Flashcards in Stroke Deck (14):
What are the causes of intra cerebral haemorrhage?
Hypertensive small vessel disease (deep small vessels)
Congophilic amyloid angiopathy (superficial/peripheral vessels)
Vascular malformation (arteriovenous malformations)
Iatrogenic (following biopsy)
What are the common regions of the brain susceptible to hypertensive haemorrhage (vessels with hyaline arteriolosclerosis)?
Lobar white matter (deep)
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
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
What are some common causes of subarachnoid haemorrhagic?
Rupture of aneurysms
- saccular (Berry)
- mycotic (infective)
Extension of intracerebral haemorrhage
What are the risk factors for saccular/berry aneurysms?
Sex (more common in females)
Coarctation of aorta (congenital narrowing)
Type 3 collagen deficiency
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)
Are saccular aneurysms more common in the anterior or posterior circulations?
What are the complications of aneurysm rupture?
Subarachnoid haemorrhage (+/- intraparenchymal
Cerebral oedema and raised ICP
Vasospasm and infarction
Obstruction of ventricles -> hydrocephalus
What are the risk factors for stroke?
Cardiac disease (AF, patent interstitial septum, HF)
What are the 2 main causes of lacunae infarcts?
Small vessel disease:
Hypertensive (hyaline arteriolosclerosis) - deep vessels
Congophilic amyloid angiopathy (superficial supratentorial vessels)
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
Days to weeks after cerebral infarction what would you expect to see?
Sharply demarcated infarct