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Cerebrovascular Dis.

Cerebrovascular Disease

Things that can lead to a stroke ? * Thrombosis, embolism & hemorrhage
Arterial area that is at greatest risk for infarcts ? * Watershed area between the anterior and middle cerebral artery
Reduction in blood flow that lasts longer than several seconds = ? * Cerebral Ischemia
Cessation of flow lasting longer than several seconds = ? * Cerebral Infarct
Spontaneous rapid restoration of flow with symptoms subsiding within 24 hours = ? * Transient Ischemic Attack (TIA)
When the ENTIRE brain is affected from ischemia ? * GLOBAL cerebral ischemia
Usu cause of global cerebral ischemia ? * Severe HYPOtensive state
Global Cerebral Ischemia things that can happen ? * Can see mild confusion, with full recovery of tissues..... * can see widespread neuronal death that puts people in a vegatative state..... *
Global Cerebral Ischemia morphology ? * swollen brain with wide gyri, narrow sulci, poor gray-white demarcation.... * 12-24hrs = see red neurons, eosinophils, and neutrophils... * 24hrs-2wks = Macrophages and necrosis.... * 2+weeks = more necrosis
Cells that are most susceptible to global ischemia ? * Pyramidal cells of hippocampus, (Sommer sector), Purkinje cells of cerebellum & cortical pyramidal neurons
Global Cx Presentation = ? * can really see anything since the entire brain is affected
Some things that can mimic stroke ? * Seizures, intrcranial tumors, bleeds, migraine, fever/infection
Pathophysiology of Ischemic Stroke = ? * Acute occlusion of intracranial vessel, that can result in brain death in 4 - 10 mins from zero bd flow.... * Ischemic penumbra = look larger, but once swelling goes down, we see a smaller area
2 Pathways to focal infarctions = ? * Necrotic pathway = No ATP made by cells ..... * Apoptotic pathway = cell apoptosis/death
Can worsen Brain Injuries ? * Hyperglycemia and Fever
Common causes that cause Ischemic Stroke ? * Thrombosis = Lacunar Stroke (From HTN).... * Emboli Occlusion (from MI/AFib/etc)
Uncommon causes ? * Hypercoagulable disorders = such as antiphospholipid syndromes, Protein S Deficiency, and Bernard–Soulier syndrome
When only a portion of the brain is affected ? * FOCAL Cerebral Ischemia
Usu causes of Focal Ischemia ? * Thrombis = Bifurcation of arteries is common area..... * Cerebral arterial occlusion ( Adequacy of Circle of Willis may contribute to why some areas still work)
Focal Stroke Morphology of Hemorrhagic Infarct ? * looks like a black splotch on the brain and see liquifactive necrosis after 10 days - 3 weeks
Nonhemorrhagic (pale, white, bland) infarct Morphology ? * same, but see no extraversion of blood and 2-3 weeks – liquifaction, which is earlier liquidfaction
Hypertensive Cerebrovascular Disease ? * Lacunar infarcts = Deep penetrating arteries & arterioles to basal ganglia, hemispheric white matter, brainstem – bc long , skinny, small A’s ...... * Slit hemorrhages
Slit Hemorrhages = ? Slit hemorrhages = Rupture of small-caliber penetrating vessels --> small hemorrhages (see brown Macros)... * can be silent and if you get enough of these, you can get multi infarct dementia
Stroke Morphology = ? * Depends on where the stroke came from, so look at the Sx and trace to its artery.... * Thalamus = see Pain.... * Cerebellar = N/V, dizziness, etc... * Frontal = personality change
Hypertensive Encephalopathy ? * Can cause diffuse cerebral dysfunction – h/a, confusion, vomiting, seizures, coma...... * Massive Hypertensive Intracranial Hemorrhage (another HTN cerbrovasc. disease)
Intracerebral (Intraparenchymal) Hemorrhage and Gross = ? * HTN is the most common cause... * Gross: see massive bleed in the brain
Cerebral Amyloid Angiopathy = ? * deposits of amyloid and use congo red stain to see apple-green birefringence... * Deposits weaken vasulcar wall to allow possible hemorrhage
CADASIL = ? * Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) .... * Heriditary form of a stroke from mutation in NOTCH 3.. * Look for in ppl w/ stroke under 20-30
Conditions associated with Saccular (Berry) aneurysms ? * Adult Polycystic Kidney Disease (APKD) ... * The rest are tissue disorders
When a Saccular Aneurysms rupture ? * Get a Subarachnoid Hemorrhage... * story in class was a 34 y/o in the shower and just falls over
Arteriovenous malformations (AVM) = ? *Is a vascular malformation in which the Artery goes straight in to the vein, so there is no reduction in pressure causing them to rupture...* Also see Tangled network of wormlike vascular channels...* Usu 1-30yo and complain of new WORST headache of life
Created by: thamrick800