Cerebrovascular Disease
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| Things that can lead to a stroke ? | * Thrombosis, embolism & hemorrhage
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| Arterial area that is at greatest risk for infarcts ? | * Watershed area between the anterior and middle cerebral artery
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| Reduction in blood flow that lasts longer than several seconds = ? | * Cerebral Ischemia
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| Cessation of flow lasting longer than several seconds = ? | * Cerebral Infarct
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| Spontaneous rapid restoration of flow with symptoms subsiding within 24 hours = ? | * Transient Ischemic Attack (TIA)
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| When the ENTIRE brain is affected from ischemia ? | * GLOBAL cerebral ischemia
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| Usu cause of global cerebral ischemia ? | * Severe HYPOtensive state
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| 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..... *
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| 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
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| Cells that are most susceptible to global ischemia ? | * Pyramidal cells of hippocampus, (Sommer sector), Purkinje cells of cerebellum & cortical pyramidal neurons
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| Global Cx Presentation = ? | * can really see anything since the entire brain is affected
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| Some things that can mimic stroke ? | * Seizures, intrcranial tumors, bleeds, migraine, fever/infection
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| 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
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| 2 Pathways to focal infarctions = ? | * Necrotic pathway = No ATP made by cells ..... * Apoptotic pathway = cell apoptosis/death
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| Can worsen Brain Injuries ? | * Hyperglycemia and Fever
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| Common causes that cause Ischemic Stroke ? | * Thrombosis = Lacunar Stroke (From HTN).... * Emboli Occlusion (from MI/AFib/etc)
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| Uncommon causes ? | * Hypercoagulable disorders = such as antiphospholipid syndromes, Protein S Deficiency, and Bernard–Soulier syndrome
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| When only a portion of the brain is affected ? | * FOCAL Cerebral Ischemia
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| 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)
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| Focal Stroke Morphology of Hemorrhagic Infarct ? | * looks like a black splotch on the brain and see liquifactive necrosis after 10 days - 3 weeks
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| Nonhemorrhagic (pale, white, bland) infarct Morphology ? | * same, but see no extraversion of blood and 2-3 weeks – liquifaction, which is earlier liquidfaction
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| Hypertensive Cerebrovascular Disease ? | * Lacunar infarcts = Deep penetrating arteries & arterioles to basal ganglia, hemispheric white matter, brainstem – bc long , skinny, small A’s
...... * Slit hemorrhages
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| 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
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| 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
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| Hypertensive Encephalopathy ? | * Can cause diffuse cerebral dysfunction – h/a, confusion, vomiting, seizures, coma...... * Massive Hypertensive Intracranial Hemorrhage (another HTN cerbrovasc. disease)
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| Intracerebral (Intraparenchymal) Hemorrhage and Gross = ? | * HTN is the most common cause... * Gross: see massive bleed in the brain
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| Cerebral Amyloid Angiopathy = ? | * deposits of amyloid and use congo red stain to see apple-green birefringence... * Deposits weaken vasulcar wall to allow possible hemorrhage
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| 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
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| Conditions associated with Saccular (Berry) aneurysms ? | * Adult Polycystic Kidney Disease (APKD) ... * The rest are tissue disorders
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| When a Saccular Aneurysms rupture ? | * Get a Subarachnoid Hemorrhage... * story in class was a 34 y/o in the shower and just falls over
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| 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
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