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Cerebrovascular Dis.
Cerebrovascular Disease
Question | Answer |
---|---|
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 cellsof 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 |