/Ischemic encephalopathy

A

after 12 hrs

layers 4-6 of cortex (RED NEURONS )

neutrophils

glial cell death

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7
Q

Subacute changes Global Hypoxic/Ischemic encephalopathy

A

24 hrs –2 weeks

tissue necrosis, macrophages & gliosis

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8
Q

Global Hypoxic/Ischemic encephalopathy

Repair after 2 weeks

A

irregular neuronal loss, gliosis & brain atrophy

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9
Q

Global Hypoxic/Ischemic encephalopathy outcomes depend on

A

Age, Duration of ischemia, Magnitude and rapidity of reduction of flow

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10
Q

Result of Global Hypoxic/Ischemic encephalopathy

A

varies from persistent neurological deficit to brain death → Deep coma & flat EE.

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11
Q

Focal brain necrosis due to complete and prolonged ischemia that affects all tissue
elements; neurons, glia, and vessels

A

INFARCTION (Focal Ischemia)

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12
Q

Risk factors of infarction

A

Family history of stroke: Genetic marker

Patients with TIA > increased Infarction in 5 years

Infarcts account for 80% of CVA

• Atherosclerosis
• Diabetes, Hypertension,age, hyperlipidemia
• Cardiac arrhythmias & Cardiomyopathy
• Hypercoagulable states
• Smoking
• Use of contraceptive pills
• Cerebral amyloid angiopathy
• Vasculitis: inflammatory or autoimmune

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13
Q

may lead to multiple small infarcts and more common

A

Embolism is more common than thrombosis

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14
Q

Other emboli are

A

fat, bone marrow, air, amniotic fluid

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15
Q

Histopathologic progression of CNS infarcts

A

1) EDEMA
2) “RED” NEURONS
3) POLYs(neutrophils)
4) MACROPHAGES (gitter cells) : clear damage , Can result in cyst and atrophy
5) GLIOSIS

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16
Q

Clinical picture of patient with INFARCTION (Focal Ischemia)

linked to site of infarction

A

• Contralateral hemiparesis
• Spasticity (UMNL)
• Loss of sensation
• Visual field abnormalities
• Aphasia (broca area in dominant hemisphere)

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17
Q

Mechanisms leading to infarction:

A

Thrombotic occlusion: Ischemic/ pale

• Embolic occlusion: hemorrhagic/ red

18
Q

Thrombotic occlusion

Where

A

o Carotid bifurcation
o Origin of middle cerebral artery
o Basilar artery at either end

19
Q

Embolic occlusion

Source + where

A

o Source: heart or atherosclerosis in carotid

o Middle Cerebral a. most affected

20
Q

Traumatic vascular injuries

A

Epidural Hemorrhage

Subdural hemorrhage

21
Q

Most occur with change head velocity e.g. boxers, battered baby & old age

Subdural hemorrhage or Epidural Hemorrhage

A

Subdural hemorrhage

22
Q

Disruption of Bridging Veins from brain to dural sinuses, more over convexities

Subdural or epidural

A

Subdural

23
Q

Which More common

A

Subdural

24
Q

Patient has short LUCID interval followed by rapid loss of consciousness

Epidural or subdural

A

Epidural Hemorrhage

25
Q

Cant cross suture, lens-shape

Epi or sub

A

Epidural

26
Q

Epidural Hemorrhage

Causes

A

Rupture of middle meningeal artery

acute & accompanied by skull fracture

Seen in 3% of significant trauma

27
Q

Fatal within 24 – 48 hrs. if untreated and treated by craniectomy

Subdural or epidural

A

Epidural Hemorrhage

28
Q

INTRACRANIAL HEMORRHAGE

A

Primary Intracerebral Hemorrhage:

Subarachnoid Hemorrhage:

29
Q

Subarachnoid Hemorrhage:
Causes

A
  1. Ruptured saccular (berry) aneurysm
  2. Arteriovenous malformation
  3. Hemangioma, telengiectasia
30
Q

Most common cause of primary intracerebral hemorrhage by 50% is

A

HT ارتفاع الضغط

31
Q

Most common cause of spontaneous subarachnoid hemorrhage F  M , age < 50 y

A

Ruptured saccular (berry) aneurysm

32
Q

Clinical signs of Subarachnoid Hemorrhage

A

• Headache, lethargy, photophobia, fever, neck rigidity.
• Focal deficit may be present depending on site of hematoma.

33
Q

• “Worst headache of my entire life” with loss of consciousness

When patient said this, that’s mean any case?

A

Ruptured saccular (berry) aneurysm.

34
Q

Ruptured saccular (berry) aneurysm
At any age group ???
Induced by ??

A

4th
- 5th decade, at apex, induced by straining, labour

35
Q

Ruptured saccular (berry) aneurysm.

A

• In 1/3 of cases rupture initiated by acute increase in intracranial pressure
• Up to 90% in anterior & middle part of Circle of Willis, arise in arterial bifurcations

36
Q

Genetic Conditions Associated with Saccular Aneurysms

A

o Polycystic kidney disease (autosomal dominant)
o Defects in extracellular matrix proteins e.g. Marfan’s syndrome

37
Q

Non-genetic Conditions Associated with Saccular Aneurysms

A

Coarctation of aorta

38
Q

Predisposing conditions Conditions Associated with Saccular Aneurysms

A

o Hypertension (fluctuation)
o Cigarette smoking (present in 54% of patients)

39
Q

INTRACRANIAL HEMORRHAGE
According to location, divided into:

A

Intracerebral
• Subarachnoid
• Epidural & Subdural

40
Q

INTRACRANIAL HEMORRHAGE of According to pathogenesis

A

• Primary hemorrhage
• Secondary to: infarcts, tumors or trauma

NS Pathology (3 decks)

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