Path II final Vascular diseases

Question 1

Brain receives what percent of cardiac output and oxygen in body?

Answer 1

15% CO

20% O2

Question 2

Cerebrovascular Disease Classification

Answer 2

1) Parenchymal Diseases
2) Infarcts due to local vascular obstruction
3) Hemorrhages within the brain parenchyma of subarachnoid space

Question 3

parenchymal injuries

Answer 3

One of three major types of Cerebrovascular Disease (5% of them)

Associated with GENERALIZED REDUCTION IN BLOOD FLOW

Example: Global Hypoxic-Ischemic Encephalopathy

Question 4

infarcts due to local vascular obstruction

Answer 4

One of three major types of Cerebrovascular Disease (80%)

AKA Stroke (Ischemic Stroke)

Question 5

Hemorrhages within the Brain Parenchyma

Answer 5

One of three major types of Cerebrovascular Disease (15% of CVD)

AKA Stroke (Hemorrhagic Stroke)

Question 6

CVD stroke

Answer 6

AKA Ischemic Stroke

Due to LONG TERM hypertension ->Hyaline Arteriosclerosis (causes obstruction of vessels less than 300 microns)

Blood can’t flow to tissue so it undergoes ischemia

People have neurological deficits due to lack of blood flow

IRREVERSIBLE

Question 7

cause of ischemic stroke?

Answer 7

LONG TERM hypertension which leads to Hyaline Arteriosclerosis

Question 8

What type of sclerosis is associated with Ischemic Stroke?

Answer 8

hyaline arteriosclerosis

Question 9

is ischemic stroke damage reversible?

Answer 9

No; irreversible

Question 10

what is the general cause of a stroke?

Answer 10

atherosclerosis

Question 11

Mechanism of a stroke

Answer 11

Atherosclerosis->platelet activation-> thrombi formation

thrombi can obstruct blood vessels and the brain

Question 12

what is the most common location of thrombi formation?

Answer 12

bifurcation of the common carotid artery and Birfurcation of the internal carotid artery

Question 13

what artery is the most common location of an ischemic stroke?

Answer 13

middle cerebral artery

Question 14

what test do you perform to identify ischemic stroke?

Answer 14

geroge’s test

Question 15

most common cause of ischemic stroke?

Answer 15

thrombosis!!

Question 16

stroke in internal carotid requires what?

Answer 16

operation

Question 17

Lacunar Area

Answer 17

Found in the mid-brain

Full necrosis and atrophy occurs here if there is a lack of blood flow

Most common infarction is associated with atherosclerosis (Followed by platelet formation and thrombosis leading to complete obstruction of blood flow)

Can also occur with a thrombi-embolism

Question 18

Where is the Lacunar Area?

Answer 18

In the mid-brain

Question 19

source of thrombosis/emboli

Answer 19

The HEART

1) Mitral Stenosis (reduced BF)
2) Artificial Valves

Question 20

mitral stenosis and thrombosis/emboli

Answer 20

Mitral Stenosis causes reduced blood flow

Thrombi are loose and can go into circulation -> Brain

Example: Bacterial Endocarditis can lead to ischemic hemorrhagic stroke (mechanical obstruction of the lumen -> Bacteria released into the parenchyme)

Question 21

bacterial endocarditis and thrombosis/emboli

Answer 21

Bacterial Endocarditis can lead to ischemic hemorrhagic stroke (mechanical obstruction of the lumen -> Bacteria released into the parenchyme)

Question 22

Artificial Valves and thrombosis/emboli

Answer 22

Artificial valves used when there is valvular insufficiency

Can promote thrombosis that can go into circulation (Thrombocytes develop)

Must take anti-coagulants for rest of life

Question 23

Hemorrhagic stroke is ___% of Cerebrovascular disease

Answer 23

15%

Question 24

Hemorrhagic stroke: 2 types

Answer 24

1) Intercerebral/Parenchymal

2) Subarachnoid Hemorrhagic Stroke

Question 25

Intercerebral/Parenchymal Stroke

Answer 25

A type of Hemorrhagic Stroke Due to LONG TERM hypertension Deposition of hyaline-like substances in the vascular wall -> Increased pressure causes rupture of these vessels and leakage into the brain Vascular cell is more brittle from hypertension -> Rupture of the vessel wall Brain is soft/gel-like and easily damaged Blood can cause atrophy of the tissues and acts like a toxin to the tissues it contacts

Question 26

Intercerebral/Parenchymal Stroke is due to what?

Answer 26

LONG TERM hypertension Vessels become brittle and rupture, leaking blood into the brain

Question 27

Problems with High Blood Pressure and Hemorrhagic Stroke

Answer 27

Causes rupture of hyalinized blood vessels Sudden increase in BP causes rupture Mechanical damage leads to degradation of the artery Brain tissue is soft and like gel -> Blood causes atrophy of the tissue (like a toxin) when in contact with brain outside of vessel

Question 28

Usually happens in people under 50

Answer 28

subarachnoid Hemorrhagic stroke

Question 29

occurs around the brain, not in it

Answer 29

subarachnoid Hemorrhagic stroke

Question 30

Usually occurs when aneurysms that are at the bifurcation rupture

Answer 30

subarachnoid Hemorrhagic stroke

Question 31

Rupture of the blood vessels of the subsrachnoid space (Generally cerebral arteries that are part of the Circle of Willis)

Answer 31

subarachnoid Hemorrhagic stroke

Question 32

What vessels are typically involved in Subarachnoid Hemorrhagic Stroke?

Answer 32

Cerebral Arteries that are part of the Circle of Willis

Question 33

2main types of aneurysms

Answer 33

1) Beri (Sacular; less than 1cm diameter) | 2) Giant (Up to 5cm diameter)

Question 34

Size of Beri Aneurysm

Answer 34

4-7mm diameter No more than 1cm diameter

Question 35

death of beri aneurysm

Answer 35

People die at age 48-50

Question 36

signs/symptoms of beri Aneurysm

Answer 36

Vague signs and symptoms that usually only appear when rupture develops

Question 37

Giant aneurysm size

Answer 37

Can be up to 5cm (pin-pong ball)

Question 38

Manifestation of giant cell aneurysm

Answer 38

similar to brain tumor headache, nausea, vomiting, papilledema

Question 39

What resolves a TIA?

Answer 39

Fibrinolytic activity of blood

Question 40

How long does it take a TIA to resolve?

Answer 40

They resolve within 24 hours

Question 41

Manifestations of TIA

Answer 41

1) Amaurosis Fugax (Unilateral vision loss)

Question 42

Amourosis fugax

Answer 42

Occurs with TIA Painless, temporary unilateral loss of vision Due to temporary thrombosis of the Opthalmic Artery Causes ischemia to retina Emboli can obstruct blood flow (most commonly due to an emboli from a stenosed carotid artery) Vision loss lasts for the period of time that the clot obstructs the flow

Question 43

Has similar symptoms to Amaurosis Fugax

Answer 43

temporal arteritis

Question 44

Most common sources of emboli in Amaurosis Fugax

Answer 44

Plaque or clot from stenosed carotid artery Other sources are heart or heart valves and arterial spasms

Question 45

How long does vision lost las with Amaurosis Fugax?

Answer 45

Only for as long as the obstruction prevents blood flow

Question 46

how to handle a TIA

Answer 46

Sit down and call 911 Give anti-coagulants which can prevent future TIA's