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Flashcards in Stroke Deck (14):
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What are the causes of intra cerebral haemorrhage?

Hypertensive small vessel disease (deep small vessels)
Congophilic amyloid angiopathy (superficial/peripheral vessels)
Blood disorders
Tumour
Vasculitis
Vascular malformation (arteriovenous malformations)
Drugs
Iatrogenic (following biopsy)

1

What are the common regions of the brain susceptible to hypertensive haemorrhage (vessels with hyaline arteriolosclerosis)?

Basal ganglia/thalamus
Lobar white matter (deep)
Cerebellum
Pons

2

What is cerebral amyloid angiopathy?

Deposition of Abeta amyloid in the walls of superficial supratentorial blood vessels - associated with Alzheimer's disease. Vessels are liable to rupture - - results in superficial haemorrhages - often recurrent

3

How do cerebral haemorrhages due to coagulopathies usually present and how are these different to hypertensive haemorrhages

With coagulopathies (ie leukaemias) you can see multiple focal haemorrhages at the same time which would be very rare for other causes of intracerebral haemorrhages

4

What are some common causes of subarachnoid haemorrhagic?

Trauma
Rupture of aneurysms
- saccular (Berry)
- mycotic (infective)
- atherosclerotic
Extension of intracerebral haemorrhage

5

What are the risk factors for saccular/berry aneurysms?

Sex (more common in females)
Increasing age
PCOS
Coarctation of aorta (congenital narrowing)
Type 3 collagen deficiency
Hypertension
Smoking
Alcohol

6

Where do saccular aneurysms commonly occur in the brain?

Sites of congenital weakness (arterial bifurcations)
- bi/trifurcation of MCA
- junction of ICA and post communicating
-anterior communicating artery (1/3rd)

7

Are saccular aneurysms more common in the anterior or posterior circulations?

Anterior

8

What are the complications of aneurysm rupture?

Subarachnoid haemorrhage (+/- intraparenchymal
Cerebral oedema and raised ICP
Vasospasm and infarction
Obstruction of ventricles -> hydrocephalus

9

What are the risk factors for stroke?

Ageing
Hypertension
Cardiac disease (AF, patent interstitial septum, HF)
Hyperlipidaemia
Diabetes mellitus
Hypercoagulable states
Smoking
Obesity

10

What are the 2 main causes of lacunae infarcts?

Small vessel disease:
Hypertensive (hyaline arteriolosclerosis) - deep vessels
Congophilic amyloid angiopathy (superficial supratentorial vessels)

11

What are the early macroscopic signs if cerebral infarction?

Cytotoxic oedema -> swelling (increased ICP) and risk of hernia toon
Loss of white/grey matter demarcation

12

Days to weeks after cerebral infarction what would you expect to see?

Reduced swelling
Liquifactive necrosis
Sharply demarcated infarct

13

Months to years following a stroke what would you expect to see macroscopically in a brain?

Cystic space - Liquifactive necrosis has been phagocytosed