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Kat's Pathology > Cerebrovascular Disease and Trauma > Flashcards

Cerebrovascular Disease and Trauma Flashcards

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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
What is a risk factor for a haemorrhagic stroke (2)
Hypertension - present in over 50% of bleeds | Arteriovenous malformations
26
How does a haemorrhagic stroke present (4)
Severe headache Vomiting Rapid loss of consciousness Focal neurological signs
27
Where do arteriovenous malformations occur within the CNS
Anywhere
28
When do arteriovenous malformations become symptomatic
Anywhere between the 2nd and 5th decade (mean age 31.2 years)
29
How do arteriovenous malformations present (4)
Haemorrhage Seizures Headache Focal neurological deficits
30
What is high pressure within an ateriovenous malformation associated with
Massive bleeding
31
How can you visualise AV malformations
Angiography
32
What is the morbidity after rupture of an AV malformation
53-81%
33
What is the mortality of an AV rupture
10-17.6%
34
What is the treatment for a ruptured AV malformation (3)
Surgery Embolization Radiosurgery
35
What is an arteriovenous malformation
A malformation in which blood passes quickly from the artery to the vein, bypassing the normal capillary network
36
What is a cavernous angioma
A well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between vascular spaces
37
Where are cavernous angiomas found
Anywhere in the CNS
38
When do cavernous angiomas become symptomatic
Usually after age 50
39
How do cavernous angiomas present (4)
Headache Seizures focal deficits haemorrhage
40
What is associated with recurrent bleeds of a cavernous angioma
Low pressure
41
What is the treatment for a cavernous angioma
Surgical
42
What does a target sign in a T2 weighted head MRI indicate
Cavernous angioma
43
What is the most common cause of sub-arachnoid haemorrhage
Rupture of a berry aneurysm - present in 1% of the general population
44
What is the pathogenesis of sub-arachnoid haemorrhages (3)
80% - internal carotid artery bifurcation 20% - occur withint he vertebro-basilar circulation 30% - multiple aneurysms
45
What is associated with the greatest risk of rupture of a berry aneurysm
Diameter > 6-10mm
46
What is the presentation of a subarachnoid haemorrhage (3)
Sudden onset of severe headache (worst headache ever) Vomiting Loss of consiousness
47
What is the treatment fo berry aneurysm
Endovascular treatment - coil
48
What is an infarction (CNS)
Tissue death due to ischaemia
49
What is the most common form of cerebrovascular disease
Ischaemia
50
What proportion of strokes are ischaemia
70-80%
51
What is the most common cause of CV ischaemia
Cerebral atherosclerosis
52
What are some risk factors for cerebral ischaemia (3)
Hypertension Smoking Diabetes
53
What does the term focal cerebral ischaemia mean
Defined vascular territory
54
What does the term global cerebral ischaemi mean
Systemic circulation failure
55
What vessels is cerebral ischaemia worst in
Larger vessels - e.g. extracerebral arteries
56
What are larger vessels prone to
Thrombosis
57
What are the most common sites of thrombosis (2)
Near carotid bifucation | In Basilar artery
58
What is the most common cause of intra cerebral ischaemia
Emboli
59
Where do cerebral emboli usually originate (2)
Heart | Atherosclerotic plaque
60
What artery is most commonly affected by emboli
Middle cerebral artery branches
61
What are the three vascular territories of the brain
Anterior cerebral artery Middle cerebral artery Posterior cerebral artery
62
What are the pathological features of CNS infarcts (4)
Tissue necrosis (stains) Rarely haemorrhagic Permanent damage in the affected area No recovery of tissue
63
What are the pathological features of CNS haemorrahagic events (5)
``` Bleeding. Dissection of parenchyma Fewer macrophages Limited tissue damage (periphery) Partial recovery possible ```
64
What is the single largest cause of death in people under 45
Trauma
65
What proportion of trauma deaths can be attributed to TBI
25%
66
What is the morbidity associated with TBI (2)
19% vegetative or severely disabled | 31% good recovery
67
What are the different forms of brain trauma (6)
``` Non-missile and missile. Non-missile. Acceleration/deceleration. Rotation. RTA, falls and assaults. Focal or diffuse. ```
68
What are the clinical features of a skull fracture (4)
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
Where does bruising occur in skull fractures (2)
Behind ears | Racoon eyes
70
What is a contusion
Brain in collision with the skull - surface bruising
71
What is a brain laceration
A contusion with torn pia mater
72
What areas of the brain are bruised in a contusion (2)
Lateral surfaces of hemispheres | Inferior surfaces of frontal and temporal lobes
73
What are the two types of brain contusion
Coup | Contrecoup
74
What is diffuse axonal injury
Shear and tensile forces of TBI affect axons (stretching) during head injury
75
What does diffuse axonal injury occur
At the time of head injury
76
What is particularly vulnerable in diffuse axonal injury
Midline structures are particularly affected (e.g. corpus callosum, rostral brainstem and septum pellucidum)

Kat's Pathology (105 decks)

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