Vascular Flashcards
Dolichoectasia
Arterial disease causing elongation, distension, and tortuosity most commonly occuring in the basilar artery with possible extension into the vertebral artery. Other common sites are the supraclinioid segment of the internal carotid with possible extension into the MCA. Usually associated with atherosclerosis > Ehler-Danlo’s synd type IV, Marfan’s, pseudoxanthoma elasticum, and alpha 1 antitrypsin deficiency.
Charcot-Bouchard aneurysms
miliary aneurysms or micoraneurysms. Occur in samll arteries (100-300 um) in the putamen, globus pallidus, and thalamus > caduate, internal capsule, centrum semiovale, and cortical gray. Usually associated with HTN
MCA Infarction
Insula, upper temporal lobe and lower frontal-parietal lobe.
ACA infarction
Midline extending from the frontal tip and along the cingulate gyrus
Venous infarction
The brain has very good venous collaterals. Therefore, thrombosis must usually be fairly extensive before an infarction can be resulted. Common sites are: superior sagittal sinus (72%), lateral sinuses (70% combined), and straight sinus (13%). Thrombosis commonly extends to several sinuses and veins. Thrombosis of cerebral veins, especially the cortically ones, rarely results in tissue damage, but thrombosis of the deep internal veins and the great vein of Galen may cause severe damage to the basal ganglia and brain stem. Macroscopically, the hemorrhagic infarct may extend from the thrombosed vein to the white matter. Venous infarction usually leads to a triangular shaped infarction with the tip of the triangle at the white matter.
Paravertebral venous plexus of Batson
extensive system of venous channels both within and alongside the spinal canal providing direct communication from peritoneal sites and the lower body to the cranial cavity. There are no valves in Batson’s plexus and flow may be bi-directional during the Valsalva maneuver or a change of body position. Venous infarction due to thrombosis of the Batson plexus is rather uncommon because of the large number of collaterals.
Laminar necrosis of the cortical gray matter
Due to global ischemia. The cortical gray matter ribbon seems to be exceptionally thin in some area and appears like a chalky thin line. The chalky appearance is resulted from the mineralization (calcification) of the necrotic cortex. These changes are particularly prominent in the so-called borderline zone between the ACA and MCA. These areas are most prone to hypoxic/ischemic changes due to fact that it is located at the far edge of both the anterior and middle cerebral artery territories.
There are other areas with necrosis and collapse in putamen and thalamus. It should be noted that patients surviving systemic hypotension and cardiorespiratory arrest with successful resuscitation often have necrosis of basal ganglia.
Cerebral amyloid angiopathy
Pathology of the case: Obviously, there is depositin of amyloid beta (Aβ) in the blood vessels. Cerebral amyloid angiopathy (CAA) is a vascular disease in which amyloid is deposited into the small vessels of the brain and leptomeninges, causing them to become thickened, rigid, and prone to rupture. CAA is a frequent cause of acute hemorrhage occurring in the cerebral hemispheres, in contrast to hypertensive hemorrhages which tend to occur in the pons, cerebellum, and deep gray nuclei.
On H&E staining, affected vessels will appear as rounded, rigidly open vessels, with eosinophilic material in the vessel wall. The presence of amyloid can be confirmed with a Congo-red stain, for which apple-green birefringence is confirmatory, or with beta-amyloid immunohistochemistry. These depositions are usually positive for P-component on IHC.
CAA is frequently found in patients with Alzheimer disease and should be included in the work up of autopsy brains for Alzheimer disease. CAA is not related to other forms of systemic amyloidosis.
Laminar necrosis
often seen in lamina 3 and 5 where large neurons are present. Due to hypoxia/ischemia
Obstruction of anterior spinal artery
The anterior spinal artery supplies the central and anterior part of the spinal cord while the two posterior spinal arteries supply mainly the dorsal column. Infarction resulted from obstruction of the anterior spinal artery will lead to ischemic changes of the central part of the spinal cord, the anterior horn and the white matter surrounding the cord. The dorsal column should be spared.
Icelandic Cerebral Amyloid Angiopathy
aka Hereditary cystatin C amyloid angiopathy (HCCAA) is a rare, fatal amyloid disease in young people in Iceland caused by a mutation in cystatin C. Predisposing to intracerebral hemorrhage, stroke and dementia. The condition is inherited in a dominant fashion.
Dutch Cerebral Amyloid Angiopathy
The Dutch type of hereditary cerebral amyloid angiopathy is the most common form. Stroke is frequently the first sign of the Dutch type and is fatal in about one third of people who have this condition. Survivors often develop dementia and have recurrent strokes. About half of individuals with the Dutch type who have one or more strokes will have recurrent seizures (epilepsy). APP gene
Iowa Cerebral Amyloid Angiopathy
Iowa type. This type is characterized by memory loss, problems with vocabulary and the production of speech, personality changes, and involuntary muscle twitches (myoclonus). APP gene
Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL)
an inherited condition that causes stroke and other impairments caused by mutations in the HTRA1 gene. It is inherited in an autosomal recessive pattern.
Abnormalities affecting the brain and other parts of the nervous system become apparent in an affected person’s twenties or thirties. Often, muscle stiffness (spasticity) in the legs and problems with walking are the first signs of the disorder. About half of affected individuals have a stroke or similar episode before age 40. As the disease progresses, most people also develop mood and personality changes, dementia, memory loss, and worsening movement problems. Other characteristic features include premature hair loss (alopecia) during adolescence and vertebral disc degeneration with low back pain.
Familial British and Danish dementia
ITM2B/BRI2 located on chromosome 13 inhibits APP processing and reduces amyloid beta peptide deposition
