Flashcards in Cerebrovascular Disease Deck (25)
Where do intraparenchymal hemorrhages occur?
1) Basal ganglia (MOST common)
2) Internal capsule
What causes intraparenchymal hemorrhages?
Systemic HTN, Charcot-Bouchard aneurysm of lenticulostriate vessels
What are the 2 most vulnerable regions of brain to ischemia?
Hippocampus (pyramidal cells in layers 3, 5, 6) and Purkinje cells of cerebellum
When is irreversible damage to the brain after hypoxia seen?
2 types of strokes?
Ischemic and hemorrhagic
2 types of ischemic strokes?
Global and focal cerebral ischemia
What causes global ischemia?
2) Hypotension (shock)
3) Chronic hypoxia (anemia)
4) Repeated episodes of hypoglycemia (insulinoma)
What occurs after 5-10 secs of cessation of cerebral blood supply?
What occurs after 1 min of cessation of cerebral blood supply?
Cessation of neural activity
Where is cortical laminar necrosis seen?
Moderate global ischemia
What are 3 causes of focal ischemia?
What is an ischemic stroke?
Regional ischemia that results in focal neurologic deficits for >24 hrs
What is a transient ischemic attack?
Brief reversible episode of focal neuro dysfunction with sxs lasting <24 hrs
Where do you see a pale infarction at the periphery of the cortex?
Where do you see hemorrhagic infarction at periphery of cortex?
What are thrombotic strokes due to?
Ruptured plaque due to atherosclerosis
What are embolic strokes due to?
A-fib, usually involves MCA
What are lacunar strokes due to?
Secondary to hyaline arteriolosclerosis (HTN, DM) affecting the lenticostriate arteries)
What is seen after 12-48 hrs?
What is seen after 24-72 hours?
Neutrophils + necrosis
What is seen after 3-5 days?
Macrophages that light up with oil red O
What is seen after 1-2 weeks?
Reactive gliosis + vascular proliferation
What is seen after >2 weeks?
How do you treat ischemic strokes?
tPA within 4.5 hrs (as long as pt presents within 3 hrs of onset and there is no major risk of hemorrhage)