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Flashcards in CNS Part 3 Deck (42)
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1

the most prevalent neurologic disorder in terms of morbidity and mortality.

Cerebrovascular disease

2

3 main categories of cerebrovascular disease

Thrombotic, embolic, hemorrhagic

3

Focal cerebral ischemia follows reduction of blood flow to a ... area that is generally due to an embolus or thrombosis in a large vessel, or vasculitis in medium or small sized vessels.

localized

4

Global cerebral ischemia occurs when there is a ... reduction of cerebral perfusion such as in cardiac arrest and severe sustained hypotension.

generalized

5

Global hypoxia results in ... , which typically occur at the border of areas supplied by the anterior and middle cerebral arteries, and ..., which is related to the short, penetrating vessels.

border zone infarcts; laminar necrosis

6

third leading cause of death and the leading cause of major disability in the United States.

stroke

7

2 main classifications of strokes

ischemic, hemorrhagic

8

Most common type of stroke

ischemic

9

Most debilitating type of stroke

hemorrhagic

10

In the first ..., neurons become vacuolated and eosinophilia of the neuronal cytoplasm occurs (red neurons)

12 to 24 hours

11

After approximately ..., infiltration of a cerebral infarct by neutrophils begins at the edges of the lesion where vascular supply has remained intact.

24 hours

12

Between ... , the infarcted area is characterized by increased numbers of macrophages and surrounding reactive gliosis.

1 and 14 days

13

From ... after a cerebral infarction, necrosis of tissue occurs along with an influx of neutrophils and macrophages.

24 hours to 2 weeks

14

end result of cerebral infarct

reactive proliferation of astrocytes, termed gliosis

15

nonspecific reactive change of glial cells in response to damage to the central nervous system

gliosis

16

This process, which constitutes a form of gliosis known as ... begins within hours of the initial CNS injury

microgliosis

17

Later, approximately 3–5 days after the initiating event, ... , precursor cells, are also recruited to the site and may contribute to remyelination.

oligodendrocytes

18

The final component of gliosis is ... , the proliferation of surrounding astrocytes, which are the main constituents of the glial scar.

astrogliosis

19

Macroscopic examination of the brain may reveal diffuse edema with narrowed sulci and widened gyri

cerebral infarction

20

Neurons are the most sensitive of all cell types to anoxic injury. Seen here are red neurons which are dying neurons as a result of sustained hypoxia.

red neurons

21

Gliosis, both within and around the infarct, is evident most prominently at what time?

by the second week

22

most common cause of thrombotic occlusion

Atherosclerosis

23

Most frequently, the vessel found to have the greatest degree of compromise in ischemic stroke

middle cerebral artery.

24

Complete occlusion of a cerebral vessel is frequently preceded by fleeting and transient neurologic symptoms

Transient ischemic attacks

25

TIAs are important to recognize because they may be clinical markers for an increased

risk of subsequent cerebral infarction.

26

Valvular vegetations in S.B.E. and thrombi in the auricular appendages, often associated with ... , can also embolize to the brain.

atrial fibrillation

27

is the primary underlying cause of most cases of intracerebral hemorrhage.

hypertension

28

Cerebellar and brainstem stokes generally occur as a result of pathology in the ... arteries

vertebral or basilar

29

The most frequent cause of clinically signifigant subarachnoid hemorrhage is the

rupture of a berry (saccular) aneurysm.

30

thin wall out-pouching from an area on the circle of Willis

berry aneurysm

31

the most common type of clinically significant vascular malformation.

Arteriovenous malformations

32

In macroscopic appearance, they resemble a tangled network of wormlike vascular channels and have a prominent, pulsatile arteriovenous shunt with high blood flow through the malformation.

AVMs

33

Petechiae and fibrinoid necrosis of arterioles in the gray and white matter may be seen microscopically

Hypertensive encephalopathy

34

the most common type of skull fracture

linear

35

linear fractures that cause the bones of the skull to separate at the skull sutures in young children whose skull bones have not yet fused.

Diastatic skull fractures

36

those in which a bone is shattered into many pieces, can result in bits of bone being driven into the brain.

Comminuted skull fractures

37

mastoid ecchymosis = suspect basilar skull fracture

battle's sign

38

bilateral periorbital ecchymosis = if patient unconscious or with hx of head trauma suspect basilar skull fracture

raccoon's eyes

39

Vessels within the dura, most importantly the ... artery, are vulnerable to injury, particularly with skull fractures.

middle meningeal

40

may occur as a result of the rupture of a meningeal artery, usually associated with a skull fracture

epidural hematoma

41

A fracture that lacerates either the ... or a ... is present in 85-95% of patients with epidural hematomas.

middle meningeal artery (MMA); dural venous sinus

42

damage to bridging veins between the brain and the superior sagittal sinus leads to the accumulation of blood between the dura and the arachnoid.

sub dural hemorrhage