Cerebrovascular Diseases

Question 0

What are three things that can go wrong and cause cerebrovascular diseases?

Answer 0

Thrombosis - clot that stays and gets bigger
Embolism - clot that forms and moves (also made up of fat or cholesterol)
Hemorrhage - bleed, rupture

Stroke applies to all three

Question 1

What is the third leading cause of death in the US?

Answer 1

Cerebrovascular diseases

Question 2

What is global cerebral ischemia?

Answer 2

• global ischemia
• caused by hypotension
• outcome: mild-transient confusion, severe-persistent vegetative state or brain death
• watershed infarcts, laminar necrosis, or diffuse necrosis

Question 3

What areas are particular suspectable to hypoxia?

Answer 3

Areas at edges of vascular supply (watershed infarcts)
Anterior and middle cerebral artery boarder

Watershed infarct is associated with hypotension

Question 4

What is laminar necrosis?

Answer 4

Damage in just one area, kinda random

Vessels in meningitis supply brain is one explanation

Question 5

What do you see with patients who have been on a respirator for a long time?

Answer 5

Global ischemia

Liquifacting necrosis - liquid

Question 6

When does hazy gray-white demarcation happen?

Answer 6

Global Ischemia

Cannot tell gray apart from white (the boarder)

Question 7

What is focal ischemia?

Answer 7

-Obstruction of blood flow to focal spot
Two ways:
- ischemic (pale) infarcts - thrombosis, often arise from artherosclerotic plaques (looks for pale). More common
- hemorrhagic (red) - was something plugging but then it was re opened and blood flushed in. Due to emboli and reperfusion, often arises from the heart
TSIs are often the harbingers

Question 8

What does streptokinase do?

Answer 8

Synthetic way that breaks clots
Used in pale infarcts

Would kill a person with red infarcts

Question 9

What do ischemic infarcts look like?

Answer 9

2days: white, wet, swollen
2-10days: gelatinous, outlines are visible
10-21days: liquefaction and cavitation

Question 10

What do hemorrhagic infarcts look like?

Answer 10

Punctuate of big
Red
Eventually resolution and cavitation

Question 11

What are the microscopic changes of focal infarcts in order?

Answer 11

1. Red neurons,edema, swollen astrocytes
2. Lots of neutrophils
3. Less neutrophils, macrophages
4. Gliosis
5. More macrophages
6. Dense gliosis and new capillaries

Hemorrhagic looks the same but with blood cells

Question 12

Where do you see lacunar infarcts?

Answer 12

Hypertensive cerebrovascular disease

Question 13

What is a lacunar infarct?

Answer 13

A tiny blood vessel that travels to the deep areas of the brain becomes occluded

See macrophages and gliosis

Develop arteriole sclerosis

Have little holes

Have necrosis

Question 14

What is a slit hemorrhage?

Answer 14

In hypertension

Vessel is perforated and there are slits

Macrophages and gliosis
See some hemosiderin and lipid laden

No necrosis

Question 15

Where does acute hypertensive encephalopathy arise?

Answer 15

In malignant hypertension

Question 16

What is acute hypertensive encephalopathy?

Answer 16

Diffuse dysfunction: confusion, convulsions, coma

Increased ICP
Swollen brain with petechiae and fibrinoid necrosis of arterioles

Diffuse

Question 17

What is fibrinoid necrosis?

Answer 17

Happens mostly in vessels

Has a pinkish color that looks like fibrin

Question 18

What is an intracranial hemorrhage?

Answer 18

Any bleed in the cranium

Particularly in the brain

Question 19

What is hemorrhage in the parenchyma or subarachnoid space usually due to?

Answer 19

Not trauma

Cerebrovascular disease

Question 20

When do parenchymal hemorrhages happen?

Answer 20

60yrs

• due to rupture of small imtraparenchymal vessel
• can be ganglionic (BG) or lobar (elsewhere)
• most commonly caused by hypertension

Question 21

What are tiny aneurysms called?

Answer 21

Charcot-Bouchard micro aneurysms

Micro aneurysms

Happen in BG and deep

Question 22

What is a subarachnoid hemorrhage caused by?

Answer 22

A busted aneurysm

Fourth common cause of cerebrovascular disease

Question 23

What are some characteristics of a berry aneurysm?

Answer 23

• smoking
• slow growing
• 1 cm or greater, 50% risk of bleeding per year
• more common at branch points

Question 24

What are clinical features of a SAH?

Answer 24

• worst headache ever
• loss of consciousness in minutes
• death in 25-50%
• if survive there are risks for vasospasm
• communicating hydrocephalus