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Block 8 Week 4 Colt > Vascular Path of the CNS - Parks > Flashcards

Vascular Path of the CNS - Parks Flashcards

1
Q

what common bifurcating artery in the neck may occlude causing an ischemic stroke?

A

the carotid bifurcation

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2
Q

which part of an atherosclerotic plaque can break off and emobolize?

A

the outer, non calcified portions

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3
Q

What are the two common ways that common carotid stenosis can lead to embolization?

A
  1. fragment of the plaque itself breaks off and lodges in the brain
  2. PLT aggregates forms an embolus which lodges in the brain
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4
Q

Narrowing of the common carotid leads to what physical exam finding?

A

bruit

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5
Q

a thrombus or embolus will lead to (focal/global) ischemia

A

focal ischemia

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6
Q

infarcts of the internal capsule have what types of symptoms?

A

motor symptoms and hemiparesis

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7
Q

What are the common locations for focal embolus or thrombus?

A

carotid bifurcation
MCA
penetrating arteries

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8
Q

what happens to the brain that is downstream from an embolus?

A

it swells

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9
Q

What are the characteristics of a high risk plaque?

A

lipid rich
thin fibrous capsule
can rupture and thrombose

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10
Q

T/F: thrombosis due a high risk plaque rupture is an indication for the use of tPA

A

true

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11
Q

What happens when you rupture a high risk plaque?

A

complete occlusion of the artery

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12
Q

What ion enters the cell as it is dying which then leads to membrane damage, nuclear damage, and decreased ATP?

A

Ca

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13
Q

Explain how calcium enters dying neurons uncontrollably? what is this called?

A

EXCITATORY CYTOTOXICITY
Normally Na and Ca enter cells in small bursts due to glutamate. In stroke, surrounding neurons have released glutamate, but can’t take it back up because they’re dying, so the neurons are taking in more and more calcium from the glutamate

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14
Q

Mild ischemia leads to cell death via what mechanism while severe ischemia leads to cell death via….

A

mild: apoptosis
severe: necrosis

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15
Q

what type of free radicals are generated in ischemia?

A

nitrogen free radicals

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16
Q

what is the name for the tissue at risk?

A

penumbra

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17
Q

t/f: reperfusion of the penumbra will reduce the final size of the lesion

A

true

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18
Q

when looking at a histo slide of neurons from an ischemic stroke, why is there so much empty space between the neuons?

A

edema from cell injury

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19
Q

Edema post stroke peaks on what day?

A

2-3

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20
Q

edema post stroke can have a mass effect for how many days?

A

10

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21
Q

edema from a stroke can lead to what serious complication?

A

herniation

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22
Q

24-48 hours after a stroke, what type of infiltrate is present?

A

neutrophils

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23
Q

After day 10, what type of infiltrate is present in stroke tissue?

A

macrophages and microglia

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24
Q

An old infarct will see proliferation of what cell type because the brain doesn’t have fibroblasts?

A

astrocytes

25
Q

What is the name for brain scarring?

A

gliosis

26
Q

Gliosis become sites for future…

A

seizures

27
Q

Cystic degeneration means that you are looking at the area of an old…

A

infarct

28
Q

liquefactive necrosis leads to what type of degeneration?

A

cystic degen

29
Q

why do you want to stop A fib?

A

it can embolize to the brain

30
Q

What change to the heart valve can embolize and cause a stroke?

A

vegetations; they are friable

31
Q

where do vegetative emboli from the heart tend to lodge in the brain?

A

MCA

32
Q

you can find bacteria in the areas of infarct if the emboli was caused by…

A

infective endocarditis

33
Q

when do you get global ischemia?

A

follows cardiac arrest where no blood is being pumped
severe hypotension in shock, aka hypovolemic shock from blood loss
or ischemic/hypoxic encephalopathy

34
Q

loss of sulci on MRI is due to edema from….

A

global ischemia

35
Q

are neurons or glial cells more sensitive to ischemia?

A

neurons

36
Q

Describe neruonal vulnerability

A

neurons in different parts of the brain are more vulnerable to ischemia

37
Q

What is a watershed infarct?

A

an infarct due to global ischemia that occurs at the distal ends of the arteries where there is the least blood flow

38
Q

what are the two pathologic changes that occur in global ischemia?

A

watershed infarct

cortical laminar necrosis

39
Q

Border zone infarcts are aka

A

watershed infarcts

40
Q

What artery supplies the internal capsule and other deep brain structures?

A

the MCA

41
Q

The deeper the lesion in the brain, the (blank) it is

A

worse

42
Q

HTN will cause a hemorrhage into superficial or deep areas of the brain?

A

deep

43
Q

HTN accelerates what process that leads to MI and stroke?

A

atherosclerosis

44
Q

Blow out hemorrhages occur because of ….

A

uncontrolled HTN

45
Q

what is the name for the penetrating arteries of the brain?

A

lenticulostriate arteries

46
Q

What other organs besides the brain have small arteries coming off of a big hose?

A

kidneys and eye;

therefore the brain, kidneys, and eye are the most susceptible to HTN damage

47
Q

Lacunar infarcts can happen as a result of….

A

HTN

48
Q

T/F: lacunar infarcts are commonly asymptomatic

A

true

49
Q

what is notable about the symptom presentation of lacunar infarcts?

A

tend to be whole-body hemiparesis; face-arm-leg or arm-leg

50
Q

T/F: berry/saccular aneurysms pose no direct threat as long as they don’t rupture

A

true

51
Q

Are berry aneurysms acquired

A

no, all congenital

52
Q

Where do berry aneurysms commonly present in the circle of willis?

A
  1. anterior cerebral artery near anterior communicating
  2. MCA-either farther out or near posterior communicating
  3. Basilar-posterior junction
53
Q

Where does the blood go when a berry aneurysm ruptures?

A

either over the brain or into the brain

54
Q

What happens when a ruptured aneurysm bleeds over the brain?

A

subarachnoid hemorrhage

55
Q

When aneurysms rupture, you get a ….

A

strok

56
Q

What makes berry aneurysms worse?

A

HTN

57
Q

What disease is associated with aneurysms?

A

polycystic kidney disease

58
Q

The likelihood of an aneurysm to rupture is directly related to…

A

its size

59
Q

Ateriovenous malformations can rupture and cause a stroke with the first sign often being…..

A

a headache

Block 8 Week 4 Colt (7 decks)

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