Cerebrovascular Disease

Question 1

Where do intraparenchymal hemorrhages occur?

Answer 1

1) Basal ganglia (MOST common)

2) Internal capsule

Question 2

What causes intraparenchymal hemorrhages?

Answer 2

Systemic HTN, Charcot-Bouchard aneurysm of lenticulostriate vessels

Question 3

What are the 2 most vulnerable regions of brain to ischemia?

Answer 3

Hippocampus (pyramidal cells in layers 3, 5, 6) and Purkinje cells of cerebellum

Question 4

When is irreversible damage to the brain after hypoxia seen?

Answer 4

5 mins

Question 5

2 types of strokes?

Answer 5

Ischemic and hemorrhagic

Question 6

2 types of ischemic strokes?

Answer 6

Global and focal cerebral ischemia

Question 7

What causes global ischemia?

Answer 7

1) Atherosclerosis
2) Hypotension (shock)
3) Chronic hypoxia (anemia)
4) Repeated episodes of hypoglycemia (insulinoma)

Question 8

What occurs after 5-10 secs of cessation of cerebral blood supply?

Answer 8

LOC (syncope)

Question 9

What occurs after 1 min of cessation of cerebral blood supply?

Answer 9

Cessation of neural activity

Question 10

Where is cortical laminar necrosis seen?

Answer 10

Moderate global ischemia

Question 11

What are 3 causes of focal ischemia?

Answer 11

1) Thrombotic
2) Embolic
3) Lacunar

Question 12

What is an ischemic stroke?

Answer 12

Regional ischemia that results in focal neurologic deficits for >24 hrs

Question 13

What is a transient ischemic attack?

Answer 13

Brief reversible episode of focal neuro dysfunction with sxs lasting <24 hrs

Question 14

Where do you see a pale infarction at the periphery of the cortex?

Answer 14

Thrombotic stroke

Question 15

Where do you see hemorrhagic infarction at periphery of cortex?

Answer 15

Embolic stroke

Question 16

What are thrombotic strokes due to?

Answer 16

Ruptured plaque due to atherosclerosis

Question 17

What are embolic strokes due to?

Answer 17

A-fib, usually involves MCA

Question 18

What are lacunar strokes due to?

Answer 18

Secondary to hyaline arteriolosclerosis (HTN, DM) affecting the lenticostriate arteries)

Question 19

What is seen after 12-48 hrs?

Answer 19

Red neurons

Question 20

What is seen after 24-72 hours?

Answer 20

Neutrophils + necrosis

Question 21

What is seen after 3-5 days?

Answer 21

Macrophages that light up with oil red O

Question 22

What is seen after 1-2 weeks?

Answer 22

Reactive gliosis + vascular proliferation

Question 23

What is seen after >2 weeks?

Answer 23

Glial scar

Question 24

How do you treat ischemic strokes?

Answer 24

tPA within 4.5 hrs (as long as pt presents within 3 hrs of onset and there is no major risk of hemorrhage)

Question 25

When is tPA contraindicated?

Answer 25

Bright areas on noncontrast CT indicating hemorrhage