CNS Path Quiz 6 part 2

Question 1

3 categories of cerebrovascular disease

Answer 1

thrombotic
embolic
hemorrhagic

Question 2

two pathophysiologic processes taking place in cerebrovascular disease?

Answer 2

• lack of blood supply and oxygen (ischemic)

- rupture of blood vessels (hemorrhagic)

Question 3

two types of cerebral ischemia

Answer 3

focal (localized)- due to thrombi/emboli

global- due to cardiac arrest, hypotension

Question 4

Microscopically, ischemic and infarcted cells will fail to

Answer 4

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

Question 5

Macroscopically, in cerebrovascular disease the brain may appear

Answer 5

edematous with swollen gyri and narrowed sulci

poor demarcation between white and grey matter

Question 6

global hypoxia results in

Answer 6

border zone infarcts

laminar necrosis

Question 7

cerebral infarction aka

Answer 7

stroke

loss of circulation to an area of the brain

Question 8

risk factors for stroke

Answer 8

advanced age
HTN
DM
high cholesterol 
tobacco use
atrial fib

Question 9

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

Answer 9

N/V
h/a
change consciousness

Question 10

ischemic stroke due to

Answer 10

thrombosis
emboli
systemic hypoperfusion

Question 11

hemorrhagic stroke due to

Answer 11

intracerebral hemorrhage
subarachnoid hemorrhage
subdural hemorrhage
epidural hemorrhage

Question 12

80% of strokes are which category?

Answer 12

ischemic

Question 13

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

Answer 13

hemorrhagic

Question 14

Approximately 50% of all stroke deaths occur within

Answer 14

the first 48 hours

Question 15

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

Answer 15

red neurons

dead neurons as a result of hypoxia

Question 16

what changes occur after 24 hrs in a stroke patient?

Answer 16

neutrophil infiltration at edges of lesion

Question 17

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

Answer 17

incr. macrophages

gliosis (not scars dues to lack of fibrosis)

Question 18

gliosis aka

Answer 18

reactive proliferation of astrocytes

Question 19

first response in gliosis

Answer 19

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

Question 20

gliosis eventually leads to

Answer 20

a dense fibrous network of neuroglia

Question 21

macroscopically one can see what after 12-24 hrs?

Answer 21

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

Question 22

most common cause of thrombotic occlusion

Answer 22

atherosclerosis

Question 23

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

Answer 23

middle cerebral artery

Question 24

infarction due to embolism may show

Answer 24

punctate hemorrhages

Question 25

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

Answer 25

HTN

Question 26

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

Answer 26

CT because it's much better at picking up blood

Question 27

how does hemorrhage look on CT

Answer 27

``` radio-opaque midline shift (corpus collosum) ```

Question 28

dreaded complications of hemorrhagic stroke?

Answer 28

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

Question 29

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

Answer 29

vertebral and basilar arteries

Question 30

whats the most common cause of a subarachnoid hemorrhage?

Answer 30

rupture of saccular aneurysm (berry aneurysm)

Question 31

what IS a berry aneurysm?

Answer 31

out-pouching from the circle of Willis

Question 32

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

Answer 32

anterior communicating artery

Question 33

what's the most common type of vascular malformation?

Answer 33

Arteriovenous malformations

Question 34

an arteriovenous malformation hemorrhage differs from a hypertensive hemorrhagic how?

Answer 34

AVM hemorrhage has less blood

Question 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

Answer 35

arteriovenous malformation

Question 36

acute hypertensive encephalophathy is characterized by

Answer 36

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

Question 37

what 3 physical forces can coexist to produce head injury?

Answer 37

skull fractures parenchymal injury vascular injury

Question 38

The characteristic neurologic picture of concussion includes

Answer 38

loss of consciousness, | temporary respiratory arrest and loss of reflexes

Question 39

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

Answer 39

Anisocoria

Question 40

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

Answer 40

parenchymal injury

Question 41

cerebral injury at the point of contact

Answer 41

coup

Question 42

brain damage opposite the point of contact

Answer 42

countercoup

Question 43

most common type of skull fracture?

Answer 43

linear skull fractures

Question 44

linear fracture that occurs along sutures lines in young children

Answer 44

diastatic skull fracture

Question 45

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

Answer 45

middle meningeal artery

Question 46

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

Answer 46

Epidural hematoma

Question 47

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

Answer 47

Subdural hematoma

Question 48

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

Answer 48

Subdural hematoma | fronto-parietal regions of the cerebral hemispheres

Question 49

accumulation of blood between the dura and skull is called?

Answer 49

Epidural hematoma

Question 50

irreversible cessation of ALL brain function

Answer 50

brain death

Question 51

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

Answer 51

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

Question 52

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

Answer 52

NO

Question 53

cerebral injury at the point of contact

Answer 53

coup

Question 54

brain damage opposite the point of contact

Answer 54

countercoup

Question 55

most common type of skull fracture?

Answer 55

linear skull fractures

Question 56

linear fracture that occurs along sutures lines in young children

Answer 56

diastatic skull fracture

Question 57

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

Answer 57

middle meningeal artery

Question 58

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

Answer 58

Epidural hematoma

Question 59

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

Answer 59

Subdural hematoma

Question 60

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

Answer 60

Subdural hematoma | fronto-parietal regions of the cerebral hemispheres

Question 61

accumulation of blood between the dura and skull is called?

Answer 61

Epidural hematoma

Question 62

irreversible cessation of ALL brain function

Answer 62

brain death

Question 63

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

Answer 63

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

Question 64

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

Answer 64

NO