NeuroPatho of Vascular Disease

Question 1

are more strokes ischemic or hemorrhagic?

Answer 1

ischemic is 80%`

Question 2

are neurons or glial cells more susceptible to ischemic injury?

Answer 2

neurons…use more oxygen

Question 3

what cells of cerbellum are most sensitive to infarct?

Answer 3

purkinje cells

Question 4

name three areas of brain that are stroke vulnerable

Answer 4

hippocampus
neocortex
watershed regions

Question 5

how long till stroke visible on CT?

Answer 5

6-8 hours

Question 6

what are initial changes seen on CT with stroke?

Answer 6

blurring of gray and white matter lines

Question 7

in 1-2 days post stroke what can be seen on CT?

Answer 7

congestion and discoloration of gray matter

Question 8

over time what occurs weeks following stroke?

Answer 8

cavitation due to necrosis and no neuron replacement in brain

Question 9

when is max swelling impact following stroke seen?

Answer 9

2-7 days post event with max at 7 days

Question 10

at 12-24 hours post stroke, how do neurons appear?

Answer 10

eosinophilic cytoplasm with pyknotic nuclei

Question 11

what cell starts to come into ischemic area at 1-3 days post stroke?

Answer 11

neutrophils start necrosis

Question 12

3-5 days post stroke what type of cell do we have a lot of?

Answer 12

macrophages

Question 13

at 1-2 weeks post stroke what cell is around?

Answer 13

lots of astrocytes and microglia

Question 14

what appears at site of ischemia more than 2 weeks post stroke?

Answer 14

glial scar

Question 15

what is focal ischemia of a deep penetrating vessel called?

Answer 15

lacunar infarct

Question 16

what regions are commonly an issue with global ischemia?

Answer 16

watershed regions

Question 17

what is difference in focal and global ischemia?

Answer 17

global is whole brain losing flow…like hypotension

focal is blockage of a specific vessel…thromboembolic

Question 18

what is a drug that causes brain hemorrhage?

Answer 18

cocaine

Question 19

what is most common cause of acute non traumatic intracerebral hemorrhage?

Answer 19

hypertension

Question 20

what two vessels does acute hypertensive hemorrhage clasically occur in?

Answer 20

lenticulostriate branches of MCA and pontine perforators of the basilar

Question 21

pontine and cerebellar hemorrhages are associated with compression of what?

Answer 21

the brainstem

Question 22

where are lacunar infarcts located? what two things are here?

Answer 22

in deep cerebral nuclei…globus pallidus and putamen

Question 23

what leads to infarcts being cut out in lacunar infarcts?

Answer 23

liquefactive necrosis

Question 24

what is the most common cause of a subarachnoid hemorrhage?

Answer 24

ruptured berry aneurysms

Question 25

what does gross brain look like in subarachnoid hemorrhage?

Answer 25

between arachnoid and pia so entire surface of brain red as is the sulci

Question 26

where do berry aneurysms occur?

Answer 26

circle of willis

Question 27

are more berry aneurysms found in anterior or posterior circulation of circle of willis?

Answer 27

much more in anterior

Question 28

what portions of the circle of willis commonly allow formation of berrys?

Answer 28

junctions of vessels

Question 29

what is special about vessel junctions that allow for berry aneurysms to form?

Answer 29

no media in blood vessel to prevent outpouching

Question 30

what are three layers of blood vessel? which is not present in berry aneurysm?

Answer 30

adventitia (outside) media internal elastica (inside)

Question 31

what are risk factors for berry aneurysms rupture?

Answer 31

HTN, cigs, cocaine, alcohol

Question 32

what type of disorders are berry aneurysms associated with?

Answer 32

connective tissue disorders like ehler danlos

Question 33

what can a subarachnoid hemorrhage lead to following the hemorrhage? when does it occur?

Answer 33

5-10 days after hemorrhage can have secondary vasospasm leading to ischemia

Question 34

what is an arteriovenous malformation?

Answer 34

connection of artery and vein without intervening capillary

Question 35

what is risk with arteriovenous malformation?

Answer 35

rupture into brain or subarachnoid

Question 36

what is Rx for arteriovenous malformation?

Answer 36

embolize and surgical resection

Question 37

what is a cavernous angioma?

Answer 37

tumor composed of small thin walled vessels

Question 38

name two risk with cavernous angioma

Answer 38

seizure and rupture

Question 39

what happens in giant cell arteritis?

Answer 39

pan arteritis with giant cells formin granulomas in the vessles

Question 40

what vessel is common in giant cell arteritis?

Answer 40

temporal artery

Question 41

what is Rx for giant cell arteritis?

Answer 41

steroids

Question 42

what is change seen in primary angiitis of CNS?

Answer 42

focal segmental granulomatous change

Question 43

what vessels seen in primary angiitis of CNS?

Answer 43

medium sized and small vessels of the leptomeninges and superficial cortex

Question 44

what does polyarteritis nodosa cause in CNS?

Answer 44

focal segmental inflamm with neutros and then necrosis