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Neuroscience > Stroke > Flashcards

Flashcards in Stroke Deck (42):
1

What is stroke?

Development of focal or global neurologic deficit related to a vascular event

2

Are strokes always visible?

Yes

But 'silent' vascular events may occur

3

Describe the pathologic processes involved in stroke, and the percentage of patients in which they occur?

Infarction (75%)

Haemorrhage (20%)

Subarachnoid haemorrhage (5%)

4

What are the risk factors for cerebral infarction?

Ageing

Hypertension

Cardiac disease

Hyperlipidaemia

Diabetes Mellitus

Hypercoagulable states

Smoking

Obesity

5

What is cerebral infarction?

Necrosis of cerebral tissue in a particular vascular distribution due to vessel occlusion or severe hypoperfusion 

6

What is the cause of cerebral infarction?

Usually related to arterial obstruction 

Can also be arterioles, veins, heart

7

Describe the mechanisms of infarction?

Inadequate supply of blood due to pump failure

Inadequate supply of blood due to narrowed vessel lumen (atheroscelrosis, thrombosis, hypertensive vessel thickening, diabetes, amyloid angiopathy)

Vessel occlusion by embolus

8

Describe the causes of occlusion in vessels that cause cerebral infacrtion?

Large artery occlusion: thrombotic, may be embolic

Small vessel occlusion: thrombotic, may be embolic

Venous occlusion: thrombotic 

9

Describe this pathology, and how it relates to stroke?

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Valve vegetations

Due to non-bacterial thrombotic endocarditis

Vegetations can enter the systemic circulation 

10

Describe this pathology, and how it relates to stroke?

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Probe-patent interatrial septum

Potential for thrombus that form in venous system to pass from RA to LA, and then enter the brain 

11

What is the most common site for thrombi to develop?

Venous system

12

Describe this pathology, and how it relates to stroke?

Atherosclerosis in Circle of Willis

Common sites: vertebral arteries, basilar artery, internal carotid termination artery, proximal middle cerebral artery 

13

Describe this pathology, and how it relates to stroke?

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Thrombotic vessel occlusion in atherosclerosis

14

Describe this pathology, and how it relates to stroke?

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LEFT: old carotid endarterectomy

RIGHT: recent carotid endarterectomy 

Procedure is performed to prevent ulcerated or stenotic atherosclerosis from causing cerebral infarction 

15

Describe this pathology, and how it relates to stroke?

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Swelling 36 hours after cerebral infarct

Due to cell membrane break down, accumulation of fluid and adjacent vasogenic oedema

Also herniation here 

16

Describe how a brain looks immediately after cerebral infarction?

Initially, appears normal

Then starts to swell

Lose demarcation between grey and white matter

Herniation may occur 

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17

Describe this pathology, and how it relates to stroke?

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Viable neurons centrally, surrounded by axonic-ischaemic neurons

Initally cells swell up, then neurons die, nucleus becomes pyknotic, and eventually disappears 

Supporting glial cells have not died 

18

Describe this pathology, and how it relates to stroke?

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Infarct that is days/weeks old 

Swelling has gone down

Tissue breaks down

Cerebral tissue necrotic - macrophages mving in to remove dead tissue 

 

19

What is the pathology?

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Liquefactive necrosis

20

Describe this pathology, and how it relates to stroke?

Infarct after months/years 

Loss of cerebral tissue

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21

Describe this pathology, and how it relates to stroke?

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BRAIN: Cerebral haemorrhagic infarcts

Due to embolism from cardiac ventricle thrombus (small fragments of thrombus flicked up to brain)

HEART: Wall thinned, aneurysm of ventricle (can lead to thrombus)

22

What is haemorrhagic infarction charcteristic of?

Embolic events

23

Describe this pathology?

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Haemorrhagic transformation in recent infarct 

24

Describe this pathology, and how it relates to stroke?

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Hyaline arterioloscelrosis

Most usually due to hypertension

Vessel balloons > enlargement of vascular lumen > can rupture> haemorrhage or thrombosis

Vascular disease can be at small vessel level such as this 

25

Describe this pathology, and how it relates to stroke?

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Old lacunar infarct 

Small vessel occlusion > small infarct 

May not be clinically important if in less important areas of brain 

May be devastating if in important areas of brain 

26

Why do people with cerebral infarction die?

Most commonly, die of complications due to them being incapacitated or having other risk factors: pneumonia, cardiovascular disease, pulmonary thromboembolism

May also die due to cerebral swelling or involvement of vital centres 

27

Describe the possible complications of raised ICP?

Herniation

Brainstem haemorrhages 

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28

What are the causes of intracerebral haemorrhage?

Hypertensive small vessel disease

Congophylic (amyloid) angiopathy

Blood disorders

Tumour

Vasculitis

Vascular malformation 

Drugs

29

Which vessels does amyloid angiopathy affect?

Small vessels 

Much more likely to affect vessels at periphery of brain 

30

What is the major cause of hypertensive haemorrhage?

Where does it usually occur?

Small vessel disease due to hyaline arteriolosclerosis

Usually occurs in basal ganglia/thalamus, lobar white matter, cerebellum or pons

31

Describe this pathology, and how it relates to stroke?

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Intracerebral haemorrhage

Due to hyaline arteriolosclerosis

Also an old contralateral 'slit' haemorrhage 

32

What is cerebral amyloid angiopathy?

Deposition of ab amyloid in walls of superficial supratentorial blood vessles 

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33

What disease states is cerebral amyloid angiopathy associated with?

Superficial haemorrhages 

Alzheimer's disease 

34

Describe this pathology?

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Amyloid angiopathy

Senile plaque left of centre 

Thickening of walls of small vessels

35

Describe this pathology?

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Multifocal synchronous haemorrhages

Due to coagulopathy

Must be a systemic problem, due to multifocal lesions 

36

Describe this pathology?

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Rupture of congenital ateriovenous malformation

Following attempted therapeutic embolisation 

37

List the non-traumatic causes of subarachnoid haemmorhage?

Rupture of saccular/Berry aneurysm

Rupture of other types of aneurysm (mycotic, atherosclerotic)

Extension of intracerebral haemorrhage 

38

Describe the risk factors for developing saccular aneurysm?

Gender - female

Age - in younger, not elderly

Polycystic kidney disease

Coarctation of aorta

Type III collagen deficiency

Hypertension

Smoking/alcohol

39

Describe this pathology?

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Ruptured basilar artery due to saccular aneurysm 

40

Where do saccular aneurysms usually occur?

Sites of congenital weakness at arterial bifurcations

More often in anterior circulation than posterior 

Favoured sites: bi/trifurcation of MCA, junction of ICA and posterior communicating artery, anterior communicating artery

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41

Describe this pathology?

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Ruptured anterior communicating artery aneurysm

With inter and intraventricular haemorrhage 

42

Describe the complications of aneurysm rupture?

How are they prevented?

Subarachnoid haemorrhage 

Cerebral oedema and raised ICP

Vasospasm 

Infarction

Hydrocephalus due to ventricular obstruction 

 

Prevented by clipping neck of aneurysm to prevent further bleeding