CNS Path Quiz 6 part 2 Flashcards Preview

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Flashcards in CNS Path Quiz 6 part 2 Deck (64):
1

3 categories of cerebrovascular disease

thrombotic
embolic
hemorrhagic

2

two pathophysiologic processes taking place in cerebrovascular disease?

-lack of blood supply and oxygen (ischemic)
-rupture of blood vessels (hemorrhagic)

3

two types of cerebral ischemia

focal (localized)- due to thrombi/emboli
global- due to cardiac arrest, hypotension

4

Microscopically, ischemic and infarcted cells will fail to

stain properly with vital stains such as a H. and E. stain

5

Macroscopically, in cerebrovascular disease the brain may appear

edematous with swollen gyri and narrowed sulci
poor demarcation between white and grey matter

6

global hypoxia results in

border zone infarcts
laminar necrosis

7

cerebral infarction aka

stroke
loss of circulation to an area of the brain

8

risk factors for stroke

advanced age
HTN
DM
high cholesterol
tobacco use
atrial fib

9

while it's hard to distinguish hemorrhagic from ischemic stroke, what sx point towards hemorrhagic?

N/V
h/a
change consciousness

10

ischemic stroke due to

thrombosis
emboli
systemic hypoperfusion

11

hemorrhagic stroke due to

intracerebral hemorrhage
subarachnoid hemorrhage
subdural hemorrhage
epidural hemorrhage

12

80% of strokes are which category?

ischemic

13

which category of stroke is more severe and results in higher mortality rates?

hemorrhagic

14

Approximately 50% of all stroke deaths occur within

the first 48 hours

15

first 12-24 hours of a stroke, neurons undergo which changes?

red neurons
(dead neurons as a result of hypoxia)

16

what changes occur after 24 hrs in a stroke patient?

neutrophil infiltration at edges of lesion

17

1-14 days after what changes take place in a stroke patient?

incr. macrophages
gliosis (not scars dues to lack of fibrosis)

18

gliosis aka

reactive proliferation of astrocytes

19

first response in gliosis

microgliosis (migration of macrophages and local microglia to the injury site)

20

gliosis eventually leads to

a dense fibrous network of neuroglia

21

macroscopically one can see what after 12-24 hrs?

discoloration (appears red)
softening in the affected
arterial territory with edema

22

most common cause of thrombotic occlusion

atherosclerosis

23

which vessel has the greatest degree of compromise in ischemic stroke?

middle cerebral artery

24

infarction due to embolism may show

punctate hemorrhages

25

intracerebral hemorrhage (a type of hemorrhagic stroke) is caused by what?

HTN

26

which imaging should be done first in a hemorrhagic stroke? why?

CT because it's much better at picking up blood

27

how does hemorrhage look on CT

radio-opaque
midline shift (corpus collosum)

28

dreaded complications of hemorrhagic stroke?

-incr intracranial pressure
-herniation
*greater risk of stroke occurs further down (brainstem or cerebellum)

29

cerebellar and brain stem strokes generally occur as a result of pathology where?

vertebral and basilar arteries

30

whats the most common cause of a subarachnoid hemorrhage?

rupture of saccular aneurysm (berry aneurysm)

31

what IS a berry aneurysm?

out-pouching from the circle of Willis

32

where's the most common spot for a berry aneurysm to occur?

anterior communicating artery

33

what's the most common type of vascular malformation?

Arteriovenous malformations

34

an arteriovenous malformation hemorrhage differs from a hypertensive hemorrhagic how?

AVM hemorrhage has less blood

35

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

arteriovenous malformation

36

acute hypertensive encephalophathy is characterized by

diffuse cerebral dysfunction
bleeding does not remit spontaneously, so rapid intervention is necessary

37

what 3 physical forces can coexist to produce head injury?

skull fractures
parenchymal injury
vascular injury

38

The characteristic neurologic picture of concussion includes

loss of consciousness,
temporary respiratory arrest and loss of reflexes

39

unequal pupil size can be a sign of brain injury (more serious than concussion)

Anisocoria

40

contusion (brain bruise) and laceration (tearing of brain tissue) are associated with injury to what part of the brain?

parenchymal injury

41

cerebral injury at the point of contact

coup

42

brain damage opposite the point of contact

countercoup

43

most common type of skull fracture?

linear skull fractures

44

linear fracture that occurs along sutures lines in young children

diastatic skull fracture

45

in skull fracture, what artery is at particular risk of injury?

middle meningeal artery

46

if the meningeal artery should rupture in a skull fracture, what is this called?

Epidural hematoma

47

rupture of veins between the brain and the superior sagittal sinus is called what?

Subdural hematoma

48

accumulation of blood between the dura and the arachnoid in a skull fracture is called? occurs in what part of brain?

Subdural hematoma
fronto-parietal regions of the cerebral hemispheres

49

accumulation of blood between the dura and skull is called?

Epidural hematoma

50

irreversible cessation of ALL brain function

brain death

51

in order to declare someone brain dead, what perimeters must be met?

-pt not in hypotensive shock
-body temp above 32 deg
-no drug intoxication or neuromuscular blockage causing coma

52

is an EEG showing the absence of any physiologic brain activity necessary to declare a patient brain dead?

NO

53

cerebral injury at the point of contact

coup

54

brain damage opposite the point of contact

countercoup

55

most common type of skull fracture?

linear skull fractures

56

linear fracture that occurs along sutures lines in young children

diastatic skull fracture

57

in skull fracture, what artery is at particular risk of injury?

middle meningeal artery

58

if the meningeal artery should rupture in a skull fracture, what is this called?

Epidural hematoma

59

rupture of veins between the brain and the superior sagittal sinus is called what?

Subdural hematoma

60

accumulation of blood between the dura and the arachnoid in a skull fracture is called? occurs in what part of brain?

Subdural hematoma
fronto-parietal regions of the cerebral hemispheres

61

accumulation of blood between the dura and skull is called?

Epidural hematoma

62

irreversible cessation of ALL brain function

brain death

63

in order to declare someone brain dead, what perimeters must be met?

-pt not in hypotensive shock
-body temp above 32 deg
-no drug intoxication or neuromuscular blockage causing coma

64

is an EEG showing the absence of any physiologic brain activity necessary to declare a patient brain dead?

NO