Histopathology 19: Cerebrovascular Disease And Trauma Flashcards
(26 cards)
What are the 2 types of hydrocephalus ?
Non-communicating
Communicating
What is the main cause of non-communicating hydrocephalus ?
The choroid plexus gets stuck in the cerebral aqueduct blocking csf flow
What is a common cause of communicating hydrocephalus?
Meningitis infection- causes inflammation of the meninges which blocks csf reabsorption into the venous sinuses
What are the 3 main types of herniation in the brain ?
- Subfalcine herniation
- uncal herniation (medial temporal lobe down through the tentorial notch)
- Tonsillar herniation (coning)- cerebellum is pushed through the foramen magnum
What features can be seen on histology suggesting AVM (atrioventricular malformation) ?
Complex intertwining vessels
What is the characteristic sign of Cavernous Angioma on MRI ?
Target sign on T2 weighted MRI
What is a non-traumatic Intra-parenchymal haemorrhage ?
Haemorrhage into the brain parenchyma due to rupture of a small intraparenchymal vessels
Most commonly into the basal ganglia
What is the most common cause of non-traumatic intra parenchymal haemorrhages ?
Hypertension
With which symptoms/signs can a fissure fracture present ?
Otorrhoea- CSF fluid leaks out of the ears
Rhinorrhoea- CSF fluid leaks out of the nose
Battle sign and raccoon eyes
Rotational traumatic brain injury tend to cause damage to which structures in the brain ?
Midline structures - corpus callosum, rostral brainstem, septum pellucidum
Describe the features of subarachnoid haemorrhage ?
- Haemorrhage in the subarachnoid space.
- Caused by ‘berry’ aneurysm, hypertension, trauma, AVM - severe ‘thunder clap’ headache radiating to the occiput - associated with polycystic kidney disease, coarctation of the aorta
Describe the features of extradural haemorrhage ?
- Bleed above the dura due to damage to the middle meningeal artery
- associated with severe trauma and fracture to the pterion
- subsequent lucid interval.
Describe the features of Intracerebral haemorrhage (haemorrhage stroke) ?
- Caused by hypertension and arteriovenous malfor- mations.
- Hypertension may lead to either hyaline arteriosclerosis or Charcot–Bouchard aneurysms.
Describe the features of subdural haematoma ?
- Bleed between the dura and arachnoid due to an acute tear in bridging veins.
- caused by trauma.
- features of raised intracranial pressure (headaches, confusion, nausea and vomiting), altered mental state
- Insidious onset usually taking 48 hours
what are 2 types of cerebral oedema
VASOGENIC - disruption of the BBB
CYTOTOXIC - secondary to cellular injury (eg hypoxia. ischaemia)
cerebral oedema on MRI
loss of gyri
describe the route CFS takes
choroid plexus pumps out CSF
goes from lateral ventricles - intraventricular foramina - 3rd ventricle
cerebral aqueduct - 4th ventricle
medulla - central canal
subarachnoid space
CSF goes via arachnoid granulations - returns to systemic circulation
normal ICP
7-15mmHg in a supine adult
increased pressure causes herniation
features of non-traumatic intra-parenchymal haemorrhage
haemorrhage into the brain parenchyma due to rupture of small intraparenchymal vessels
common in basal ganglia
hypertension in 50%
presents as: severe headache, vomiting, LOC, focal neurological signs
presentation of AV malformations
haemorrhage
seizures
headache
focal neurological deficits
occur under high pressure causing a massive bleed
features of cavernous angiomas
well-defined malformative lesion composed of closely packed vessels with no parenchyma interposed between the vascular spaces
presents as: headache, seizures, focal deficits, haemorrhage
tend to occur at lower pressure
features of sub-arachnoid haemorrhages
rupture of a berry aneurysm
most in the inter-carotid bifurcation
highest risk of rupture when 6-10m in diameter
presents as: sudden onset severe headache, vomiting, LOC
features of cerebral infarction
tissue death due to ischaemia
cerebral atherosclerosis = most common cause
especially affects the carotid bifurcation or the basilar artery
largest area supplied by middle CA
types of head trauma
missile + non-missile
acceleration and deceleration
focal or diffuse
