Day 1 review

Question 1

• Faster and cheaper
• Radiation
• Better for bone, blood and trauma
• Bone and blood – bright
• Fat and air – dark
higher resolution but requires radiation and dye

Answer 1

CT

Question 2

• Slower and more expensive

* Better for soft tissue

Answer 2

MRI

Question 3

– fat and brain are bright; csf and air are dark

Answer 3

• T1

Question 4

– CSF and fat are bright; air and bone are dark

Answer 4

• T2

Question 5

• MRA – no dye or radiation, good for

Answer 5

aneurysms and stenosis

Question 6

Use ___ for acute stroke to evaluate for hemorrhage

Answer 6

CT:
• Hemorrhage will be bright
• CTA to evaluate source of bleeding
• No findings in early acute ischemic stroke

Question 7

is most sensitive for acute stroke findings

Soft tissue like spinal cord

Answer 7

• MRI

Question 8

• Extracellular
• White matter
• Tumor, abscess, hematoma, contusion
• Inflammatory, chemo and cytokines
• Breakdown of BBB in tumor,
• Responds to steroids

Answer 8

Vasogenic

Question 9

Intracellular
• Gray matter
• Ischemia, meningitis, trauma, hepatic enceph.
• Cellular swelling from sodium (and then water)
• Dysfunctional membrane pumps
• Does not respond to steroids

Answer 9

Cytotoxic

Question 10

• Subfalcine hernation – side to side, hemispheric lesion with a_____ infarct

Answer 10

ACA

Question 11

Transtentorial/uncal – temporal lobe pushes through onto brainstem : what are the 3

Answer 11

PCA infarct, CNIII compression, Duret hemorrhage

Question 12

– through foramen magnum • Respiratory arrest and death

Answer 12

Tonsillar hernation

Question 13

• Ventricular system open with Decreased absorption at arachnoid granulations
• Meningitis, hemorrhage, thrombosis
• Or CSF overproduction
• Choroid plexus tumor

Answer 13

Communicating hydrocephalus

Question 14

• Obstruction of ventricular system

* Tumor, aqueductal stenosis, thickened meninges

Answer 14

Noncommunicating hydrocephalus

Question 15

Common location of contusions

Answer 15

orbital and temporal regions, crests of gyri

Question 16

What happens in acute contusions?

Answer 16

see superficial hemorrhage and edema

Question 17

What happens in Chronic contusions

Answer 17

– cavitated, macrophages with hemosiderin, fibrillary astrocytes

Question 18

____on the injury side,_____ on the opposite

Answer 18

Coup

contracoup

Question 19

• axonal shearing in white matter
• Petechial hemorrhages
• Maximum deficit at onset

Answer 19

Diffuse Axonal

Question 20

• Skull fracture (high speed)
• Accumulates slowly (lucid interval)
• Always life threatening
• Middle meningeal artery
• Convex appearance

Answer 20

Epidural hematoma

Question 21

• Any trauma, common in elderly
• Can present acute, subacute or chronic
• Bridging veins
• Can become chronic
• Concave appearance

Answer 21

Subdural hematoma

Question 22

• ______ worse than hypoxia alone
• Reduced O2 delivery to tissues,
• If low BP, worst in ________

Answer 22

Ischemia

watershed/borderzone areas

Question 23

AReas susceptible to ischema

Answer 23

• Hippocampus CA1, cortical lamina 3-5, cerebellar purkinje cells most sensitive
• Neurons>oligodendrocytes>astrocytes
• Red is dead (dead neurons appear red after ischemia)

Question 24

• soft swollen brain, loss of G/W distinction

* 8-12hr Red neurons; up to 48hr neutrophils

Answer 24

• Acute focal ischemia

Question 25

* liquefactive necrosis | * Macrophages, necrotic tissue, reactive astrocytes, vascular proliferation

Answer 25

Subacute focal ischemia

Question 26

• Cavitation, glial scar

Answer 26

presentes in Chronic focal ischemia

Question 27

* Bleeding can occur after an infarct if reperfusion into ischemic brain * More common in :

Answer 27

embolic stroke, cortical lesions | ***Tends to be petechial blood with surrounding ischemic brain edema

Question 28

Describe Large vessel atherosclerosis

Answer 28

* Carotid bifurction, MCA origin, basilar origin * Plaque rupture causes thrombosis * Complete vessel occlusion can cause stroke if collateral circulation isn’t adequate

Question 29

Small vessel hyaline arteriolosclerosis

Answer 29

* Seen in HTN and DM * Small perforator vessels (basal ganglia, Internal capsule, thalamus, pons, white matter) * Lacunar strokes 1-1.5cm

Question 30

Embolism | • Tend to go to distal branches at cortex with ____ Most common vessel

Answer 30

MCA | *Shower of emboli can happen A/P, L/R

Question 31

Embolism from cardiac source cause by:

Answer 31

• Atrial fibrillation, valvular disease, MI with akinetic segment • Endocarditis

Question 32

Artery to artery embolism | • Carotid plaque, intracranial stenosis

Answer 32

another source of embolism

Question 33

venous clotting,leads to bleeds from back pressure in draining veins :Parasagittal bleeds

Answer 33

CVT

Question 34

Hypertension causing intercerbral hemorrhage | • Causes _______at small penetrating vessels (same ones that cause lacunes)

Answer 34

hyaline arteriolosclerosis

Question 35

areas susceptible to hyaline arteriolosclerosis causing intercerbral hemorrhage

Answer 35

• Basal ganglia, pons, cerebellum, thalamus, IC and white matter

Question 36

How does intracerebral hemorrhage differ from hemorrhagic infarct?

Answer 36

not having surrounding infarcted tissue | • Large clot (hematoma) rather than petechial blood

Question 37

* AVM * Congenital abnl of vessels with arterio-venous direct connection * High bleed risk * Presents with seizures, bleeding, focal deficit

Answer 37

AVM: intracerebral hemorrhage

Question 38

* Lobar hemorrhage * elderly * Beta amyloid on congo red stain

Answer 38

Amyloid angiopathy: intracerebral hemorrhage

Question 39

* Develop with age, medial defect is congenital * Bifurcations of circle of willis, ACOM>MCA>ICA>basila * Worse with smoking ,HTN

Answer 39

Berry aneurysm; subarachnoid hemorrhage