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Neuro Exam 2 > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

Hypoxic/Ischemic separates into those conditions that involve a lack of oxygen delivery to the entire brain, ______ischemia (e.g. watershed infarcts, selective vulnerability), and those affected by a lack of blood flow and oxygen delivery to an area of the brain, ______ ischemia (e.g. thrombotic or embolic infarcts)

A

Hypoxic/Ischemic separates into those conditions that involve a lack of oxygen delivery to the entire brain, global ischemia (e.g. watershed infarcts, selective vulnerability), and those affected by a lack of blood flow and oxygen delivery to an area of the brain, focal ischemia (e.g. thrombotic or embolic infarcts)

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2
Q

—Hypertension is associated with hemorrhages due to ______ in the wall of affected blood vessels (e.g. basal ganglia and pons) perhaps due to microaneurysms, lacunar infarcts, and encephalopathy/dementia.

A

—Hypertension is associated with hemorrhages due to breaks in the wall of affected blood vessels (e.g. basal ganglia and pons) perhaps due to microaneurysms, lacunar infarcts, and encephalopathy/dementia.

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3
Q

—Insufficient oxygen delivery is known as _____

A

Hypoxic injury or ischemia

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4
Q

When blood exits through the vessel wall, it is called ____

A

hemorrhage

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5
Q

_____ is an example of global ischemia

A

cardiac arrest

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6
Q

Pathology of global ischemia:

—Selective vulnerability

_____ Infarction

—Laminar Necrosis

_____ Brain

A

Pathology of global ischemia:

—Selective vulnerability

—Watershed Infarction

—Laminar Necrosis

—Respirator Brain

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7
Q

Laminar necrosis: death of cells in the ____ cortex in a ___-like pattern

A

Laminar necrosis: death of cells in the cerebral cortex in a band-like pattern

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8
Q

Areas most at risk for oxygen deficit:

—1. _________ – Sommer sector (most susceptible)

—2. Cerebellum – _______ cells (2nd most susceptible)

—3. Cortex

A

Areas most at risk for oxygen deficit:

  1. —Hippocampus – Sommer sector (most susceptible)
  2. —Cerebellum – Purkinje cells (2nd most susceptible)
  3. —Cortex
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9
Q

What is seen in this image?

A

global ischemia: red neuron change

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10
Q

What is seen in this image?

A

Watershed infarction

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11
Q

Watershed infarction

Global ischemia injury

—Occurs with ______and subsequent reperfusion

—Areas between arterial territory are dependent on flow from both arteries (no terminal anastomoses)

—With low flow, this area becomes ischemic

—Reperfusion causes leaking of blood through damaged vessels – ______

—Often bilateral

A

Watershed infarction

Global ischemia injury

—Occurs with hypoperfusion and subsequent reperfusion

—Areas between arterial territory are dependent on flow from both arteries (no terminal anastomoses)

—With low flow, this area becomes ischemic

—Reperfusion causes leaking of blood through damaged vessels – hemorrhagic

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12
Q

—Global ischemia- Laminar Necrosis:

  • Layers of the cortex vary in their sensitivity to ischemia/hypoxia
  • —Penetrating vessels from _____ form plexus in layers V and VI (Rubin)
  • —Decrease in blood pressure leads to decreased _____ in plexus
  • —Necrosis in a _____ pattern results
A

—Global ischemia- Laminar Necrosis:

  • Layers of the cortex vary in their sensitivity to ischemia/hypoxia
  • —Penetrating vessels from pia form plexus in layers V and VI (Rubin)
  • —Decrease in blood pressure leads to decreased perfusion in plexus
  • —Necrosis in a linear pattern results
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13
Q

What does this image show?

A

Laminar necrosis

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14
Q

Respirator Brain

  • —With severe ischemic or other injury, brain _____ is severe
  • —With edema, intracranial pressure is markedly ____
  • —If ICP exceeds _____pressure, blood flow to the brain (hemispheres and other parts of brain) stops
  • —Brain undergoes autolysis (i.e. no blood flow)
  • —EEG shows no cerebral activity. This correlates with brain death.
A

Respirator Brain

  • —With severe ischemic or other injury, brain edema is severe
  • —With edema, intracranial pressure is markedly increased
  • —If ICP exceeds venous pressure, blood flow to the brain (hemispheres and other parts of brain) stops
  • —Brain undergoes autolysis (i.e. no blood flow)
  • —EEG shows no cerebral activity. This correlates with brain death.
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15
Q

Focal Ischemia- Atherosclerosis with thrombosis

  • _____ vessels
  • —_____ onset possible (occlusion doesn’t have to be sudden)
  • —Anemic/Pale
  • —Less likely to reperfuse – less likely to be _____
  • —Usually single territory
A

Focal Ischemia- Atherosclerosis with thrombosis

  • —Larger vessels
  • —Slower onset possible (occlusion doesn’t have to be sudden)
  • —Anemic/Pale
  • —Less likely to reperfuse – less likely to be hemorrhagic
  • —Usually single territory
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16
Q

Focal Ischemia- Embolic stroke:

  • —Source – Clots from elsewhere
    • —Mural Thrombus
    • —Heart valves
    • —Through openings in heart (e.g. foramen ovale) – from vessels in body
    • —Carotid arteries
  • —Occlusion possible from air, fat, and other substances
  • —Often ______
  • —Blood clots are more likely to _____than thrombotic
  • —Often _____ (from shower of emboli)
A

Focal Ischemia- Embolic stroke:

  • —Source – Clots from elsewhere
    • —Mural Thrombus
    • —Heart valves
    • —Through openings in heart (e.g. foramen ovale) – from vessels in body
    • —Carotid arteries
  • —Occlusion possible from air, fat, and other substances
  • —Often hemorrhagic
  • —Blood clots are more likely to dissolve than thrombotic
  • —Often multiple (from shower of emboli)
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17
Q

What does this image show?

A

Embolism

18
Q

What does this image show?

A

Aspergillus (fungus)

19
Q

Venous infarction: blockage of outflow

  • —Often involves _____sinus
  • —Bilateral
  • —Very _____
A

Venous infarction: blockage of outflow

  • —Often involves sagittal sinus
  • —Bilateral
  • —Very hemorrhagic
20
Q

Acute Infarct Morphology

  • —Acute ischemic changes in neurons and other cells (______change) – 1st 2-3 days
  • —_____
    • —Can be marked with large infarcts
      • —Herniation
    • —Softening and increasingly friable
  • —Inflammation
    • —Fewer neutrophils than infarcts in other areas
    • —______start to appear on day 2 or 3

(___ days)

A

Acute Infarct Morphology (7-10 days)

  • —Acute ischemic changes in neurons and other cells (Red neuron change) – 1st 2-3 days
  • —Edema
    • —Can be marked with large infarcts
      • —Herniation
    • —Softening and increasingly friable
  • —Inflammation
    • —Fewer neutrophils than infarcts in other areas
    • —Macrophages start to appear on day 2 or 3
21
Q

What is shown in this image?

A

Acute infarction with severe edema

22
Q

What is shown in this image?

A

Hemorrhagic acute infarct

23
Q

What is shown in this image?

A

Acute infarction: edamatous area with vacuolization and ischemic changes in neurons

24
Q

Subacute infarcts- Morphology:

  • —Subacute (_____
  • —_____ become the predominate cell
    • —Liquefactive necrosis
    • —Thought to be from blood macrophages and activated microglia
    • —Engulf necrotic debris and leave
    • —Gross brain becomes more friable
    • —Surrounding tissue has astrocytic proliferation (_____)
A

Subacute infarcts- Morphology:

  • —Subacute (weeks)
  • —Macrophages become the predominate cell
    • —Liquefactive necrosis
    • —Thought to be from blood macrophages and activated microglia
    • —Engulf necrotic debris and leave
    • —Gross brain becomes more friable
    • —Surrounding tissue has astrocytic proliferation (gliosis)
25
Q

What does this image show?

A

Subacute infarction: friable infarct

26
Q

What does this image show?

A

Subacute infarction:

  • large number of macrophages
  • reactive gliosis at periphery
27
Q

Chronic infarct- morphology:

  • —Chronic (________)
  • —With macrophages leaving and removing necrotic tissue, a _____cavity results
  • —Cystic cavity is surrounded by _____
  • —Infarcted area of brain has less volume than normal brain
  • —_____ ex vacuo
  • —If hemorrhagic infarct, hemosiderin deposition
A

Chronic infarct- morphology:

  • —Chronic (months to years)
  • —With macrophages leaving and removing necrotic tissue, a cystic cavity results
  • —Cystic cavity is surrounded by gliosis
  • —Infarcted area of brain has less volume than normal brain
  • —Hydrocephalus ex vacuo
  • —If hemorrhagic infarct, hemosiderin deposition
28
Q

What does this image show?

A

chronic infarct with cystic area

29
Q

What does this image show?

A

chronic infarct with cystic area in putamen

30
Q

Arteriovenous malformation (AVM)

  • —abnormal and ____ connections (shunts) between arterial and venous
  • —Prone to bleed (high flow)
  • can lead to hemorrhages
A

Arteriovenous malformation (AVM)

  • —abnormal and enlarged connections (shunts) between arterial and venous
  • —Prone to bleed (high flow)
  • can lead to hemorrhages
31
Q

What does this image show?

A

a large AVM that has replaced much of the involved cerebral hemisphere

32
Q

—Rupture of aneurysm (abnormal dilation)

  • —Usually from a _____ (berry) aneurysm
    • —At bifurcations of branches of the circle of Willis (90% - anterior circulation)
      • —At bifurcation, ____ gap in smooth muscle
  • —Can be associated with fibromuscular dysplasia and genetic conditions
    • —Autosomal dominant polycystic kidney disease
    • —Ehlers-Danlos
    • —NF1
    • —Marfan
  • —Association with cigarette smoking and _____
  • —Rupture primarily leads to _____ hemorrhage, particularly in area around vessels
A

—Rupture of aneurysm (abnormal dilation)

  • —Usually from a saccular (berry) aneurysm
    • —At bifurcations of branches of the circle of Willis (90% - anterior circulation)
      • —At bifurcation, congenital gap in smooth muscle
  • —Can be associated with fibromuscular dysplasia and genetic conditions
    • —Autosomal dominant polycystic kidney disease
    • —Ehlers-Danlos
    • —NF1
    • —Marfan
  • —Association with cigarette smoking and hypertension
  • —Rupture primarily leads to subarachnoid hemorrhage, particularly in area around vessels
33
Q

What does this image show?

A

saccular aneurysms

34
Q

Where do 90% of saccular aneurysms occur?

A

from tip of basilar artery and anteriorly

35
Q

What does this image show?

A

Saccular aneurysm in common location (ACA)

36
Q

—Hypertensive hemorrhage

  • —Thought to be a result of chronic damage to the arterial wall, weakening, and rupture
  • —_______(Charcot-Bouchard) are thought by many to form as a result of the damage
  • —Can see lipohyalinosis – lipid and _____ deposition
  • —Most common sites
    • —Basal ganglia/Thalamus
    • —Pons
  • —Very destructive
  • —High mortality, if large and especially with rupture into ventricles
A

—Hypertensive hemorrhage

  • —Thought to be a result of chronic damage to the arterial wall, weakening, and rupture
  • —Microaneurysms (Charcot-Bouchard) are thought by many to form as a result of the damage
  • —Can see lipohyalinosis – lipid and hyaline deposition
  • —Most common sites
  • —Basal ganglia/Thalamus
  • —Pons
  • —Very destructive
  • —High mortality, if large and especially with rupture into ventricles
37
Q

What is seen in this image?

A

hypertensive hemorrhage

38
Q

—When intracranial pressure increases, systemic BP can increase in attempt by the body to sustain cerebral blood flow (______ reflex).

A

—When intracranial pressure increases, systemic BP can increase in attempt by the body to sustain cerebral blood flow (Cushing reflex).

39
Q

—Vascular dementia

—2nd (or 3rd) most common cause of dementia in U.S

—Results from damage to ____ matter in cerebral hemispheres secondary to _____

A

—Vascular dementia

—2nd (or 3rd) most common cause of dementia in U.S

—Results from damage to white matter in cerebral hemispheres secondary to hypertension

40
Q

What is shown in this image?

A

vascular dementia

41
Q

What is shown in this image?

A

White matter pallor and lacunar infarct

42
Q

What is shown in this image?

A

vascular dementia: vascular changes due to hypertension

Neuro Exam 2 (18 decks)

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