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    CNS Vascular

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    This document defines terms related to cerebrovascular disease like stroke and transient ischemic attack. It discusses factors that affect the severity of brain ischemia and describes different types of cerebral ischemia and hemorrhage including their characteristic morphologies. Specific vascular conditions covered include hypertensive vascular disease, subarachnoid hemorrhage, and vascular malformations of the brain.

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    CNS Vascular

    Uploaded by

    api-3705408
    106 views36 pages
    This document defines terms related to cerebrovascular disease like stroke and transient ischemic attack. It discusses factors that affect the severity of brain ischemia and describes different types of cerebral ischemia and hemorrhage including their characteristic morphologies. Specific vascular conditions covered include hypertensive vascular disease, subarachnoid hemorrhage, and vascular malformations of the brain.

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    This document defines terms related to cerebrovascular disease like stroke and transient ischemic attack. It discusses factors that affect the severity of brain ischemia and describes different types of cerebral ischemia and hemorrhage including their characteristic morphologies. Specific vascular conditions covered include hypertensive vascular disease, subarachnoid hemorrhage, and vascular malformations of the brain.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    106 views36 pages

    CNS Vascular

    Uploaded by

    api-3705408
    This document defines terms related to cerebrovascular disease like stroke and transient ischemic attack. It discusses factors that affect the severity of brain ischemia and describes different types of cerebral ischemia and hemorrhage including their characteristic morphologies. Specific vascular conditions covered include hypertensive vascular disease, subarachnoid hemorrhage, and vascular malformations of the brain.

    Copyright:

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    CNS VASCULAR DISEASE

    Jeffrey W. Oliver, M.D.


    Learning Objectives
    • Define the terms “stroke” and “transient
    ischemic attack.”
    • List factors which affect the severity of
    brain ischemia.
    • Explain the concept of selective
    vulnerability.
    • Demonstrate morphologic features of global
    cerebral ischemia.
    Learning Objectives
    • Estimate the time elapsed since a cerebral
    infarct occurred based on morphology.
    • Differentiate primary thrombotic from
    embolic cerebral infarcts based on
    morphology.
    • List the characteristic morphologic
    manifestations of hypertensive cerebral
    hemorrhage.
    Learning Objectives
    • List causes of subarachnoid hemorrhage.
    • Recognize clinical and morphologic
    features of arteriovenous malformations of
    brain.
    CLINICAL TERMS
    • Stroke - acute onset of focal neurologic
    symptoms due to any pathologic process of
    intracerebral blood vessels
    • Transient Ischemic Attack (TIA) -
    reversible ischemic brain injury
    FACTORS AFFECTING
    SEVERITY OF ISCHEMIC
    DAMAGE
    • Collateral circulation
    • duration of ischemia
    • magnitude of flow reduction
    • rapidity of flow reduction
    GLOBAL CEREBRAL
    ISCHEMIA
    • Due to hypotension/hypoperfusion
    • Selective vulnerability – laminar infarcts
    • Watershed infarcts - infarcts at border zones
    between fields of arterial irrigation
    • Respirator brain - autolytic softening that
    occurs following prolonged mechanical
    ventilation in a “brain dead” individual
    FOCAL INFARCTS
    • Thrombotic infarcts - atherosclerosis,
    vasculitis; usually nonhemorrhagic
    • Embolic infarcts - mural thrombi, carotid
    atherosclerosis; MCA most common;
    usually hemorrhagic
    • Venous infarcts - thrombosis of superior
    sagittal sinus; very hemorrhagic
    CEREBRAL INFARCT
    MORPHOLOGY
    • After first 12 hours - red neurons
    • Up to 48 hours - neutrophils, replaced by
    macrophages stuffed with myelin debris
    • 1-2 weeks - gliosis
    • May resolve into cystic cavity
    CEREBRAL HEMORRHAGE
    • Epidural hematoma
    • Subdural hematoma
    • Subarachnoid hemorrhage
    • Intracerebral (intraparenchymal)
    hemorrhage
    HYPERTENSIVE VASCULAR
    DISEASE
    • Accounts for >50% of intraparenchymal
    hemorrhages, usually basal ganglia or thalamus
    • Charcot-Brouchard microaneurysms
    • Lacunar infarcts
    • Hypertensive encephalopathy - headache, seizures,
    confusion with malignant HTN
    • Muti-infarct dementia
    • Binswanger’s disease - dementia and white matter
    loss
    SUBARACHNOID
    HEMORRHAGE
    • Bleeding between arachnoid and pia
    • Usually due to ruptured Berry (saccular)
    aneurysm at branch points of Circle of
    Willis
    • Other causes: trauma, bleeding disorder,
    AVM, rupture of intraparenchymal
    hemorrhage into ventricular system
    VASCULAR
    MALFORMATIONS
    • Arteriovenous malformation - irregular tangle of
    vessels with AV shunt, usually cerebrum; may
    present as seizures, subarachnoid, or
    intraparenchymal hemorrhage
    • Cavernous hemangioma - Collection of dilated
    vessels without AV shunt; usually cerebellum or
    pons
    • Capillary telangiectasia - microscopic foci of
    dilated vessels separated by normal brain tissue;
    usually pons

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