Common Cns Vascular Disorders

Front 1

What are the causes of global hypoxic injury?

Back 1

-Ischemia secondary to athersclerosis of the carotid artery
-Chronic carbon monoxide poisoning
-Chronic hypoxemia (eg, chronic lung disease)
-Cardiac arrest, shock
-Repeated episodes of hypoglycemia in a type I diabetic (type I DM).

Front 2

What are the complications associated with global hypoxic injury?

Back 2

a. Cerebral Atrophy due to apoptosis of neurons in layers 3, 5, and 6 of the cerebral cortex. This produces laminar necrosis & apoptotic neurons that stain bright red with eosin(called red neurons or eosinophilic).
b. Watershed infarcts that occur at junctions of arterial territories. Areas in-between do not have overlapping blood suppy; therefore the tissue is not well supplied with oxygen. Example junction between the anterior and middle cerbral arteries.
c. Cerebrovascular accident (stroke)

Front 3

What is this?

Back 3

Cerebral Atrophy

Front 4

What is this?

Back 4

Watershed infarct

Front 5

What are the key associated vessels with the circle of willis.

Back 5

-Internal carotid artery
-Anterior Cerebral Artery
-communicating branch of Anterior Cerebral Artery
-Anterior Communicating Artery
-Middle Cerebral Artery
-lenticostriate branches of the middle Cerebral Artery
-Posterior Cerebral Artery
-Posterior Communicating Artery
-Basilar Artery

Front 6

What locatations are most susceptible to watershed infarct?

Back 6

-Junction between anterior and middle cerebral artery.

Front 7

Definition of a watershed infarct.

Back 7

-Occurs at the junctions of arterial territories. The blood supply does not overlap. Therefore this area is not well supplied with oxygen.

Front 8

List the five type of cerebrovascular accidents.

Back 8

1. Atherosclerotic stroke
2. Embolic stroke
3. Intracerebral hemorrhage
4. Subarachnoid hemorrhage
5. Lacunar infarcts

Front 9

Definition of atherosclerotic strokes.

Back 9

Thrombotic(disrupted plaque) that causes a pale infarct (liquefactive necrosis) resulting in ischemia. Reperfusion usually does not occur. If reperfusion occurs there is a hemorrhagic infarction.

Front 10

Pathogenesis of atherosclerotic strokes

Back 10

-Result of a disrupted plaques resulting in pale infarct (liquefactive necrosis). Platelet thrombus develops over a disrupted plaque
-Occurs in the Middle Cerebral Artery and the internal carotid artery near the bifurcation.
-Most occur in the distribution of the middle cerebral artery (MCA).
-Reperfusion usually does not occur.
-If reperfusion occurs it results in hemorrhagic infarction.

Front 11

What are the gross and microscopic findings in an atherosclerotic stroke?

Back 11

1. Wedge-shaped area of pale infarction. Develops at the periphery of the cerebral cortex.
2.Swelling of the brain occurs with loss of demarcation between grey and white matter. Myelin begins to break down.
3. Gliosis is the reaction to injury. Astrocytes proliferate at the margins of the infarct. Microglial cells (macrophages) remove lipid debris.
4. Cystic area develops after 10 days to 3 weeks.

Front 12

What is this?

Back 12

Wedge-shaped area of pale infarction due to an atherosclerotic (thrombotic) stroke.

Front 13

Transient ischemic attacks (TIA)

Something you should know & the definition, which has recently changed.

Back 13

Precede most strokes.

Definition - Deficits lasting 1-2 hours without CT or MRI evidence of damage.

Front 14

Amaurosis fugax-Definition, clinical findings, etc.

Back 14

A type of TIA."Fleeting vision"
a. Retinal vessel embolization of a cholesterol plaque. It can visualized with an ophthalmoscope & is called a Hollenhurst plaque.
b. It produces a sudden loss in vision.
c. It is described as a curtain coming down over the eye and then going up when vision is restored.

Front 15

Red neurons

Back 15

What should you be recognizing in this image?

Front 16

Patient presents with following symptoms:
1. Contralateral hemiparesis and sensory loss in face and upper extremity
2. Expressive aphasia if Broca's area in dominant (left 85%) hemisphere involved.
3. Visual field is involved
4. Head & eyes deviate toward side of lesion

Which artery is involved in this stroke?

Back 16

Middle Cerebral Artery (MCA)

Front 17

Patient has:
1. Vertigo & Ataxia
2. Ipsilateral sensory loss in face
3. Contralateral hemiparesis and sensory loss in the trunk & limbs

Which artery is involved in this stroke?

Back 17

Vertebrobasilar arterial system

Front 18

Patient has
1) Paresis/paralysis in the contralateral leg and foot
2) Parethesia or anethesia in the contralateral leg and foot

Which artery is involved in this stroke?

Back 18

Anterior Cerebral Artery

Front 19

Definition of embolus

Back 19

Detached mass

Front 20

Source of emboli in an embolic stroke.

Back 20

1) Most often originate from the left heart
2) Atherosclerotic debris from the Middle Cerebral Artery (MCA) and Carotid artery

Front 21

Definition of embolic stroke.

Back 21

Hemorrhagic infaction that extends to periphery of cerebral cortex

Front 22

Where do most embolic strokes occur?

Back 22

Most occur in the distribution of the middle cerebral artery (MCA)

Front 23

What produces hemorrhage in an embolic stroke?

Back 23

Reperfusion after lysis of embolic material produces hemorrhage

Front 24

How do you treat non-hemorrhagic infarcts

Back 24

Thrombolytic therapy

Front 25

Is thrombolytic therapy indicated in a embolic stroke?

Back 25

No, it is hemorrhagic infarction, where thrombolytic therapy is contraindicated.

Front 26

Intracerebral hemorrhage definition

Back 26

Intracerebral hemorrhage is a complication of hypertension that is due to stress imposed the vessels by the high pressure.
(1) Branches of lenticulostriate vessels from MCA develop Charcot-Bouchard macroaneurysms
(2) Ruputure of aneurysms produces intracerebral hemorhage (hematoma)

Front 27

Where are the common sites of intracerebral hemorrhage

Back 27

1. Basal ganglia (35-50% occur in the putamen)
2. Thalamus (10%)
3. Pons and Cerebellar hemispheres (10%)

Front 28

What is the result of treating hypertension?

Back 28

Treatment of hypertension reduces the incidence of stroke by more than 40%

Front 29

Definition of a Subarachnoid hemorrhage

Back 29

-A hemorrhage that is below the arachnoid mater.

Front 30

Pathogenesis of a subarchnoid hemorrhage

Back 30

A subarachnoid hemorrhage is caused by the rupture of congenital berry aneurysm in most cases and bleeding from an arteriovenous malformation in others.

Front 31

What is the patient presentation who has a subarachnoid hemorrhage?

Back 31

Patient presents grabbing the back of their head (occiput) that has sudden occurred and is the "worst headache ever" with nuchal rigidity.

Front 32

How many patients die after a subarachnoid hemorrhage?

Back 32

50%

Front 33

What are the complications of a subarachnoid hemorrhage?

Back 33

-More hemorrhage (buhwahaha, evil laugh)
-Hydrocephalus
-Permanent neurologic deficits

Front 34

What are the clinical findings of a subarachnoid hemorrhage?

Back 34

1) Sudden onset of a severe occipital headache
2) About 50% die soon after hemorrhage
3) Complications include-
a) Further hemorrhage
b) Hydrocephalus
c) Permanent neurologic deficits.

Front 35

Where do most congenital berry aneurysms develop?

Back 35

They develop at junctions of the communicating branches of main cerebral artery because the junction lacks internal elastic lamina and smooth muscle. The most common site for berry aneurysm is the junction of the communicating branch with the ACA.

Front 36

Where does the blood from the rupture go?

Back 36

Blood goes into the subarachnoid space and covers the surface of the brain.

Front 37

What are the CSF color changes in pathologic bleeds?

Back 37

1) Pink, yellow, or orange-tinged CSF after centrifugation
2) Pink color is due to oxyhemoglobin from ruptured RBCs
-color first occurs 2-4 hours post bleed; peaks 24-36 hours; subsides 4-8 days
3) Yellow to orange color (xanthochromia) is due to oxyHb breakdown to bilirubin.

Front 38

Xanthochromia

Back 38

A yellow to orange color due to breakdown oxyHb to bilirubin is a sign of pathologic bleed. It firsts appears 12 hours post bleed; peaks 2-4 days; subsides 2-4 weeks.

Front 39

Subarachnoid hemorrhage

Back 39

rupture of congenital berry aneurysm

Front 40

List the three types of strokes associated with hypertension

Back 40

1. Intercerebral hemorrhage
2. Subarachnoid hemorrhage due to ruptured berry aneurysm
3. Lacunar Stroke

Front 41

Definition of lacunar infarct

Back 41

-Cystic areas of microinfarction < 1 cm in diameter caused by hyaline arteriolosclerosis that are secondary to hypertension (most common) or diabetes mellitus

Front 42

Lacunar

Back 42

Lake

Front 43

Where is the lesion & type of stroke if patient has motor deficits with or without dysarthria?

Back 43

A lacunar infarct of the posterior limb of the internal capsule

Front 44

Where is the lesion & What is the type of stroke if the patient has only sensory deficits?

Back 44

A lacunar infarct of the thalamus.