SN10-diseases of the NS

generalized hypoperfusion/ diffuse brain ischemia is seen whensystolic BP is <50mmHg cardiac arrest shockwhat are possible outcomes/severities of diffuse brain ischemia1. mild short-lived ischemia --> transient post-ischemic confusional state with eventual complete recovery 2. severe--> coma & persistent vegetative state (due to widespread neuronal death) 3. border zone or watershed infarctsDoes focal infarction (vessel occlusion by emboli or thrombi) occur in global ischemia (generalized hypoperfusion)?yes, sometimes. global ischemia leads to widespread death of neurons but sometimes it can lead to infarction of certain areas called watershed or border zone areas (focal ischemia)Arterial occlusion of vascular thrombosis or embolism (more common) leads to _____________________.focal ischemia or infarctionSevere ischemia with no _______________ leads to infarctionno collateral circulation "The collateral circulation is a network of specialized endogenous bypass vessels that is present in most tissues and provides protection against ischemic injury caused by ischemic stroke, coronary atherosclerosis, peripheral artery disease, and other conditions and diseases."embolic infarctions are more common than thrombosis. The source of EI is from----1. cardiac (MOST FREQUENT SOURCE) 2. arterial 3.paradoxical emboli (uncommon) 4. non-thrombic emboli (uncommon)Emboli tend to lodge where _______________ branch or in areas of pre-exisiting __________________. The territory nourished by the ___________ artery is most commonly affectedblood vessels luminal stenosis Middle cerebral arteryArterial Thrombotic occlusion causes cerebral infarctions mostly due to ____________________atherosclerosiswhat are the common sites of primary thrombosis, in CNS, due to atherosclerosis?1. carotid bifurcation 2. origin of the MCA 3. end of basilar arteryIn thrombotic occlusion, fragmentation of the thrombus can cause a ______________distal embolismmacroscopic and radiologic appearance of infarcts can be ______________ or _________________pale hemorrhagicnon-hemorrhagic (pale) infarcts are usually associated with arterial _________________ and can be treated with ___________________. example: ____________________thrombosis thrombolytic therapies liquefactive necrosisHemorrhagic infarcts are usually associated with _________________ events. The hemorrhage occurs from the damaged _____________. ____________________ therapies are CONTRAINDICATEDembolic vessels thrombolyticrisk factors for cerebrovascular diseaseHypertension Diabetes hypercholesterolemia Cigarette smoking (same as those w/ ischemic heart disease)the clinical feature of a stroke is ___________________ that develop rapidly over ____________ and may continue to evolve over ___________neurological deficits- determined by the area of brain involved minutes hoursT/F Transient Ischemic attack (TIA) results in infarctionFalse! No acute infarction TIA is a transient episode of neurological dysfunction caused by focal brain, spinal-cord, or retinal ischemia without acute infarctionT/F TIA Shows no evidence on infarction on CT angiography and MRA imagingTrueTIA caries a _______________ risk of stroke and is considered a __________high short-term WARNINGT/F 1. The diagnosis of a stroke is based on duration of symptoms. 2. In a CT scan, ischemic infarcts appear bright while hemorrhagic infarcts appear dark.1. False-- It is based on tissue appearance on imaging rather than duration of symptoms. 2. False-- In CT scan an ischemic infarct appears dark while hemorrhagic infarct appears brightwhat are 2 types of vasculitis (uncommon cause of focal brain ischemia)1. infectious 2. immune mediatedthrombotic occlusion of cerebral veins or dural sinuses are an _________________ cause of brain infarction. venous infarcts are often ___________________uncommon hemorrhagic- embolism occlusionwhat are pre-disposing factors of thrombotic occlusion of cerebral veins? symptoms?infection- septic cavernous sinus trauma hypercoagulable states symptoms: headache, papilledema, focal motor or sensory deficit, seizurewhat are 2 types of primary (non-traumatic) CNS hemorrhage?1. intraparenchymal brain hemorrhage 2. subarachnoid hemorrhageIntraparenchymal hemorrhage: 1. peak age of incidence: 2. most are caused by rupture of a ________________1. 60 years old 2. small intra-parenchymal blood vesselIntraparenchymal hemorrhage causes1-HYPERTENSION** (most common) Others are less common 2- vascular malformation 3- a berry aneurysm 4- bleeding tumor 5- amyloid angiopathy 6- bleeding disorders.T/F In Intraparenchymal hemorrhage the location and size of the bleed will determine the clinical manifestation and survival. In surviving patients the hematoma does not resolve.First statement is true second is false -In surviving patients hematoma resolves over time leaving a cavity with brownish rim________________ is the most common cause of subarachnoid hemorrhage while ____________________ is the most common cause of intraparenchymalRuptured berry aneurysm hypertensionarteriovenous malformation isan abnormal communication between an artery and a vein. clumps togethersubarachniod hemorrhage presents with sudden onset of severe ________________ with __________. Subarachnoid hemorrhage caries risk of ischemic brain injury from __________________headache stiff neck Vasospasmswhenever subarachnoid hemorrhage is suspected, a _____________ puncture is done to reveal blood in ____________lumbar CSF (blood in CSF confirms diagnosis)hypertension accelerates _________________ in large & medium sized arteries causing _______________ in the brainatherosclerosis thrombosis & infarctionwhen chronic hypertension effects small arteries and arterioles it is called ________________________ and __________________Hyaline arteriolar sclerosis- these vessels may occlude and are weak & vulnerable to rupture micro-aneurysmeffects on chronic HT on the brain due to small BV pathology include:1- massive intracerebral hemorrhage 2- lacunar infarcts=bleeding infarcts (can be asymptomatic or cause significant neuro impairment) 3- slit hemorrhages (can be asymptomatic or cause significant neuro impairment)which one is a disease of hypertensive cerebrovascular disease A. Hypertension that accelerates atherosclerosis in large and medium arteries. Causes Thrombosis and infarction in the brain B. Hyaline arteriolar sclerosis (small blood vessel) C. Micro- aneurysms (small blood vessel) D. Acute hypertensive encephalopathy E. all the aboveE FYI- Acute hypertensive encephalopathy is due to sudden acute rise in BPtrauma/ head injury can be _______________ and/or _______________ injuryvascular parenchymala ___________________ happens when by impact of moving head on a rigid surface causing transient neurological dysfunctionconcussion- no neuronal death! no brain damageneurologic recovery in a concussion is usually complete, yet _______________ for the event persistsamnesia________________ is caused by the direct blow to the head ex: a baseball bat causing parenchymal injury, vascular rupture, and hematomacontusion (unlike concussion, there is brain damage here) injury can be at the site of injury called coup or opposite of the site of injury called countercoupwhat is the epidural (extradural) hematoma? site? what artery is effected?-collection of clotted blood b/w the skull bone and dura -site: pterion -middle meningeal artery (MMA)the slow collection of blood in epidural hematoma is termed ____________lucid interval_________________ hematoma is a collection of clotted blood b/w the dura & arachnoid causing rupture of bridging veins. ____________ & ___________ are most susceptiblesubdural infants & elderlywhat is the more common form of subdural hematoma?chronicwhat is the pathological mechanism of raised intracranial pressure?1- focal lesions: tumor, hemorrhage, abscess, etc 2- diffuse lesions: hypertensive encephalopathy, cerebral edema, CSF blockagewhat are the consequences of increased brain volume in the skull?1- reduced perfusion (passage of blood) to the brain 2- produce a herniation syndrome 3- neuronal injury & neurologic deficit__________________ is a congenital condition for excessive accumulation of CSF in the ventricular system causing an expansion of ventricles and increasing intracranial pressure at birthhydrocephalusHydrocephalus causesObstruction of CSF flow Impaired drainage/ resorption of CSFall of the following are true of CNS tumor except: A. it is not cancer B. peaks in childhood C. symptoms of focal neurological deficits (tissue damage), seizures, and increased cranial pressure. D. ICP can lead to mass effect, hydrocephalus, cerebral edema, and herniationA. It is cancer! accounts for 2% of cancers in the body and 20% in children (second to leukemia)prognosis of clinical outcome is affected by _______________ and __________________1. Histology type- malignant vs benign. Low grade vs High grade 2. Anatomic siteT/F ******** know! Metastasis of primary CNS tumors outside of CNS is rareTRUE usually occurs along the brain and spinal cord via subarachnoid spacethe primary CNS tumor in 2/3 childhood is ________________ while in 2/3 adults it is _______________________.childhood- infratentorial Adult- supratentorial (adult supervises child)in childhood infratentorial tumors ________________________ is the most common type followed by ___________________ and ________________________astrocytoma > medulloblastoma > ependymomawhat are the most common primary spinal cord tumors?1. schwannoma 2. Meningioma 3. ependymomawhat are the most common organs to have cancer that metastasizes to the brain?-lung -breast -kidney -colon -melanomamost common primary CNS tumor is ________________gliomaGliomas include:1. Astrocytoma (most common) 2. ependymoma 3. glioblastomainfiltrating astrocytoma grading namesgrade II- diffuse grade III- anaplastic grade IV- glioblastoma_____________ astrocytoma is most common primary adult brain tumor. ________________ astrocytoma is a grade I benign tumor in children occuring in the cerebellum. ______________ is often cystic, bipolar, with long hair-like processesinfiltrating non-infiltrating= pilocytic non-infiltratingEpendymoma in children occurs near _________________ and in adults in the ___________________children: fourth ventricle--> hydrocephalus adults: spinal cord_____________________ grows along surface of brain and spinal cord, is usually in adult females, slow growing, benign and produces symptoms related to brain or spinal cord compressionmeningiomaneural tube defect risk factor isfolate deficiencywhat are common neural tube defects?spina bifida meningocele myelomeningocele

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