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Cerebrovascular Diseases (CVD)


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Name the four common etiologies of Cerebrovascular disease
ischemia/hypoxia, infarction, hypertensive CVD, intracranial hemorrhage
Characterize the two types of ischemic CVD
Global- caused by a fall in cerebral perfusion pressure below that compensated by autoregulation(45-170mmHg)& Focal ischemia- due to stenosis or arterial occlusion
Discuss the etiology of Global Ischemia
cardiac tamponade (low blood pressure) or raised intracranial pressure (trauma) results in infarction accentuated in watershed areas or areas where two blood supplies anastamose (parasaggital)
What neuronal populations are most sensitive to hypoxia?
CA1 in hippocampus, Layer 3 & 5 ex/internal pyramidal cells in the cerebral cortex, Cerebellar purkinje neurons
In general what neurons are most susceptible to hypoxia?
Large ones
What are the major causes of brain hypoxia?
Low O2 Content (Carbon monoxide poisoning), ischemia, histotoxic hypoxia-an inability of the tissue to utilize the oxygen (cyanide poisoning)
What are the morphological changes associated with hypoxic neurons?
Neurons turn pink or red and pyknotic (neurons shrink and become obscure)
Define stroke.
A clincial term used to describe a cerebrovascular accident/focal neurological deficit due to a vascular disorder syndrome lasting greater then 24 hours. (70%)infarction or (30%)hemorrhage.
Define cerebral infarction.
Vascular necrosis characterized by death of all cellular components.
What are some common causes of cerebral infarction?
Embolic events-atherosclerotic
Thrombotic events- basilar artery
Venous occlusion- related to infectious processes
How does one categorically date infarctions?
Acute- identical to global ischemia PMN infiltrate
Subacute- Macrophage infiltration, increase in vasculature.
Remote/cystic- cavitary lesion with some gliotic cells
What is the major manifestation of hyertensive cerebrovascular disease?
Intracerebral hemorrhage, lacunar infarct, subcortical atherosclerotic leukoencephalopathy and hypertensive encephalopathy
What are the major areas of the brain affected by hypertensive cerebral artery disease.
Hemorrhage in basal ganglia straight striate arteries (have a right angle thus very susceptible to changes in bp)
Brainstem (another common area) is fatal
Descirbe and discuss the etiology of the lacunar infarct.
small cavitary infarct seen in the basal ganglia and the thalamus associated with HTN...typically Asympotomatic unless it occurs in the anterior limb of the internal capsule
Discuss/Describe the etiology of subcortical atherosclerotic leukoencphalopathy.
Slow gradully progressive disease associated with the elderley, AD, hypertension and dementia
What is hypertensive encephalopathy?
Occurs in the setting of a sudden rise in bp (>200)eliciting a severe headache, vomitting and visual auras...predisposed by pregnancy or glomerular nephritis
What are the three different manifestations of intracranial hemmorrhage?
Epidural- traumatic rupture of the middle meningeal artery in the epidural space
Subdural- seen in elderley associated with senescent atrophy of brain and stretching of vasculature...associated with very minor trauma in elderly
What are the major risk factors associated with intracranial hemmorrhage?
Hypertension, ruptured annuerysm and vascular malformation.
Discuss the common etiology of Subarachnoid Hematoma?
1. Non-traumatic rupture of a saccular or berry annuerysm
2. Vascular malformation (5%)
3.infectious/mycotic annuerysm
Where are the majority of annuerysms localized?
90% Anterior circulation, 10% posterior
What are the most common causes of vascular malformation?
Arteriovenous malformation (embedded in CNS tissue)second most common cause of SAH, cavernous hemangioma (not embedded), cavitary telengectasia and venous angiomas- clinically silent.
In what patient population do Arteriovenous malformations typically present?
middle aged SAH/focal ischemia, blood shunted from arterial to venous system bypassing arterial bed and resulting in focal ischemia.
Discuss Cerebral Amyloid Angiography.
Manifests as lobar hemorrhage. Always associated with dementing disease such as Alzheimers. Deposition of AB peptide distinguishing it from systemic amyloidosis. Congo (+)
What are some etiologies of intraparenchymal hemorrhage?
Drug abuse, tumors, AVM, hypertensive hemorrhage.
What are the leading causes of death in the U.S
Heart DZ
Cerebrovascular DZ

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