Flashcards in Neuropathology of Cerebrovascular Disease Deck (29)
What is the source of anterior flow in the brain?
Internal Carotid ~70% of CBF
What is the source of posterior flow in the brain?
Vertebral Arteries 30% of CBF
What is the order of cells in the CNS from most to least sensitive to ischemia?
neurons > oligodendrocytes > endothelial cells > astrocytes
What changes appear 6-12 hours after global cerebral ischemia?
What are areas that are very vulnerable to ischemia?
- Pyramidal neurons in cerebral cortex (layers 3, 5 and 6) – leads to LAMINAR NECROSIS
- Pyramidal neurons of hippocampus (long term memory)
- Purkinje cells of cerebellum
What artery feeds the lateral areas of the brain?
What artery feeds the superio-medial area of the brain?
What artery feeds the inferio-medial area of the brain?
What are the main causes of small vessel disease in the CNS?
What is the cause of thrombotic strokes?
Rupture of atherosclerotic plaque
What is the cause of embolic strokes?
Cardioembolism often from atrial fibrillation
What vessels does lacunar stroke affect?
What is the most common artery involved in embolic infarct?
What can be seen with lacunar strokes?
Arterial Hyalinosis from Hyaline Arteriolosclerosis as a result of HTN
‐ Circumscribed hematoma surrounded by brain tissue
‐ Hemorrhage may extend into the subarachnoid space or to the ventricles
Bleeding into subarachnoid space
What is the most common cause of subarachnoid hemorrhage?
What are the associations of Berry aneurysms?
- AD Polycystic Kidney Disease
- Marfan's Syndrome
Where are most Berry aneurysms found?
Anterior Communicating Artery in the Circle of Willis
Rare in adults but common in premature infants with massive intraventricular hemorrhages being instantaneously fatal
They are small lineal areas of bleeding in the midbrain and upper pons of the brainstem. They are caused by a traumatic downward displacement of the brainstem.
Blood between dura and the skull - often due to rupture of the middle meningeal artery
Blood underneath the dura covering brain surface - due to tearing of bridging veins
What can tonsillar herniation lead to the compression of?
Compression of the brainstem which can lead to cardiopulmonary arrest
What can subfalcine herniation lead to the compression of?
Compression of ACA leads to infarction
What can uncal herniation lead to the compression of?
- CN III - eye will go down and out and dilate
- PCA which causes occipital lobe infarction
- Rupture of the paramedian arteries leading to Duret hemorrhages
Downward displacement of cerebellar tonsils into foramen magnum
Displacement of the cingulate gyrus under falx cerebri