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Kat's Pathology > Cerebrovascular Disease and Trauma > Flashcards

Cerebrovascular Disease and Trauma Flashcards

1
Q

What is cerebral oedema

A

Excess accumulation of fluid in the brain parenchyma

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2
Q

What are the two main types of cerebral oedema (2)

A

Vasogenic - disruption of the blood brain barrier

Cytotoxic - secondary to cellular injury (e.g. hypoxia/ischaemia)

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3
Q

What does cerebral oedema result in

A

Raised ICP

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4
Q

How is cerebral oedema cleared from the parenchyma (3)

A

Into subarachnoid CSF
Into ventricles
Into bloodstream

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5
Q

What does cerebral oedema look like on CT

A

Loss of differentiation of brain parenchyma

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6
Q

What is a non-communicating hydrocephalus

A

Involves obstruction of flow of CSF

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7
Q

What is a communicating hydrocephalus

A

Involves no obstruction, but problems with reabsorption of CSF into venous sinuses

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8
Q

What is ICP measured in

A

mmHg

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9
Q

What is the normal ICP at rest

A

7-15mmHg for a supine adult

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10
Q

What can cause a rise in ICP (3)

A

Space occupying lesions
Oedema
Or both!

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11
Q

What are the consequences of raised ICP

A

Increased pressure forces brain against unyielding bony wall of skull - results in herniation of brain structures where space is available

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12
Q

What are the three areas of brain herniation (3)

A

Subfalcine herniation
Transtentorial herniation
Tonsillar herniation

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13
Q

What is the third largest cause of death in the UK

A

Stroke

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14
Q

How many people does stroke affect every year

A

More than 100,000 people

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15
Q

What is the definition of a stroke (WHO)

A

A stroke is a clinical syndrome characterised by rapidly developing clinical symptoms and/or signs of focal, and at times global loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.

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16
Q

What causes of stroke does the WHO definition include (4)

A

Cerebral infarction.
primary intracerebral haemorrhage
Intraventricular haemorrhage
Most cases of subarachnoid haemorrhage

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17
Q

What causes of stroke does the WHO definition exclude (4)

A

Subdural haemorrhage
Epidural haemorrhage
Intracererbral haemorrhage
Infarction caused by infection or tumour

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18
Q

What is a transient ischaemic attack (TIA)

A

A temporary blockage of a cerebral artery by a clot - this is a warning stroke that should be taken very seriously

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19
Q

How long does a TIA typically last

A

Less than 5mins, on average lasting 1min

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20
Q

What are the consequences of a TIA

A

There is usually no permanent injury to the brain

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21
Q

What proportion of people with get a TIA will suffer a significant infarct within 5 years

A

1/3rd

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22
Q

What is a good predictor of future infarcts

A

TIA

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23
Q

What is a haemorrhagic stroke

A

A haemorrhage into the substance of the brain, due to the rupture of a small intraparenchymal vessel

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24
Q

What is the most common location of haemorrhagic strokes

A

Basal ganglia

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25
Q

What is a risk factor for a haemorrhagic stroke (2)

A

Hypertension - present in over 50% of bleeds

Arteriovenous malformations

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26
Q

How does a haemorrhagic stroke present (4)

A

Severe headache
Vomiting
Rapid loss of consciousness
Focal neurological signs

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27
Q

Where do arteriovenous malformations occur within the CNS

A

Anywhere

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28
Q

When do arteriovenous malformations become symptomatic

A

Anywhere between the 2nd and 5th decade (mean age 31.2 years)

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29
Q

How do arteriovenous malformations present (4)

A

Haemorrhage
Seizures
Headache
Focal neurological deficits

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30
Q

What is high pressure within an ateriovenous malformation associated with

A

Massive bleeding

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31
Q

How can you visualise AV malformations

A

Angiography

32
Q

What is the morbidity after rupture of an AV malformation

A

53-81%

33
Q

What is the mortality of an AV rupture

A

10-17.6%

34
Q

What is the treatment for a ruptured AV malformation (3)

A

Surgery
Embolization
Radiosurgery

35
Q

What is an arteriovenous malformation

A

A malformation in which blood passes quickly from the artery to the vein, bypassing the normal capillary network

36
Q

What is a cavernous angioma

A

A well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between vascular spaces

37
Q

Where are cavernous angiomas found

A

Anywhere in the CNS

38
Q

When do cavernous angiomas become symptomatic

A

Usually after age 50

39
Q

How do cavernous angiomas present (4)

A

Headache
Seizures
focal deficits
haemorrhage

40
Q

What is associated with recurrent bleeds of a cavernous angioma

A

Low pressure

41
Q

What is the treatment for a cavernous angioma

A

Surgical

42
Q

What does a target sign in a T2 weighted head MRI indicate

A

Cavernous angioma

43
Q

What is the most common cause of sub-arachnoid haemorrhage

A

Rupture of a berry aneurysm - present in 1% of the general population

44
Q

What is the pathogenesis of sub-arachnoid haemorrhages (3)

A

80% - internal carotid artery bifurcation
20% - occur withint he vertebro-basilar circulation
30% - multiple aneurysms

45
Q

What is associated with the greatest risk of rupture of a berry aneurysm

A

Diameter > 6-10mm

46
Q

What is the presentation of a subarachnoid haemorrhage (3)

A

Sudden onset of severe headache (worst headache ever)
Vomiting
Loss of consiousness

47
Q

What is the treatment fo berry aneurysm

A

Endovascular treatment - coil

48
Q

What is an infarction (CNS)

A

Tissue death due to ischaemia

49
Q

What is the most common form of cerebrovascular disease

A

Ischaemia

50
Q

What proportion of strokes are ischaemia

A

70-80%

51
Q

What is the most common cause of CV ischaemia

A

Cerebral atherosclerosis

52
Q

What are some risk factors for cerebral ischaemia (3)

A

Hypertension
Smoking
Diabetes

53
Q

What does the term focal cerebral ischaemia mean

A

Defined vascular territory

54
Q

What does the term global cerebral ischaemi mean

A

Systemic circulation failure

55
Q

What vessels is cerebral ischaemia worst in

A

Larger vessels - e.g. extracerebral arteries

56
Q

What are larger vessels prone to

A

Thrombosis

57
Q

What are the most common sites of thrombosis (2)

A

Near carotid bifucation

In Basilar artery

58
Q

What is the most common cause of intra cerebral ischaemia

A

Emboli

59
Q

Where do cerebral emboli usually originate (2)

A

Heart

Atherosclerotic plaque

60
Q

What artery is most commonly affected by emboli

A

Middle cerebral artery branches

61
Q

What are the three vascular territories of the brain

A

Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery

62
Q

What are the pathological features of CNS infarcts (4)

A

Tissue necrosis (stains)
Rarely haemorrhagic
Permanent damage in the affected area
No recovery of tissue

63
Q

What are the pathological features of CNS haemorrahagic events (5)

A 
Bleeding. 
Dissection of parenchyma 
Fewer macrophages 
Limited tissue damage (periphery) 
Partial recovery possible
64
Q

What is the single largest cause of death in people under 45

A

Trauma

65
Q

What proportion of trauma deaths can be attributed to TBI

A

25%

66
Q

What is the morbidity associated with TBI (2)

A

19% vegetative or severely disabled

31% good recovery

67
Q

What are the different forms of brain trauma (6)

A 
Non-missile and missile. 
Non-missile. 
Acceleration/deceleration. 
Rotation. 
RTA, falls and assaults. 
Focal or diffuse.
68
Q

What are the clinical features of a skull fracture (4)

A

Fissure fractures often extend into the base of the skull.
May pass through the middle ear or anterior cranial fossa.
Otorrhoea or rhinorrhoea.
Infection risk

69
Q

Where does bruising occur in skull fractures (2)

A

Behind ears

Racoon eyes

70
Q

What is a contusion

A

Brain in collision with the skull - surface bruising

71
Q

What is a brain laceration

A

A contusion with torn pia mater

72
Q

What areas of the brain are bruised in a contusion (2)

A

Lateral surfaces of hemispheres

Inferior surfaces of frontal and temporal lobes

73
Q

What are the two types of brain contusion

A

Coup

Contrecoup

74
Q

What is diffuse axonal injury

A

Shear and tensile forces of TBI affect axons (stretching) during head injury

75
Q

What does diffuse axonal injury occur

A

At the time of head injury

76
Q

What is particularly vulnerable in diffuse axonal injury

A

Midline structures are particularly affected (e.g. corpus callosum, rostral brainstem and septum pellucidum)

Kat's Pathology (105 decks)

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