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49 Cards in this Set
- Front
- Back
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Define stroke
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sudden onset of neurologic deficit due to a disorder of blood vessels or coagulation
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Ischemia causes the release of ____ neurotransmitters which results in
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excitatory (glutamate), persistent opening of membrane channels and the influx of Ca and NO
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3 factors that influence tissue survival in ischemia
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Collateral flow, duration of ischemia, magnitude and rapidity of reduction of flow
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In global cerebral ischemia are neurons or glia more vulnerable?
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Neurons
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Watershed infarcts are due to systemic___
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hypotension
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The tissue between the superior and middle frontal gyri is in which watershed region?
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ACA and MCA
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What would be noticed in the cortex on autopsy of a person who survived an episode of severe systemic hypotension
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laminar necrosis
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Are superficial or deep cortical layers more sensitive to ischemia?
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Deep
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Name 2 mechanisms of focal large vessel occlusion
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Thrombosis
Embolism |
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Which sites are particularly susceptible to atherosclerosis
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Branch points of large vessels
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Name 3 types of arteriosclerosis
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Atherosclerosis (large arteries)
Arteriolosclerosis (arterioles) Monckeberg medial sclerosis (Ca deposits do not encroach lumen) |
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Name 4 sources of emboli to the brain
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Cardiac mural thrombus
Vegetations on valves Emboli from carotid plaque Infarct distal to embolus |
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Emboli from the carotid to the ophthalmic artery can result in
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Transient Monocular Blindness
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What is Libman-Sacks endocarditis
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small vegetations on heart valves seen in systemic lupus erythematosus
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Define atrial myxoma and consequences
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A tumor of the heart attached to the wall of left atrium, pieces of the tumor can break off and travel to brain or other organs
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Fat emboli are usually seen in what scenario?
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Fractures of long bones
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Most hemorrhagic infarcts are
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embolitic, due to reperfusion of ischemic tissue when embolus moves
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Plasma protein leakage across endothelium and increased smooth muscle matrix synthesis indicates chronic stress from
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hypertension
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Histologic changes in arteriolosclerosis, the arterioles show
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homogenous hyaline thickening associated with luminal narrowing
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Focal small vessel occulusion predisposes the patient to
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lacunar infarction and hemorrhage
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Arteriolosclerosis primarily affects the media or intima? Atherosclerosis?
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Arteriolosclerosis- media
Atherosclerosis- intima |
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Define a lacune and the mechanism behind a lacunar infarct
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Lacune- infarct <1.5 cm results from lipohyalinosis of small penetrating end arteries
Atherothrombotic not embolic |
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Evolution of infarct Gross
First 6 hrs 48hrs 2-10 days 10 days onward |
First 6hs- no change
48hrs- edema border between infarct indistinct 2-10 days- gelatinous border distinct 10 days on- liquifaction and cavity |
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Evolution of an infarct microscopic
after 12 hrs Up to 48hrs 1 week |
After 12hrs- acute ischemic necrosis of neurons, cytotoic and vasogenic edema, pallor
48hrs- neutrophils 1 week- see dense glial scar at border of cavity |
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Spontaneous intracranial hemorrhage may be these two types
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Intraparenchymal, subarachnoid
(epidural and subdural are usually trauma) |
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The most common cause (more than 50%) of spontaneous intracerebral hemorrhage is due to
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hypertension
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Drugs associated with spontaneous intracerebral hemorrhage
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cocaine and amphetamines
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Central White Matter, Putamen, Thalamus, Pons, Cerebellum
Put these sites in order of frequency of hypertensive intracerebral hemorrhage |
Putamen
Central White Matter Thalamus Cerebellum Pons *same order for lacunar infarcts |
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Underlying vascular pathology of a hypertensive intracranial hemorrhage or lacunar infarct is
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Arteriolosclerosis
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Does a hypertensive hemorrhage cause an infarct?
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No there is a rupture of vessels rather than an occlusion
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Amyloid angiopathy is associated with and which disease processes
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lobar hemorrhage
aging, Alzheimers, hereditary cerebral amyloidosis |
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Which stain is used to see deposits of amyloid
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Congo red
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Some causes of spontaneous subarachnoid hemorrhage include
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Ruptured saccular aneurysm
Coagulopathy Vasculitis Sinus or vein thrombosis |
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An atherosclerotic aneurysm usually happens in the__ is it likely to rupture?
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basilar artery
it is not likely to rupture but may compress brain stem |
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A mycotic aneurysm describes
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infectious endocarditis, the embolus lodges near brain surface
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The most common cause of spontaneous subarachnoid hemorrhage is ruptured
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saccular aneurysm
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Common sites of saccular aneurysms, 80-90% of aneurysms are in the ___
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anterior circulation, especially the anterior communicating artery
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5 common sites of saccular aneurysms
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PICA
top of basilar Pcomm ICA MCA |
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Acute sequelae in ruptured saccular aneurysm includes
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Vasospasm, rebleeding, and obstruction of ventricles resulting in hydrocephalus
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Chronic sequelae in ruptured saccular aneurysm includes
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fibrosis of leptomeninges resulting in communicating hydrocephalus
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Name 5 types of vascular malformations and which is the most damaging
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Arteriovenous (AVM) *most damage
Venous Angioma Cavernous Angioma Telangiectasia Varix |
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Clinical problems with arteriovenous malformation
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Hemorrhage, seizures, and atypical migraine
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What is cavernous hemangioma
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dilated thin-walled vascular channels devoid of intervening brain tissue, can cause seizures when subcortical
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What is capillary telangiectasia
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Microscopic foci of dilated, thin-walled capillaries seperated by normal brain (usually found in pons)
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Mechanism of Foix-Alajouanine disease
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Venous malformation of spinal cord and meninges, usually lumbosacral
progressive neurological symptoms |
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An example of varix is
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malformation of vein of Galen
associated with high output congestive heart failure in newborns |
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In a sagittal sinus thrombosis you may notice these clinical signs
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increased intracranial pressure with low level of consciousness and papilledema
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An empty delta sign is associated with
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A sagittal sinus thrombosis
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Are venous infarcts hemorrhagic? Unilateral or Bilateral
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Hemorrhagic, and bilateral
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