Cerebrovascular Disease and Infections Flashcards
(25 cards)
Which type of deficits might you see if the Anterior Cerebral Artery is affected?
Upper motor neuron-type weakness & cortical-type sensory loss; contralateral hemiplegia initially
contralateral leg more than the arm or face
Alien Hand Syndrome: semiautomatic movements of the contralateral arm not under voluntary control
What artery is affected if a patient has contralateral homonymous hemianopia?
Posterior Cerebral Artery (PCA)
What deficits are seen with infarcts/ischemic events in the Middle Cerebral Artery (MCA)?
Aphasia, hemineglect, hemianopia, face-arm sensorimotor loss
gaze preference toward side of lesion
What are two major causes of focal ischemia?
Atherosclerosis and Hypertension
What is a “watershed” area?
Watershed/border areas are the regions between 2 major blood vessels
(ACA-MCA) and (MCA-PCA)
most susceptible to ischemia and infarction
What are the most common sites of Thrombosis in the cerebrovascular circulation?
- Carotid bifurcation
- Origin of MCA
- Either end of Basilar Artery
Upon histological examination of an embolus, a megakaryocyte is identified. What type of embolus is this?
Fat Embolus
(megakaryocyte is in bone marrow, fat embolus caused by trauma to long bones)
What is this an image of?
Shower emboli
Caused by fat embolism
A patient with a hematologic disorder (sickle cell, leukemia, etc) presents with SOB; What must you be aware of?
These patients often have hypercoagulability
How is TIA described?
TIA initially described as neurological deficit <24 hrs. caused by temporary brain ischemia.
More typical duration is around 10 min
Ischemic deficits >10 min produce permanent cell death
Why are TIA’s so dangerous?
They’re usually a warning sign for potentially larger ischemic injury to the brain and thus are a_neurological emergency_
What are the two types of stroke?
Hemorrhagic (red) and Ischemic (Pale, bland, anemic)
What causes a hemorrhagic stroke?
Hemorrhage secondary to reperfusion of damaged vessels (directly via collaterals or dissolution of occlusion)
What is a “lacunar infarct”?
small vessel infarct resembling small lakes (lacunes)
associated with hypertension and arteriolar sclerosis
Located in the medial and lateral lenticulostriate arteries
-Clinically silent or devastating - depends on location
If a patient shows up with BP of at least 180/200, what must be an immediate concern?
Hypertensive Encephalopathy
Charcot-Bouchard Microaneurysms are associated with….?
Chronic Hypertension
What are some characteristics of Amyloid Angiopathy?
- Parenchymal “lobar” hemorrhage
- “lead-pipe” appearance of vessels
- Amyloid deposits in vessel walls
- Also known as Congophilic Amyloid Angiopathy (stains Congo Red)
- usually seen in older patients (70-80yrs)
What are characteristics of CADASIL?
- Seen in patients with recurrent strokes and dementia
- First detectable around 35 years old
- autosomal dominant
- thickening of the media &adventitia, loss of smooth muscle cells, and PAS+ deposits
What is the most frequent cause of a Subarachnoid Hemorrhage?
Rupture of Saccular Berry Aneurysm in the Circle of Willis
Fusiform Aneurysms are seen in which artery?
Basilar Artery
What are you at increased risk for, following a SAH?
First few days after DAH, regardless of etiology, increased risk of additional ischemic injury from vasospasm affecting vessels bathed in extravasated blood
What are the 4 types of vascular malformations?
- Arteriovenous Malformations
- Cavernous Malformation/Hemangiomas
- Capillary Telangiectasias
- Venous Angiomas
What are AVM (Arteriovenous Malformations)?
Tangle, worm-like vascular channels with prominent pulsatile arteriovenous shunting with high blood flow
happens in the subarachnoid space
most common in the MCA and posterior branches
What is the most common route of CNS infection?
Hematogenous
arterial primarily, but retrograde venous spread via anastomosis with facial veins possible
