Stroke

Question 1

Stroke تعريف

Answer 1

Acute neurological dysfunction occurring as a result of a vascular process, causing death or lasting damage

Question 2

TRANSIENT ISCHEMIC ATTACK (TIA)

Answer 2

Transient episode of neurologic dysfunction caused by focal brain ischemia, lasting
between few minutes to 24 hrs, without acute infarction & without loss of consciousness.» high risk of developing stroke

Question 3

Global Hypoxic/Ischemic encephalopathy due to

Answer 3

generalized decrease in cerebral blood flow

Question 4

Features of global hypoxia: Selective Vulnerability of neurons in certain locations:

Answer 4

• Pyramidal cells in hippocampus
• Purkinje cells of the cerebellum
• Neurons in basal ganglia
• Cortical neurons especially in arterial boundary zones

Question 5

Watershed (Borderzone) infarcts include:

Answer 5

1. Boundary between anterior & middle cerebral arteries (Cerebral Convexities)
2. Boundary between superior & posteriorcerebellar arteries (Posterior cerebellum)
3. Necrosis few centimeters lateral to interhemispheric fissure.

Question 6

Acute Global Hypoxic/Ischemic encephalopathy

Answer 6

after 12 hrs

layers 4-6 of cortex (RED NEURONS )

neutrophils

glial cell death

Question 7

Subacute changes Global Hypoxic/Ischemic encephalopathy

Answer 7

24 hrs –2 weeks

tissue necrosis, macrophages & gliosis

Question 8

Global Hypoxic/Ischemic encephalopathy

Repair after 2 weeks

Answer 8

irregular neuronal loss, gliosis & brain atrophy

Question 9

Global Hypoxic/Ischemic encephalopathy outcomes depend on

Answer 9

Age, Duration of ischemia, Magnitude and rapidity of reduction of flow

Question 10

Result of Global Hypoxic/Ischemic encephalopathy

Answer 10

varies from persistent neurological deficit to brain death → Deep coma & flat EE.

Question 11

Focal brain necrosis due to complete and prolonged ischemia that affects all tissue
elements; neurons, glia, and vessels

Answer 11

INFARCTION (Focal Ischemia)

Question 12

Risk factors of infarction

Answer 12

Family history of stroke: Genetic marker

Patients with TIA > increased Infarction in 5 years

Infarcts account for 80% of CVA

• Atherosclerosis
• Diabetes, Hypertension,age, hyperlipidemia
• Cardiac arrhythmias & Cardiomyopathy
• Hypercoagulable states
• Smoking
• Use of contraceptive pills
• Cerebral amyloid angiopathy
• Vasculitis: inflammatory or autoimmune

Question 13

may lead to multiple small infarcts and more common

Answer 13

Embolism is more common than thrombosis

Question 14

Other emboli are

Answer 14

fat, bone marrow, air, amniotic fluid

Question 15

Histopathologic progression of CNS infarcts

Answer 15

1) EDEMA
2) “RED” NEURONS
3) POLYs(neutrophils)
4) MACROPHAGES (gitter cells) : clear damage , Can result in cyst and atrophy
5) GLIOSIS

Question 16

Clinical picture of patient with INFARCTION (Focal Ischemia)

linked to site of infarction

Answer 16

• Contralateral hemiparesis
• Spasticity (UMNL)
• Loss of sensation
• Visual field abnormalities
• Aphasia (broca area in dominant hemisphere)

Question 17

Mechanisms leading to infarction:

Answer 17

Thrombotic occlusion: Ischemic/ pale

• Embolic occlusion: hemorrhagic/ red

Question 18

Thrombotic occlusion

Where

Answer 18

o Carotid bifurcation
o Origin of middle cerebral artery
o Basilar artery at either end

Question 19

Embolic occlusion

Source + where

Answer 19

o Source: heart or atherosclerosis in carotid

o Middle Cerebral a. most affected

Question 20

Traumatic vascular injuries

Answer 20

Epidural Hemorrhage

Subdural hemorrhage

Question 21

Most occur with change head velocity e.g. boxers, battered baby & old age

Subdural hemorrhage or Epidural Hemorrhage

Answer 21

Subdural hemorrhage

Question 22

Disruption of Bridging Veins from brain to dural sinuses, more over convexities

Subdural or epidural

Answer 22

Subdural

Question 23

Which More common

Answer 23

Subdural

Question 24

Patient has short LUCID interval followed by rapid loss of consciousness

Epidural or subdural

Answer 24

Epidural Hemorrhage

Question 25

Cant cross suture, lens-shape Epi or sub

Answer 25

Epidural

Question 26

Epidural Hemorrhage Causes

Answer 26

Rupture of middle meningeal artery acute & accompanied by skull fracture Seen in 3% of significant trauma

Question 27

Fatal within 24 – 48 hrs. if untreated and treated by craniectomy Subdural or epidural

Answer 27

Epidural Hemorrhage

Question 28

INTRACRANIAL HEMORRHAGE

Answer 28

Primary Intracerebral Hemorrhage: Subarachnoid Hemorrhage:

Question 29

Subarachnoid Hemorrhage: Causes

Answer 29

1. Ruptured saccular (berry) aneurysm 2. Arteriovenous malformation 3. Hemangioma, telengiectasia

Question 30

Most common cause of primary intracerebral hemorrhage by 50% is

Answer 30

HT ارتفاع الضغط

Question 31

Most common cause of spontaneous subarachnoid hemorrhage F  M , age < 50 y

Answer 31

Ruptured saccular (berry) aneurysm

Question 32

Clinical signs of Subarachnoid Hemorrhage

Answer 32

• Headache, lethargy, photophobia, fever, neck rigidity. • Focal deficit may be present depending on site of hematoma.

Question 33

• “Worst headache of my entire life” with loss of consciousness When patient said this, that’s mean any case?

Answer 33

Ruptured saccular (berry) aneurysm.

Question 34

Ruptured saccular (berry) aneurysm At any age group ??? Induced by ??

Answer 34

4th - 5th decade, at apex, induced by straining, labour

Question 35

Ruptured saccular (berry) aneurysm.

Answer 35

• In 1/3 of cases rupture initiated by acute increase in intracranial pressure • Up to 90% in anterior & middle part of Circle of Willis, arise in arterial bifurcations

Question 36

Genetic Conditions Associated with Saccular Aneurysms

Answer 36

o Polycystic kidney disease (autosomal dominant) o Defects in extracellular matrix proteins e.g. Marfan’s syndrome

Question 37

Non-genetic Conditions Associated with Saccular Aneurysms

Answer 37

Coarctation of aorta

Question 38

Predisposing conditions Conditions Associated with Saccular Aneurysms

Answer 38

o Hypertension (fluctuation) o Cigarette smoking (present in 54% of patients)

Question 39

INTRACRANIAL HEMORRHAGE According to location, divided into:

Answer 39

Intracerebral • Subarachnoid • Epidural & Subdural

Question 40

INTRACRANIAL HEMORRHAGE of According to pathogenesis

Answer 40

• Primary hemorrhage • Secondary to: infarcts, tumors or trauma