Nervous System (Block 6): Cv Pathology 2

Front 1

what pathology is shown here? how will pt experience this?

Back 1

hypertensive intracerebral hemorrhage; usually will suddenly rupture and pt with have a sudden headache. then they get homonymous hemi field defect.

Front 2

what 3 places can you develop intracerebral hemorrhages?

Back 2

BG/thalamus, pons, cerebellum

Front 3

pt had sudden bad headache and then got ipsilateral ataxia. what may have happened?

Back 3

cerebellar hemorrhage.

Front 4

what is shown here? can surgery repair this type of damage? what can surgery NOT repair?

Back 4

cerebellar hemorrhage. pt may get tonsillar herniation very quickly leading to respiratory failrue.

surgery can be done here with good prognosis. however, surgery is not an option when you bleed into your pons or your hemispheres, only hemorrhage in the cerebellum

Front 5

what is this showing? where can this pathology occur?

Back 5

microaneurysms (they can be found in the BG/thalamus, pons, cerebellum). these are the most common sites of hypertensive hemorrhages.

KNOW: hypertensive intracranial hemorrhages are due to microaneuryms!!

Front 6

which is more common cause of stroke, ischemia or hemorrhage?

Back 6

ischemia

Front 7

what are the 2 types of hemmorhages?

Back 7

intracerebral hematoma (ICH)
subarachnoid hemorrhage (SAH)

Front 8

what are the 4 types of intracerebral hematomas?

Back 8

- high BP-->hypertensive ICH
- amyloid angiopathy --> lobar ICH
- hemorrhage into tumors
- coagulation defects (either medically induced by warfarin or through pathway defects)

Front 9

what pathology is shown here? how does it occur? what are its clinical findings?

Back 9

amyloid angiopathy (which is a major cause of LOBAR HEMORRHAGE IN ELDERLY PATIENTS)

DEPOSITION OF AMYLOID IN THE VESSEL WALLS AND THAT WEAKENS STRUCTURAL INTEGRITY OF VESSEL WALL- MORE PRONE TO HEMORRHAGE. FOR SOME REASON, THESE ANEURYSMS OCCUR OUTSIDE OF THE 3 STRUCTURES MENTIONED ABOVE, THESE ARE CALLED LOBAR INTRACEREBRAL HEMORRHAGE. PT SAYS, “MAN I HAVE A HEADACHE!” PT MAY HAVE SOME FRONTAL BEHAVIORAL ABNORMALITIES, CONTRA HEMIPARESEIS, MAYBE A BROCA’S APHASIA (DEPENDING ON THE LOCATION)

Front 10

what type of hemorrhage is shown here?

Back 10

amyloid angiopathy (structurally unsound vessels with beta amyloid stuck in the vessel wall) ==> lobar ICH

- pateints with alzheimer's are prone to these types of hemorrhages (go figure!)

Front 11

what is shown here?

Back 11

amyloid angiopathy--> lobar ICH

Front 12

what is shown here/

Back 12

multiple hemorrhages in metastatic tumors...this pt had multiple brain tumors thta bled

BUT WHEN YOU SEE A INTRACERREBRAL HEMORRHAGE THAT’S NOT IN THE 3 ABOVE, AND THE PT DOESN’T HAVE HYPERTENSION, OR IF THEY’RE ON WARFARIN FOR DIFFERENT THINGS, THEN YOU HAVE TO THINK OF INTRACEREBRAL HEMORRHAGES LIKE THIS.

Front 13

what is important in the therapy of intracerebral hemorrhage (ICH)?

Back 13

- don't give anti-coagulant (bc you want their blood to remain sticky)
- surgical evacuation of CEREBELLAR hemorrhage, no where else!!
- can drain ventricles if hemorrhage goes there
- FACTOR VII has been shown to help slow down expansion of ICH

Front 14

what is being shown here? point to it!
what is the major cause of these kinds of hemorrhages?

Back 14

subarachnoid hemorrhage (SAH)

berry aneurysms are major cause

CONGENITAL DEFECT OF THE WALL OF THE BIG VESSELS AT BASE OF BRAIN - OVER YEARS OF EXPOSURE WILL RESULT IN GRADUAL DILATTION TO FORM A BERRY ANEURYSM, WHICH ONE DAY WILL RUPTURE. THIS PICTURE SHOWS THAT BERRY ANEURYSM CAN BE MULTIPLE. USUALLY PROXIMAL CIRCLE IN THE ANTERIOR CIRCULATION OF THE CIRCLE OF WILLIS (ACA, A COMM. A, MCA)
THERE’S 3 ANEURYMS THAT ARE SHWON ABOVE. THE LEFT TOP IS THE ONE THAT RUPTURED

Front 15

contrast berry aneurysms with mycotic aneurysms

Back 15

berry - on anterior circulation, proximally (can be multiple)

mycotic "infectious" (bacterial/fungal) - on anterior circulation also, but distally

IF THERE’S INFECTED HEART VALVE AND SHOWERING BLOOD STREAM WITH INFECTIOUS EMBOLI, MAY GO INTO THE VESSEL WALL OF THIS AREA IN THE HEAD. THEY TEND TO BE VERY DISTAL (IE. ONE OF THE BRANCHES OF THE MCA).

Front 16

what if pt says that they had a sudden onset of THE WORST HEADACHE OF THEIR LIFE?

Back 16

THAT SHOULD RAISE RED FLAG, IT COULD BE A LEAKAGE OF THE ANEURYSM AND THEIR READY TO BLOW ANYTIME. WHEN A PERSON HAS A BLEED FROM BERRY ANEURYSM, 30-40% OF THEM WILL DIE OUTRIGHT. THIS IS A VERY BAD DZ.

Front 17

what is shown here? what are 2 ways to keep this from happening again?

Back 17

ruptured berry aneurysm; dark blood in the subarachnoid space

1. neurosurgical (clip the aneuryism and isolate it from circulation so that it will eventually clot)
2. interventional neuroradiology (where you run metal coil into it and then run a current through it. the coil will separate the aneurysm)

Front 18

what does this do?

Back 18

coil will separate the aneuryism and you build an instant clot

Front 19

what happened here?

Back 19

pt with a sudden onset of worst headache of her life (from an ACA aneuryism). she was coiled, but after the coiling, the neck ripped and had a subarachnoid hemorrhage

VERY UNCOMMON

Front 20

What pathology occurred here?what would the clinical findings be?

Back 20

cavernous sinus aneurysm. internal carotid ruptures within cavernous sinus and will bleed into the sinus (better than subarachnoid hem). but you try to shunt this, could mess up CN 3,4,5,6.

Front 21

what are the similiarities and differences bw these 2 vascular malformations that could cause hemorrhages: arteriovenous malformation (AVM) & cavernous angioma?

Back 21

BOTH CAN CAUSE 3 THINGS: HEMORRHAGE, SEIZURES, AND FOCAL NEURO DEFICITS.

AVM - composed of anastomosed abnormal arterioles/veins; PRESENCE OF INTERVENING PARENCHYMA

CA - composed of capillary and small vein sized vessels THAT ARE BACK TO BACK (NO PRESENCE OF INTERVENING PARENCHYMA)

Front 22

what pathology is imaged forth? how can you treat this?

Back 22

arteriovenous malformation
treat by surgically removing this to prevent hemorrhage/stop seizures. also you can inject crazy glue to harden the vessels and block off all vessels to the AVM

Front 23

what is the pathology here? how can you tell?

Back 23

arterovenous malformation, as evidenced by the presence of intervening parenchyma

can get 3 things: hemorrhage, seizures, or focal neuro deficit

Front 24

what is the pathology here? how can you tell? what would the clinical findings be?

Back 24

temporal lobe cavernous angioma

you can tell bc of its popcorn appearance. would give you an aura prior to seizure (like smelling burnt rubber) and deja vu.

Front 25

what is the pathology here? how can you tell? what would the clinical findings be?

Back 25

temporal lobe cavernous angioma

you can tell bc of its popcorn appearance. would give you an aura prior to seizure (like smelling burnt rubber) and deja vu.

Front 26

what is this pathology? what is it composed of? name the mutation that could cause this.

Back 26

cavernous sinus in the pons; composed of capillaries and small vein sized vessels that are back to back. "popcorn" appreance on MRI.

"krit" mutation is involved in regulation of vascular growth and involved with CA

Front 27

what is wrong with this picture?

Back 27

pons showing vascular malformation due to cavernous angioma

Front 28

what is this?

Back 28

cavernous angioma found in the pons. If it Oozes too much could give you LT findings, CN findings, encroach on RAS and lead to LOC