Stroke Flashcards
What are the common regions of the brain susceptible to hypertensive haemorrhage (vessels with hyaline arteriolosclerosis)?
Basal ganglia/thalamus
Lobar white matter (deep)
Cerebellum
Pons
What are the causes of intra cerebral haemorrhage?
Hypertensive small vessel disease (deep small vessels)
Congophilic amyloid angiopathy (superficial/peripheral vessels)
Blood disorders
Tumour
Vasculitis
Vascular malformation (arteriovenous malformations)
Drugs
Iatrogenic (following biopsy)
What is cerebral amyloid angiopathy?
Deposition of Abeta amyloid in the walls of superficial supratentorial blood vessels - associated with Alzheimer’s disease. Vessels are liable to rupture - - results in superficial haemorrhages - often recurrent
How do cerebral haemorrhages due to coagulopathies usually present and how are these different to hypertensive haemorrhages
With coagulopathies (ie leukaemias) you can see multiple focal haemorrhages at the same time which would be very rare for other causes of intracerebral haemorrhages
What are some common causes of subarachnoid haemorrhagic?
Trauma Rupture of aneurysms - saccular (Berry) - mycotic (infective) - atherosclerotic Extension of intracerebral haemorrhage
What are the risk factors for saccular/berry aneurysms?
Sex (more common in females) Increasing age PCOS Coarctation of aorta (congenital narrowing) Type 3 collagen deficiency Hypertension Smoking Alcohol
Where do saccular aneurysms commonly occur in the brain?
Sites of congenital weakness (arterial bifurcations)
- bi/trifurcation of MCA
- junction of ICA and post communicating
- anterior communicating artery (1/3rd)
Are saccular aneurysms more common in the anterior or posterior circulations?
Anterior
What are the complications of aneurysm rupture?
Subarachnoid haemorrhage (+/- intraparenchymal Cerebral oedema and raised ICP Vasospasm and infarction Obstruction of ventricles -> hydrocephalus
What are the risk factors for stroke?
Ageing Hypertension Cardiac disease (AF, patent interstitial septum, HF) Hyperlipidaemia Diabetes mellitus Hypercoagulable states Smoking Obesity
What are the 2 main causes of lacunae infarcts?
Small vessel disease:
Hypertensive (hyaline arteriolosclerosis) - deep vessels
Congophilic amyloid angiopathy (superficial supratentorial vessels)
What are the early macroscopic signs if cerebral infarction?
Cytotoxic oedema -> swelling (increased ICP) and risk of hernia toon
Loss of white/grey matter demarcation
Days to weeks after cerebral infarction what would you expect to see?
Reduced swelling
Liquifactive necrosis
Sharply demarcated infarct
Months to years following a stroke what would you expect to see macroscopically in a brain?
Cystic space - Liquifactive necrosis has been phagocytosed
