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Block 8 Week 4 Colt > Vascular Path of the CNS - Parks > Flashcards

Vascular Path of the CNS - Parks Flashcards

(59 cards)

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1
Q

what common bifurcating artery in the neck may occlude causing an ischemic stroke?

A

the carotid bifurcation

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2
Q

which part of an atherosclerotic plaque can break off and emobolize?

A

the outer, non calcified portions

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3
Q

What are the two common ways that common carotid stenosis can lead to embolization?

A
  1. fragment of the plaque itself breaks off and lodges in the brain
  2. PLT aggregates forms an embolus which lodges in the brain
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4
Q

Narrowing of the common carotid leads to what physical exam finding?

A

bruit

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5
Q

a thrombus or embolus will lead to (focal/global) ischemia

A

focal ischemia

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6
Q

infarcts of the internal capsule have what types of symptoms?

A

motor symptoms and hemiparesis

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7
Q

What are the common locations for focal embolus or thrombus?

A

carotid bifurcation
MCA
penetrating arteries

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8
Q

what happens to the brain that is downstream from an embolus?

A

it swells

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9
Q

What are the characteristics of a high risk plaque?

A

lipid rich
thin fibrous capsule
can rupture and thrombose

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10
Q

T/F: thrombosis due a high risk plaque rupture is an indication for the use of tPA

A

true

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11
Q

What happens when you rupture a high risk plaque?

A

complete occlusion of the artery

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12
Q

What ion enters the cell as it is dying which then leads to membrane damage, nuclear damage, and decreased ATP?

A

Ca

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13
Q

Explain how calcium enters dying neurons uncontrollably? what is this called?

A

EXCITATORY CYTOTOXICITY
Normally Na and Ca enter cells in small bursts due to glutamate. In stroke, surrounding neurons have released glutamate, but can’t take it back up because they’re dying, so the neurons are taking in more and more calcium from the glutamate

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14
Q

Mild ischemia leads to cell death via what mechanism while severe ischemia leads to cell death via….

A

mild: apoptosis
severe: necrosis

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15
Q

what type of free radicals are generated in ischemia?

A

nitrogen free radicals

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16
Q

what is the name for the tissue at risk?

A

penumbra

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17
Q

t/f: reperfusion of the penumbra will reduce the final size of the lesion

A

true

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18
Q

when looking at a histo slide of neurons from an ischemic stroke, why is there so much empty space between the neuons?

A

edema from cell injury

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19
Q

Edema post stroke peaks on what day?

A

2-3

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20
Q

edema post stroke can have a mass effect for how many days?

A

10

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21
Q

edema from a stroke can lead to what serious complication?

A

herniation

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22
Q

24-48 hours after a stroke, what type of infiltrate is present?

A

neutrophils

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23
Q

After day 10, what type of infiltrate is present in stroke tissue?

A

macrophages and microglia

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24
Q

An old infarct will see proliferation of what cell type because the brain doesn’t have fibroblasts?

25
What is the name for brain scarring?
gliosis
26
Gliosis become sites for future...
seizures
27
Cystic degeneration means that you are looking at the area of an old...
infarct
28
liquefactive necrosis leads to what type of degeneration?
cystic degen
29
why do you want to stop A fib?
it can embolize to the brain
30
What change to the heart valve can embolize and cause a stroke?
vegetations; they are friable
31
where do vegetative emboli from the heart tend to lodge in the brain?
MCA
32
you can find bacteria in the areas of infarct if the emboli was caused by...
infective endocarditis
33
when do you get global ischemia?
follows cardiac arrest where no blood is being pumped severe hypotension in shock, aka hypovolemic shock from blood loss or ischemic/hypoxic encephalopathy
34
loss of sulci on MRI is due to edema from....
global ischemia
35
are neurons or glial cells more sensitive to ischemia?
neurons
36
Describe neruonal vulnerability
neurons in different parts of the brain are more vulnerable to ischemia
37
What is a watershed infarct?
an infarct due to global ischemia that occurs at the distal ends of the arteries where there is the least blood flow
38
what are the two pathologic changes that occur in global ischemia?
watershed infarct | cortical laminar necrosis
39
Border zone infarcts are aka
watershed infarcts
40
What artery supplies the internal capsule and other deep brain structures?
the MCA
41
The deeper the lesion in the brain, the (blank) it is
worse
42
HTN will cause a hemorrhage into superficial or deep areas of the brain?
deep
43
HTN accelerates what process that leads to MI and stroke?
atherosclerosis
44
Blow out hemorrhages occur because of ....
uncontrolled HTN
45
what is the name for the penetrating arteries of the brain?
lenticulostriate arteries
46
What other organs besides the brain have small arteries coming off of a big hose?
kidneys and eye; | therefore the brain, kidneys, and eye are the most susceptible to HTN damage
47
Lacunar infarcts can happen as a result of....
HTN
48
T/F: lacunar infarcts are commonly asymptomatic
true
49
what is notable about the symptom presentation of lacunar infarcts?
tend to be whole-body hemiparesis; face-arm-leg or arm-leg
50
T/F: berry/saccular aneurysms pose no direct threat as long as they don't rupture
true
51
Are berry aneurysms acquired
no, all congenital
52
Where do berry aneurysms commonly present in the circle of willis?
1. anterior cerebral artery near anterior communicating 2. MCA-either farther out or near posterior communicating 3. Basilar-posterior junction
53
Where does the blood go when a berry aneurysm ruptures?
either over the brain or into the brain
54
What happens when a ruptured aneurysm bleeds over the brain?
subarachnoid hemorrhage
55
When aneurysms rupture, you get a ....
strok
56
What makes berry aneurysms worse?
HTN
57
What disease is associated with aneurysms?
polycystic kidney disease
58
The likelihood of an aneurysm to rupture is directly related to...
its size
59
Ateriovenous malformations can rupture and cause a stroke with the first sign often being.....
a headache

Block 8 Week 4 Colt (7 decks)

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