Questions and Answers
What is the most common type of vascular malformation associated with autosomal dominant polycystic kidney disease?
What is the typical age range for the development of symptoms in individuals with arteriovenous malformations (AVMs)?
What is the most common consequence of hypertension on blood vessels?
What is the definition of acute hypertensive encephalopathy?
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Which type of vasculitis is characterized by an inflammatory process involving small and large blood vessels?
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What is the most common site for hypertensive cerebral vasculopathy?
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What is the typical presentation of acute hypertensive encephalopathy?
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What is the characteristic feature of primary angiitis of the central nervous system?
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What is the primary condition caused by amyloid peptide deposition in cerebral vessels?
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Which site is most commonly associated with primary brain parenchymal hemorrhage?
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What is the most common non-traumatic cause of subarachnoid hemorrhage?
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Which of the following is NOT a common predisposing factor for embolic infarctions?
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What type of morphology does a non-hemorrhagic infarction exhibit within the first 48 hours?
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What is the typical age demographic for primary brain parenchymal hemorrhage?
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Which complication is commonly associated with subarachnoid hemorrhage?
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Where do most berry aneurysms occur in relation to major arterial branches?
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What is the primary pathological mechanism associated with cerebral infarction?
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Which of the following describes a common consequence of both thrombosis and embolism?
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What qualitative change occurs in neurons within 12-24 hours post-insult due to ischemic injury?
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During the subacute phase of ischemic change (24 hours to 2 weeks), which of the following occurs?
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In the scenario of global cerebral ischemia, which condition is NOT typically associated with the initial injury?
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What is the primary effect of a ruptured vessel in the context of hemorrhagic stroke?
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What pathological feature is associated with a focal cerebral ischemia culminating from cerebral arterial occlusion?
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Which of the following phases involves the removal of all necrotic tissue and loss of organized CNS structure?
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Study Notes
Embolic Infarction
- More common than infarction due to thrombosis
- Predisposing factors: • Cardiac mural thrombi • Myocardial dysfunction • Valvular disease • Atrial fibrillation • DVT • Atherosclerosis
- Common site for occlusion: • Carotid bifurcation • Origin of middle cerebral artery • Supplies lateral side of frontal, temporal, and parietal lobe
Morphology
- Non-hemorrhagic: • During first 6 hours, tissue remains unchanged • After 48 hours, tissue becomes pale • After a day, brain turns gelatinous and friable • After 2-10 days, liquifactive necrosis occurs
- Hemorrhagic infarction: • Same picture with addition of blood extravasation and resorption
Intracranial Hemorrhage
- Risk factors: • HTN • Arteriovenous and cavernous malformations • Tumors
- Primary brain parenchymal hemorrhage: • Non-traumatic • Most common in mid to late adult life (60 years of age)
- Risk factors: • HTN • Basal ganglia, thalamus, pons, and cerebellum (common site of bleeding) • Small blood vessel rupture
Cerebral Amyloid Angiopathy
- Condition caused by amyloid peptide deposition in medium and small caliber meningeal and cortical vessels
- Weakens vessel walls and increases risk of hemorrhage
- Main site: lobar hemorrhage in cerebral cortex
Subarachnoid Hemorrhage
- Hemorrhage in the subarachnoid space
- Causes: • Rupture of berry aneurysm (most common non-traumatic cause) • Vascular malformation • Trauma • Tumors
- Bleeding can occur at any time, but commonly associated with acute increase in intracranial pressure
- Clinical features: • Headache • Rapidly lose consciousness • Hydrocephalus (common complication)
Berry Aneurysm
- Occurs in the anterior circulation near major arterial branch points
- Maybe single or multiple
- Congenital condition that develops over time
- Increased risk in patients with autosomal dominant polycystic kidney disease and genetic disorder of extracellular matrix protein
- Probability of rupture related to size
Vascular Malformation
- Types: • Arteriovenous malformation (AVM) • Cavernous malformation • Capillary telangiectasia • Venous angioma
- AVM: • Most common and most dangerous • Male to female ratio: 2:1 • Age: 10-30 years • Clinical features: • Seizure • Intracerebral hemorrhage or subarachnoid hemorrhage • Lead to HF in newborn
Hypertensive CVA
- Hypertension causes hyaline arteriolar and arterial sclerosis in: • Basal ganglia • White matter • Brain stem
- Affected vasculature becomes weak and more vulnerable to rupture
- Pathology may be infarction or hemorrhage
Acute Hypertensive Encephalopathy
- Most lethal clinical consequence of hypertension
- Definition: Sustained rises in diastolic blood pressure to greater than 130 mmHg
- Causes increased intracranial pressure and global cerebral dysfunction
- Clinical features: • Headache • Confusion • Vomiting • Convulsion • Coma
Vasculitis
- Definition: Inflammatory process involving blood vessels, compromising blood flow and causing ischemia
- Types: • Infectious (affecting small and large vessels) • Systemic (involving cerebral vessels) • Primary angiitis
Global Cerebral Ischemia
- Ischemia-hypoxic injury can occur in: • Severe systemic hypotension • Cardiac arrest • Shock
- Clinical outcome varies: • Mild and transient post-ischemic insult with eventual recovery (confusional state) • Severe insult leading to widespread neuronal death (global ischemia)
- Some areas are more vulnerable to ischemia and neuronal death, even with mild insult.
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Description
This quiz covers the basics of embolic infarction, including predisposing factors, common sites of occlusion, and morphology. It also compares embolic infarction with thrombosis.
