vascular disorders

Question 1

What vessels are involves in anterior circulation of cerebrum?

Answer 1

internal carotid A
anterior cerebral A
middle cerebral A

Question 2

What vessel are involved in posterior circulation?

Answer 2

vertebral A
basilar A
posterior cerebral A

Question 3

Where and when do watershed infarcts occur?

Answer 3

Bw distributions of anterior and middle cerebral arteries when diffuse hypotension occurs

Question 4

What is a common cause of cerebrovascular thrombosis? What are major sites of involvement?

Answer 4

arterial atherothrombosis, often involving:

internal/external carotid bifurcation, m.cerebral A,
vertebrobasilar A,

Question 5

What are the most common sources of thromboembolism?

Answer 5

cardiac:
a. fib
MI
bacterial endocarditis/septic emboli

Question 6

What are some noncardiac sources of thromboemboli?

Answer 6

major artery atheromatous plaques
fat emboli
air emboli

Question 7

Why are cerebral infarcts commonly hemorrhagic?

Answer 7

1. fragmentation/detachment of embolic material from initial site of impaction and,
2. repurfusion

Question 8

What are some results/consequences of septic emboli?

3Ms

Answer 8

meningitis and microabscesses

mycotic aneuysms- infected vessel walls

Question 9

What are transient ischemic attacks? What causes them?

Answer 9

mini strokes caused by plt emboli from a atherosclerotic plaque.

ischemia without infarction

Question 10

What is the clinical definition of TIAs?

Answer 10

episodes of neurological dysfunction that last a few minutes to an hour, and completely return by 24 hours.

Question 11

What are the characteristic clinical features of cerebral infarction?

Answer 11

sudden onset- vascular suggestion

deficits reflect affected vascular territory

Question 12

Outline the steps of the macroscopic pathology of cerebral infarction:

Answer 12

1- softening and edema-> herniation
2- necrosis
3- cyst-like cavitaion

Question 13

What is the important microscopic feature of the first 12-48 hours following CI?

Answer 13

coagulation necrosis leading to red-dead neurons

Question 14

What are the important microscopic features of the 3-7 days following CI?

Answer 14

m@ and PMNs begin liquefaction necrosis-

from circulation, phagocytize necrotic debris and become liquid laden m@.

Question 15

What are the important microscopic features of the 7-14 days following CI?

Answer 15

vascular proliferation and liquefaction necrosis,

reactive astrocytes and more m@

Question 16

When does organizing cavitation occur? What are they surrounded by?

Answer 16

weeks to months

reactive astrocytes

Question 17

What vessels are occluded causing lacunar infarcts?

Answer 17

deep paramedian penetrating arteries

Question 18

Where do lacunar infarcts occur? What histological changes do they cause?

Answer 18

lipohyalinosis ateriolosclerosis

Question 19

What diseases are lacunar infarcts associated with?

Answer 19

HYP and DM

Question 20

What are the variants of venous infarcts?

Answer 20

lacunar

venous

Question 21

What typically results from a venous infarction?

Answer 21

Hemorrhagic infarction

Question 22

What conditions/states often precipitate superior sagittal sinus thrombosis (SSST)? What can SSST cause?

Answer 22

infection
dehydration

bilateral parasagittal hemorrhagic cerebral infarcts

Question 23

What is the pathogenesis of venous infarcts?

Answer 23

rapid thrombotic occlusion of deep cerebral veins/venous sinuses causing diminished flow/venous congestion–> ischemia and hemorrhagic infarction

Question 24

What are the clinical aspects of HYP hemorrhages?

Answer 24

sudden headache, obtundation

deficits reflective of location

Question 25

Describe the pathogenesis of hyp hemorrhages? Where do they commonly occur?

Answer 25

rupture of Charcot-Bouchard aneurysms that cause displacement of CNS elements,

occurs in deep cerebral gray and WM,
also occurs deep WM, thalamus, pons and cerebellum

Question 26

If CNS element’s involvement, causes hyp hemorrhages to be more fatal?

Answer 26

lateral ventricle

Question 27

What is commonly seen in the deep penetrating arteries of HYP hemorrhages?

Answer 27

Charcot- Bouchard aneurysms

Question 28

What space do hemorrhages from saccular aneurysms occur in CNS?

Answer 28

subarachnoid

Question 29

What is the classical clinical picture of a saccular berry aneurysm?

Answer 29

middle aged, no preexisting conditions
worst headache of life
stiff neck- meningismus

Question 30

Where do saccular aneurysms occur? Most common locations?

Answer 30

bifurcations of large vessels, especially proximal branches of circle of Willis

1. jnx of: internal carotid- posterior communicating- middle cerebral A
2. jnx: ant. cerebral- ant. communicating A.
3. first branch of m. cerebral A.

Question 31

What causes the formation of saccular berry aneurysm?

Answer 31

1. developmental defect of media/elastica, and

2. repeated/prolonged hemodynamic stress

Question 32

Commonly presenting with hemorrhages and seizures in 20’s/30’s are what?

Answer 32

arteriovenous malformations resulting from abl maturation of vessels during development.

Question 33

What does this malformation result in grossly?

Answer 33

tangle of abl arteries, veins and communicating shunts, leaving the pt predisposed to bleeding.

Question 34

Histologically, how does arteriovenous malformation present?

Answer 34

large arteries and thick walled veins with intervening brain tissue

Question 35

What is the radiographical appearance of cavernous malformation?

Answer 35

dark rim on MRI

Question 36

What is the histological appearance of a cavernous sinus?

Answer 36

dilated venous/capillary channels,
and a rim of hemosiderin,
minimal intervening brain tissue

Question 37

Cerebral amyloid angiopathy is described as?

Answer 37

An elderly- alzheimer associated, often familial- cause of lobar hemorrhage