CNS Pathology 4 Cerebral Vascular Disease II
Terms in this set (32)
venous thrombosis in the cranial cavity
most commonly in lateral and sagittal sinuses, or as part of a generalised cortical venous thrombosis.
Causes haemorrhagic infarction of the cerebral cortex and subcortical white matter.
Occurse with local sepsis, dehydration or drugs (e.g. oral contraceptives).
How does hypertension affect cerebral vessels? What other disease can cause this?
Weakens them. Affects large and small vessels. Large: Atherosclerosis is accelerated Small: arterioles - causes arteriolosclerosis. Also caused by diabetes.
What is a Charcot-Bouchard aneurysm? Where do they often occur? What are they associated with and what do they commonly cause?
Microaneurysms of the brain which occur in small blood vessels.
Most often located in the lenticulostriate vessels of the basal ganglia.
Associated with chronic hypertension. Common cause of stroke.
What are the four main injuries due to effects of hypertension on the brain?
lacunar infarcts (lacunar means small)
Acute hypertensive encephalopathy
hypertensive intracerebral hemorrhage
What is a lacunar infarct?
Arteriolar sclerosis of the deep penetrating arteries and arterioles that supply the basal ganglia and hemispheric white matter as well as the brainstem.
Causes single or multiple, small cavitary infarcts known as lacunae, less than 15 mm wide
A lacunar stroke involving the internal capsule will cause what symptoms of stroke?
pure motor stroke
A lacunar stroke involving the thalamus will cause what symptoms of stroke?
pure sensory stroke
What are Slit Hemorrhages?
Rupture of small penetrating vessels which resorb over time leaving behind a slitlike cavity (slit hemorrhage) rich in hemosiderin-laden macrophages
Vascular (Multi-infarct) Dementia: Definition, location of occurrence, and three main causes
Multiple, bilateral, gray and white matter infarcts due to:
(1) cerebral atherosclerosis
(2) cerebral arteriolar sclerosis
(2) thrombosis or embolization from carotid vessels or heart
When vascular dementia is a result of infarcts only in the white matter what is it called?
Acute Hypertensive Encephalopathy: Definition and gross and microscopi finding
clinicopathologic syndrome caused by malignant hypertension
Gross: Edematous brain with or without transtentorial or tonsillar herniation
Microscopic: Petechiae and fibrinoid necrosis of arterioles in the gray and white matter
Symptoms of Acute Hypertensive Encephalopathy
Diffuse cerebral dysfunction, including headaches, confusion, vomiting, and convulsions, sometimes leading to coma and death.
What are the two types of intracranial hemorrhage
Intracerebral (intraparenchymal) and subarachnoid
Intracerebral Hemorrhage: Cause, age of occurrence and location
Spontaneous (nontraumatic) intraparenchymal hemorrhages
Commonly in middle to late adult life
Most are rupture of a small intraparenchymal vessel
What are the two major underlying etiologies of Intracerebral Hemorrhage?
Hypertension (50% of clinically significant hemorrhages, 15% of deaths in HTN pts)
Cerebral amyloid angiopathy (CAA)
Others: systemic coagulation disorders, bleeding into a tumor, vasculitis, aneurysms, and vascular malformations
What are the two types of hemorrhage that occur in Intracerebral Hemorrhage?
Ganglionic hemorrhages (basal ganglia and thalamus)
Lobar hemorrhages (the lobes of the cerebral hemispheres)
Where are the most common areas of Hypertensive Hemorrhage?
Putamen & Thalamus (65%)
What is Cerebral Amyloid Angiopathy (CAA) and what does it cause? What patients does it usually occur in?
Amyloidogenic peptides, deposit in the walls of medium- and small-caliber meningeal and cortical vessels.
Causes weakening of vessel wall & risk of hemorrhage
Older patients and in Alzheimers, as it is one of the causes of amyloid disease in the brain
What special stains and testing is required to detect amyloid to confirm Cerebral Amyloid Angiopathy (CAA)?
immunohistochemistry with antibodies against amyolid
What is the most frequent cause of a Subarachnoid Hemorrhage? What other causes are there?
Most often a rupture of a saccular (berry) aneurysm
Other causes: extension of a traumatic hematoma, rupture of a hypertensive intracerebral hemorrhage into the ventricular system, vascular malformation, hematologic disturbances, and tumors.
Saccular (Berry) Aneurysm: What is it, Where do they occur?
Most common type of intracranial aneurysm
90% found in anterior part of Circle of Willis - near major arterial branch points in the anterior circulation
Multiple aneurysms exist in 20% to 30% of cases at autopsy
What causes Saccular (Berry) Aneurysm?
-majority are sporadic
-genetic: First degree relatives of patients with such aneurysms; Certain inherited disorders (e.g polycystic kidney dis, NF1, Marfan, Ehlers-Danols Syndrome ); Coarctation of aorta
Only manifests in adult life
What is the difference in fusiform aneurysm and saccular aneurysm?
fusiform (secondary to atherosclerosis) causes a swelling from all sides of the vein
saccular is an outpouching on one side
What is the pathogenesis of Saccular (Berry) Aneurysm?
gap in the circular muscle layer causing weakness at the bifurcation
Saccular (Berry) Aneurysm: how do they manifest?
Rupture of an aneurysm with clinically significant SAH most in fifth decade; F>M
Rate of bleeding is 1.3% per year; probability of rupture increasing with size of lesion. >10 mm in diameter =50% risk of bleeding per year.
1/3 associated with acute increases in intracranial pressure, such as with straining at stool
Affected individuals are stricken with a sudden, excruciating headache ("the worst headache I've ever had"), rapidly losing consciousness.
Saccular (Berry) Aneurysm outcomes
25% - 50% of patients die with the first rupture. The rest improve and recover consciousness in minutes.
Repeat bleeding common - cannot predict. Each repeat bleeding= prognosis worse.
What are the acute and late Clinical Sequelae of Saccular (Berry) Aneurysm?
Acute: risk of additional ischemic injury from vasospasm
Late: Meningeal scarring and fibrosis leading to obstruction of CSF flow and interruption of its resorption
Atherosclerotic Aneurysms: How and where do they appear and what is the cause
Fusiform - a swelling instead of outpouching sac
Large vessels (common sites of atherosclerosis)
Where do Mycotic (Infectious) Aneurysms take place?
Distal cerebral arteries
What are Vascular Malformations? What are the clinical features?
Named according to the type of the vascular channels in the malformation
Clinical features: Asymptomatic
Intracerebral or subarachnoid hemorrhage, Seizures, Focal neurological deficit
Tangles of arteries and veins of variable caliber and wall thickness
Gliotic intervening parenchyma
Typically located in the cerebral cortex
Hemorrhage usually not catastrophic but recurring
Less common than AVM
Thin-walled vascular channels with little or no intervening neural parenchyma
Most are asymptomatic
May be multiple in up to 20% of patients
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