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Cerebrovascular Disease Flashcards

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1
Q

Two forms of cerebrovacular disease ?

A

1) Hypoxia, Ischemia, infarction; impairment of blood supply and oxygenation of CNS tissue
2) Hemorrhagic; rupture of CNS vessels

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2
Q

Common etiology of CNS infarction?

A

Embolism, can be global or focal

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3
Q

Common etiologies of hemorrhagic accident in the CNS

A
  • Hyoertension
  • Vascularanomalies (aneurysms and malformations )
  • trauma
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4
Q

Stroke is defined as ?

A

Sudden onset of neurological deficit resulting from hemorrhage or or focal ischemia

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5
Q

Epidemiology of cerebrovadcular disease?

A
  • their most common cause of death: (after heart disease and cancer)
  • most common cause of neurological morbidity and mortality
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6
Q

Biological process that takes place in ischemia?

A

Ischemia leads to
- ATP Depletion
- loss of membrane potential needed for neuronal electrical activity
- elevation of cytoplasmic calcium levels
- inappropriate release of excitatory amino acid neurotransmitters that cause cell damage via calcium influx
- Glutamate release through N methyl D aspartate type glutamate receptors (NMDA)

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7
Q

Zones of ischemic injury

A

1) umbra - necrotic tissue
2) penumbra - At risk tissue

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8
Q

Clinicalpathologic form of CVD includes?

A
  • Global cerebral ischemia (diffuse ischemic encephalopathy)
  • Transient ischemic attack ( TIA)
  • Stroke ( hemorrhagic or ischemic )
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9
Q

Causes of diffuse ischemic encephalopathy

A
  • fall in blood flow to the brain (shock, cardiac arrest, hypotension)
  • Infarcts in watershed areas (between anterior and middle cerebral arteries)
  • Damage to vulnerable regions (purkinje neurons, hippocampus pyramidal cell layer -CA1 (sommer sector), pyramidal neurons of the cortex )
  • cortical laminar necrosis *(diffuse ischemic necrosis of the neocortex, may lead to brain death)
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10
Q

Morphological features of DIE

A
  • Gross; ischemic areas are edmatous with widened gyri and narrowed sulci
  • Loss of hey and white matter differentiation
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11
Q

Pseudo-laminar necrosis pattern is formed from?

A

Uneven cortical neuronal loss and gliosis alternating with preserved zones

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12
Q

TIA symptoms last for about how many hours?

A
  • less than 24hrs
  • Due to small platelet thrombi or artheroemboli
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13
Q

Infarction (85%) in stroke can be due to ?

A

1) thrombotic occlusion
- atherosclerosis of the cerebral arteries
- leads to anemic /white infarcts
2) embolic occlusion
- leads to hemorrhagic infarcts
- throboemboli from cardiac chambers
3) small-vessel disease
- related to hypertension
- hyaline atherosclerosis
- leads to lacunae infarcts/lacunae

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14
Q

Inflammatory process that leads to infarction include?

A
  • Infectious vasculitis
  • Polyarteritis nodosa
  • Primary angitis of the CNS
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15
Q

Microscopic changes associated with cerebral infarction

A

Microscopy**:
- Red neurons (12-24hrs after injury)
- neutrophilic infiltration (24-48hrs)
- histiocytic infiltration and disappearance of neurons (2-10days)
- liquefactive necrosis, histiocytes filled with products of myelin breakdown (2-3weeks)
- fluid filled cavity, reactive astrocytes, lipid-layden macrophages (glitter cells) (3 wks- 1 month )
- Reactive gliosis (astrogliosis) - (years after)

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16
Q

Gross changes associated with infarction

A
  • Little to no change in cerebrum (0 - 24hrs)
  • Indistinct gray-white mater junction (24-48hrs)
  • friable tissue with marked edema (2-10days)
  • tissue liquefies (2-3weeks)
  • fluid filled cavity demarcated by gliotic scar (3weeks to months)
  • old cyst surrounded by gliotic scar (years)
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17
Q

What causes white infarcts and red infarcts?

A

Thrombosis - white infarcts (anemic infarcts)
Embolism - red infarcts ( hemorrhagic infarcts)

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18
Q

Lacunae Infarcts Commonly affect?

A
  • The putamen and caudate
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19
Q

Intra-cerebral hemorrhage / Intraparenchymal hemorrhage most commonly caused by?

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A

Hypertension:
- Basal ganglia (putamen in 50% - 60% of cases)
- Thalamus, pons, centrum semiovale and cerebellum rarely

20
Q

Other causes of intracerebral hemorrhage?

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A
  • Vascular malformations (AVMs)
  • Cerebral amyloid angiopathy
  • Neoplasms
  • Vasculitides
  • Abnormal hemostasis
  • Hematological malignancies
  • Infection
21
Q

Symtoms of hemorrhagic strike?

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A
  • Severe headache
  • Frequent projectile vomiting and nausea
  • Steady progression of symtoms over 15-20mins
  • Coma
22
Q

Intracerebral hemorrhage account for how many percentage of death in chronic hypertensive patients ?

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A
  • 15% of death in chronic hypertensive patients
23
Q

How does hyoertension lead to hemorrhagic stroke ?

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A

1) hypertension leads to weakening of the vessel through hyaline arteriosclerosis
2) Focal vessel necrosis
3) formation of micro-aneurysms (Charcot Bouchard aneurysms)

24
Q

The second most common etiology of Intraparenchymal hemorrhage is ??

Study These Flashcards
A

Cerebral amyloid angiopathy (CAA)

  • Amyloidogenic oeotide deposit in vessel walls leading to weakening of vessels.
    Similar to that in Alzheimer’s disease
25
**stiff Amyloid** deposition characteristically involves the?
**leptomeningeal** and **cerebral cortical vessels**
26
A rare form of.stroke caused by NOTCH3 receptor mutation is ?
CADASIL - **cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy** - *abnormal folding of extra cellular membrane* - concentric medial and adventitial thickening - Basophilic **granular osmophilic deposits** and smooth muscle dropout
27
Most common cause of SAH?
**Ruptured berry aneurysms** - extension of intracerebral/subdural hematoma - vascular malformations - trauma - hypertensive intracerebral hemorrhage - abnormal hemostasis tumors
28
Symptoms of SAH?
- **Thunderclap headache** - Nuchal rigidity - Neurological deficiency on one side - Stupor
29
Berry aneurysms are ?
- **Thin walled saccular out-pouching**, consisting of **intima** and **adventitia** only - congenital focal weakness of an artery, not identifiable at birth - occur in 2% of the population - 20-30% of patients have multiple aneurysms - most cases are sporadic
30
Most common site of berry aneurysms is?
The **anterior circle of willis** at branching points - Anterior cerebral artery branching
31
Disorders associated with berry aneurysms ?
- Marfan syndrome - Ehler Danlos syndrome type 4 - Neurofibromatosis type 1 - Fibromuscular dysplasia - Adult polycystic kidney disease
32
Risk factors for berry aneurysms?
- Cigarette smoking - Hypertension
33
Epidemiology and prognosis go berry aneurysms
- Rupture is precipitated by sudden increase in blood pressure - slightly more common in women in 5th decade of life - prognosis; 1/3 Die, 1/3 recover, 1/3 rebleed
34
List the vessels involved in the different type of Cerebral hemorrhages?
- Epidural hematoma - ***middle meningeal artery*** - subdural hematoma - ***Bridging veins*** - subarachnoid hemorrhage - ***Berry aneurysm rupture*** - Intraparenchymal hemorrhage- ***chronic hypertension***
35
The most important effects of hypertension on the brain include ?
- Lacunar infarcts - slit hemorrhages - hypertensive encephalopathy - massive hypertensive intracerebral hemorrhage
36
What are lacunar infarcts?
**Small (<15mm) cystic infarcts** resulting from cerebral **arteriolar sclerosis** and **occlusion** Tissue loss is accompanied by Lipid laden macrophages and surrounding gliosis
37
Most commonly affected spots in lacunar infarcts?
- **Lenticular nucleus** - Thalamus - Internal capsule - Deep white matter - Caudate nucleus - Pons
38
Slit hemorrhages occur when?
Occurs when hypertension causes **small vessels rupture** They resorb but leave residual **hemosiderin laden macrophages** and associated **gliosis**
39
AHE (Acute hypertensive encephalopathy) is defied as?
- Clinicooathological syndrome caused by **Increased ICP** - Manifest as **Diffuse cerebral dysfunction** - headcahe, confusion, projectile vomiting, convulsions, coma - post mortem examination; ***edematous brain***, occasionally with ***herniation***, ***Petechiae*** and ***anterior fibrinoid necrosis***
40
Vascular (Multi-infarct) dementia so
Caused by Recurrent small infarcts Characterized by - dementia - gait abnormalities - Pseudobulbar signs
41
Causes of vascular dementia?
- Cerebral atherosclerosis - Vessel thrombosis or embolization - Cerebral arteriolar sclerosis
42
Binswanger disease - Chroninc hypertensive injury
- recurrent ischemic injury involved a subcortical white matter - myelin and axonal loss
43
Primary Intraparenchymal hemorrhage are common in what regions of the brain?
- White matter - Deep gray matter - Posterior fossa contents
44
What are boundary zones of the brain?
Regions of the cerebrum with the **least robust vascular supply**
45
Dissolution of an embolism and the repercussion can result into?
**Hemorrhagic transformation** of ischemic infarct

Anatomic Pathology (12 decks)

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