Histopathology 12 - cerebrovascular disease

Question 1

Which brain structure pumps out the CSF? Where is it?

Answer 1

Choroid plexus, lateral ventricles

Question 2

Normal flow of CSF in the brain

Answer 2

Choroid plexus –> lateral ventricles –> 3rd ventricle –> aqueduct to 4th ventricle –> subarachnoid space or spinal cord

Question 3

2 main types of cerebral oedema

Answer 3

VASOGENIC (leak)

Cytotoxic (2nd to cell injury e.g. hypoxia/ischaemia)

Question 4

two types of hydrocephalus, what are they?

Answer 4

Communicating (problem with CSF resorption in to venous sinuses)
Non-communicating (obstruction to CSF flow)

Question 5

What can be a cause of communicating hydrocephalus?

Answer 5

Infection e.g. meningitis

Question 6

3 sites of brain herniation

Answer 6

Subfalcine
Transtentorial
Tonsilar

Question 7

Define stroke

Answer 7

> 24 hours
focal/global loss of cerebral function
inadequate vascular perfusion

Question 8

Most common type of brain haemorrhage causing stroke

Answer 8

SAH

Question 9

TIA timings

Answer 9

<24 hours but most usually resolve <5 mins, caused by a clot

Question 10

2 main causes of stroke

Answer 10

Haemorrhage or infarct

Question 11

Most common site for haemorrhage stroke?

Answer 11

Basal ganglia

Question 12

Main RF for intraparenchymal haemorrhage

Answer 12

hypertension

Question 13

When do AV malformations occur?

Answer 13

under HIGH pressure –> massive bleed

Question 14

What is a cavernous angioma

Answer 14

collection of large weak capillaries with no parenchyma between them (like AVM but no brain substance wrapped up between the vessels)

Question 15

When do cavernous angiomas occur?

Answer 15

Under LOW pressure –> Recurrent bleeds

Question 16

Most common site of SAHs and most common cause?

Answer 16

Carotid bifurcation, berry aneurysms

Question 17

Tx of subarachnoid haemorrhage from rupture berry aneurysms?

Answer 17

Endovascular coiling

Question 18

Most common cause of cerebrovascular disease

Answer 18

Stroke caused by INFARCT/ Iscahemic stroke

Question 19

Main cause of ischaemic stroke

Answer 19

Cerebral atherosclerosis

Question 20

Where does cerebral atherosclerosis tend to affect?

Answer 20

Carotid bifurcation and basilar artery

Question 21

recovery in ischaemic vs haemorrhage stroke

Answer 21

Ischaemic - NO recovery

Haemorrhagic - partial

Question 22

Features of base of skull fracture

Answer 22

Rhinorrhoea/otorrhoea
Battle’s sign
Racoon’s eyes

Question 23

What is a brain contusion

Answer 23

When the brain collides with the internal surface of the skull

Question 24

what is coup

Answer 24

damage to the area of collision

Question 25

contrecoup

Answer 25

damage to the opposite side of brain to collision due to rebound of the brain

Question 26

What is diffuse axonal injury?

Answer 26

shearing and tensile forces which cause damage to the axons

Question 27

Stroke w/ contralateral leg paresis, sensory loss, cognitive defects (apathy, poor judgement) LEG > ARM - which artery affected?

Answer 27

ACA stroke

Question 28

Stroke in proximal basilar artery –> ?

Answer 28

Locked in syndrome

Question 29

Ipsilateral ataxia, Horner’s.,facial sensory loss

contralateral limb impairment of pain and temp sensation§

Answer 29

PICA stroke

Question 30

Lucid interval then LOC

Answer 30

Extradural haemorrhage (lemon, subdural is banana)