56 Pathology: Vascular Abnormalities

Question 1

Histopathology of the Brain

• How long does it take for an irreversible hypoxic injury to become visible via H&E stains?
  
  • What happens to the cell body?
  • What happens to the nucleus?
  • What happens to the nucleolus?
  • What happens to the Nissl substance?
  • What happens to the cytoplasm?
    
    • What does this look like?

Answer 1

Question 2

Response to injury

• What is gliosis?
  
  • What type of glial cell is responsible for this?
  • What happens to the cytoplasm of these cells?

Answer 2

Question 3

Cerebrovascular Disease

• How prevalent are these diseases?
• What has happened to the incidence of deaths due to this, since 1950?

Answer 3

Question 4

Cerebrovascular Disease

• What group of people has an increased risk for this?

Answer 4

Question 5

Cerebrovascular Disease

• What are the three main pathogenic mechanism for this?
  
  • Which one does the term “stroke” apply to?
  • Which 2 have similar consequences for the brain?
  • Which one is associated with hemorrhage?

Answer 5

Question 6

Hypoxia, Ischemia, and Infarction

• What is the brain’s:
  
  • percentage of body weight
  • percentage of cardiac output
  • percentage of total oxygen consumption

Answer 6

Question 7

Hypoxia, Ischemia, and Infarction

• What are the 2 general mechanisms that the brain can be deprived of oxygen?
  
  • For the functional mechanism, what are the 3 main things that can cause it?
  • For the non0funcitonal one, one are the 2 main things that can cause it?

Answer 7

Question 8

Global Cerebral Ischemia

• This is usually due to hypotension.
  
  • What level of SBP does this occur at?
• What dictates the clinical outcomes of this?
  
  • Are neurons or glial cells more susceptible to hypoxic injury?
  • What 2 types of neurons are most susceptible to hypoxic injury?

Answer 8

Question 9

Global Cerebral Ischemia

• When this is severe enough, what state can patients be in?
• What is completely absent in brain death?
  
  • What is a espirator brain?

Answer 9

Question 10

Global Cerebral Ischemia

• What happens to the gyri and sulci in the brain?

Question 11

Global Cerebral Ischemia

• Morphology
  
  • What kind of necrosis occurs when cells die in the CNS due to hypoxia?

Answer 11

Question 12

Global Cerebral Ischemia

• What are the three categories associated with the histopathological changes in irreversible ischemic injury/infarction?

Answer 12

Question 13

Global Cerebral Ischemia

• Morphology
  
  • When do early changes occur?
  • What do cells look like?
  • What cells infiltrate the damaged tissue?

Answer 13

Question 14

Global Cerebral Ischemia

• Morphology
  
  • When do subacute changes occur?
  • What happens to the tissue?
  • What cells infiltrate the tissue?
  • What happens to the vascularity of the area?
  • What happens to glial cells?

Answer 14

Question 15

Global Cerebral Ischemia

• Morphology
  
  • When does repair occur?
    
    • What 2 processes occur during this phase?

Answer 15

Question 16

Global Cerebral Ischemia

• Morphology
  
  • What are border zone aka watershed infarcts?
    
    • When do these often occur?
    • Where in the cerebral hemispheres have the greatest risk for this?

Answer 16

Question 17

Focal Cerebral Ischemia

• What leads to this?
• What happens after it?
• How can damage from focal cerebral ischemia be diminished?
  
  • What structures are responsible for this?

Answer 17

Question 18

Focal Cerebral Ischemia

• Are embolic or thrombotic infarctions more common?
  
  • What is a common source for emboli?
  • Where do thromboembolic usually arise from?
  • What is a paradoxical embolism?

Answer 18

Question 19

Focal Cerebral Ischemia

• What artery is a direct extension of the internal carotid?
  
  • How does the answer to the above question relate to embolic infarctions?
• Where do emboli tend to lodge?

Answer 19

Question 20

Focal Cerebral Ischemia

• What usually accompanies thrombotic occlusions?
• What arteries are associated with thrombotic occlusions? (3)

Answer 20

Question 21

Focal Cerebral Ischemia

• What are lacunar infarcts?
• What is hyaline arteriolar sclerosis?

Answer 21

Question 22

Focal Cerebral Ischemia

• What are the two broad groups of infants based on?
  
  • What group is first?
  • What does petechial mean?

Answer 22

Question 23

Focal Cerebral Ischemia

• GROSS Morphology of NONHEMORRHAGIC INFARCTS
  
  • What happens to the issue after
    
    • 6 hours
    • 48 hours
    • 2-10 days
    • 10 days to 3 weeks

Answer 23

Question 24

Focal Cerebral Ischemia

• Microscopic Morphology
  
  • What is seen after 12 hours?
  • What cells infiltrate during the first few days after the injury?
    
    • What happens after 2-3 weeks? Months to years?
  • What happens to the astrocytes over time?

Answer 24

Question 25

Focal Cerebral Ischemia * Clinical Features * What determines the deficits produced by an infarction? * What is the timeline for deficits?

Answer 25

Question 26

Intracranial Hemorrhage * Primary Brain Parenchymal Hemorrhage * Spontaneous Intraparenchymal Hemorrhage * When are these most common in life? * What is the cause of most of these? * What condition accompanies this? * When are these most clinically devastating?

Answer 26

Question 27

Hypertensive Intraparenchymal Hemorrhages * What does HTN do to the deep penetrating arteries and arterioles that supply the basal ganglia, white matter, and brain stem?

Answer 27

Question 28

Hypertensive Intraparenchymal Hemorrhages * What structure are do these usually occur in? (4)

Answer 28

Question 29

Parenchymal Hemorrhages * What is Cerebral amyloid angiopathy? * What does this do to the parlance of vessels? * What stain is associated with this? * How do the associated hemorrhages differ compared to HTN-associated hemorrhages?

Answer 29

Question 30

Subarachnoid Hemorrhage * What is the most common cause of nontraumatic subarachnoid hemorrhages?

Answer 30

Question 31

Subarachnoid Hemorrhage * What is the cause of about 1/3 of Subarachnoid Hemorrhage? * How do patients present with these?

Answer 31

Question 32

Subarachnoid Hemorrhage * Saccular Aneurysms * Where do most of these (90%) of these occur? * What 2 arteries are most implicated in these? * How often do people have multiple aneurysms?

Answer 32

Question 33

Subarachnoid Hemorrhage * Saccular Aneurysms * Are people born with these? * What genetic conditions give people an increased risk for these?

Answer 33

Question 34

Subarachnoid Hemorrhage * Saccular Aneurysms * What does this do to the wall of the artery? * What is notable about the muscular wall and intimal elastic lamina of the arterial wall? * What about the hylanized intima? * What part of the sac usually ruptures?

Answer 34

Question 35

Vascular Malformations * What are the 4 groups of vascular malformations? * Which one is the most dangerous? * Which one is most common? * For the answer to the above question: * Who does this affect more; males or females? * What age does this usually present at? * What symptoms/conditions accompany these malformations?

Answer 35

Question 36

Vascular Malformations * What genetic condition is commonly associated with multiple AVMs? * What kind of inheritance pattern does this condition have? * What pathway is mutated in this condition?

Answer 36

Question 37

Vascular Malformations * AVMs * What vessels can be involved in these? * Can these occur exclusively in the brain? * What do these look like grossly?

Answer 37