8.8 Cerebrovascular Disease

Question 1

• due to cardiac arrest, hypotension, suffocation, posisoning
• neurons most vulnerable, can occur in watershed areas
• CA1 of hippocampal formation, purkinje cells, pyramidal neurons

Answer 1

global ischemia

Question 2

12-24 hours after ischmia, microscopically see?

Answer 2

red neurons, microvacuolization, nuclear pyknosis

Question 3

12-48 hours after ischemia, microscopically see?

Answer 3

neutrophils

Question 4

48 hours to 2 weeks after ischemia, microscopically see?

Answer 4

macrophages, necrosis

Question 5

1 week to months after ischmia, microscopically see?

Answer 5

astrocytic proliferation

Question 6

chronic damage after ischemia, microscopically see?

Answer 6

glial scar, cyst, Wallerian degeneration

Question 7

gross changes in brain 48 hours after ischemia?

Answer 7

pale, soft, swollen

Question 8

gross changes 2-10 days after ischemia?

Answer 8

friable, demarcation

Question 9

gross changes 10-21 days after ischemia?

Answer 9

liquefaction

Question 10

in situ blood clot, majority due to atherosclerosis and plaque rupture, common sites are carotid bifurcation, MCA, and top/bottom of basilar artery

Answer 10

thrombosis

Question 11

mural thrombosis, valves, a. fib, carotid arteries, paradoxical, or fat/tumor/air

• lodge in branchpoints, mostly MCA
• petechial hemorrhages upon reperfusion

Answer 11

emboli

Question 12

• rigid encasement of brain or spinal cord
• can be vasogenic, cytotoxic, or interstitial
• due to tumor/infarct/hemorrhage/abscess/difffuse axonal injury

Answer 12

cerebral edema

Question 13

unilateral or asymmetric expansion of cerebral hemisphere displaces the cingulate gyrus under the falx, compresses ACA

Answer 13

subfalcine (cingulate) herniation

Question 14

medial aspect of temporal lobe is compressed against free margin of tentorium, CN III compression, PCA compression and occipital lobe infarct, midbrain and pons duret hemorrhage

Answer 14

transtentorial (uncal) herniation

Question 15

displacement of cerebellar tonsils through foramen magnum, brainstem compression compromising vital respiratory and cardiac centers in medulla

Answer 15

cerebellar tonsillar herniation

Question 16

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) due to mutation in _________, leads to dementia, depression, migraine w/ aura, and recurrent stroke

Answer 16

NOTCH3

Question 17

in CADASIL, the MRI shows ________ changes, and skin shows _________ changes and concentric thickening of media

Answer 17

white matter, basophilic PAS deposits

Question 18

arteriolar sclerosis due to HTN in deep nuclei, white matter, and brainstem; get lacunes in putamen, globus pallidus, deep white matter, caudate and pons

Answer 18

hypertensive CV disease

Question 19

-commonly due to HTN, leading to accelerated atherosclerosis, hyaline arteriolarsclerosis, and Charcot Bouchard aneurysms

Answer 19

intraparenchymal hemorrhage

Question 20

• lobar hemorrhages
• amyloid peptides deposited in walls of small vessels
• stains with Congo red

Answer 20

cerebral amyloid angiopathy

Question 21

tangled network of wormlike vascular channels, prominent pulstile AV shunting with high blood flow

Answer 21

AV malformation

Question 22

distended, loosely organized vascular channels arranged back to back with collagenized walls of variable thickness and no brain parenchyma b/w vessels
-low flow channels, foci of old hemorrhage, infarction, and calcification

Answer 22

cavernous angioma

Question 23

-microscopic, thin walled vascular channels separated by relatively normal brain parenchyma, usually in pons

Answer 23

capillary telangiectasia

Question 24

rupture of a saccular berry aneurysm in a cerebral artery, near major arteriolar branch point in anterior circulation (ACA and MCA)

• associated with ADPKD, NF1, marfan, ehler danlos
• risks: smoking and HTN

Answer 24

subarachnoid hemorrhage

Question 25

middle meningeal artery tear due to temporal skull fracture, extravasation of blood under arterial pressure can cause dura to separate from inner surface of skull, compression of brain

Answer 25

epidural hematoma

Question 26

• subdural space lies between the inner surface of dura and outer arachnoid layer
• bridging veins tear at any place they meet the dura
• lysis of clot in 1 week, growth of fibroblasts from dural surface into hematoma, development of hyalinized connective tissue

Answer 26

subdural hematoma