23 Questions
What is the primary cause of subdural hemorrhage?
Traumatic injury of veins crossing the subdural space
Cerebral aneurysms are a type of traumatic injury.
False
What is the definition of concussion?
Shock, unconsciousness, and post-traumatic amnesia
Cerebral strokes are a type of non-traumatic lesion of the cerebral vessels, which includes ______________________.
infarction and massive spontaneous cerebral hemorrhage
Match the following types of cerebral aneurysms with their descriptions:
Berry aneurysm = Occurs between 40-60 years of age Mycotic aneurysm = Due to emboli of subacute bacterial endocarditis Atherosclerotic aneurysm = Due to atherosclerosis Traumatic arterio-venous aneurysm = Between carotid artery and cavernous sinus
What is the most common site of cerebral infarction?
Basal ganglia and internal capsule
Punctate hemorrhage is a type of massive cerebral hemorrhage.
False
What is the definition of cerebro-vascular disease?
Non-traumatic lesions of the cerebral vessels
What is the primary cause of massive intra-cranial hemorrhage (apoplexy)?
Hypertension
Cerebral strokes are always fatal.
False
What is the term used to describe the softening of brain tissue after an infarction?
Encephalomalacia
What is the term used to describe the degenerative disease affecting the peripheral nervous system?
Neuropathy
Polyneuropathy affects only one nerve.
False
Match the following types of hemorrhage:
Primary Hge = Rupture of intra-cerebral micro-aneurysm Secondary Hge = Rupture of cerebral aneurysm, vascular malformation, tumors, or blood diseases
What is the term used to describe the process of repair by gliosis in the brain?
Complete filling (if the area is small) or central calcification surrounded by gliosis (if the area is large)
What is one of the causes of increased intra-cranial tension?
All of the above
Cerebral herniation occurs through the tentorium cerebelli and foramen magnum, leading to pressure on the vital medullary centers. (True or False)
True
What is the effect of brain edema on the skull bones?
Worm-eaten appearance of the skull bones
The edematous part of the brain is swollen, pale, moist, and _______________________.
soft
Match the type of hydrocephalus with its characteristic:
Congenital = Increased CSF production Acquired = Obstruction of CSF outflow Chronic = Accumulation of CSF inside the ventricular system
What is the effect of increased intra-cranial tension on cerebral perfusion?
Decrease
Traumatic meningeal hemorrhage can occur due to traumatic injury of the middle cerebral artery. (True or False)
True
What is the term for the accumulation of CSF inside the ventricular system, leading to dilatation and subsequent atrophy of the brain parenchyma?
Hydrocephalus
Study Notes
Cerebral Infarction
- A pale infarction that shows the following changes:
- After 6 hours: pale, opaque, and dry area
- 12-48 hours: soft area with no demarcation between gray and white matter
- 48-72 hours: liquefactive necrosis with the formation of creamy fluid (Encephalomalacia)
- Weeks to months: repair by gliosis, complete filling if small, central calcification surrounded by gliosis if large
Pathology of Cerebral Infarction
- Loss of neurons, neuroglia, and blood vessels
- After 48 hours: PMNLs invade the area
- 72-96 hours: macrophages start to replace PMNLs
- 2 weeks later: macrophages clean the area
- Months later: complete healing by gliosis occurs
Prognosis of Cerebral Infarction
- Massive infarction may be fatal
Cerebral Strokes
- Massive Intra-Cranial Hemorrhage (Apoplexy) (15%)
- Definition: non-traumatic hemorrhage
- Types: Primary Hge, Secondary Hge
Cerebral Hemorrhage
- Etiology: mostly related to hypertension and rupture of intra-cerebral micro-aneurysm
- Pathology: commonest site is the middle cerebral artery (basal ganglia and internal capsule)
- Affected hemisphere bulges externally, shift of the brain to the other side, variable-sized blood clots surrounded by edematous brain tissue that may compress the ventricles
Peripheral Neuropathy
- Definition: a degenerative disease affecting any nerve of the peripheral nervous system
- Types: polyneuropathy, mononeuropathy
- Affects only one nerve in mononeuropathy
Traumatic Parenchymal Injury
- Types: concussion, contusion, laceration, traumatic intra-cerebral hemorrhage
- Massive Cerebral Hge: rapidly fatal, caused by hypertension, trauma, tumors, rupture of cerebral aneurysm
- Punctate Hge: small hemorrhagic spots due to infections, trauma, and hemorrhagic diseases
Cerebro-vascular Diseases
- Definition: non-traumatic lesions of the cerebral vessels
- Includes: inflammation, cerebral aneurysms, degeneration, cerebral strokes
Cerebral Aneurysms
- Types: berry "congenital" aneurysm, mycotic aneurysm, atherosclerotic aneurysm, traumatic arterio-venous aneurysm, intra-cerebral micro-aneurysm of benign hypertension
- Locations: circle of Willis or one of its main branches
Increase Intra-Cranial Tension
- Causes: brain edema, hydrocephalus
- Effects: brain edema, papilledema, cerebral herniation, increased intra-cranial tension, decreased cerebral perfusion, cerebral ischemia
Brain Edema
- Characteristics: swollen, pale, moist, and soft
- Effects: worm-eaten appearance of the skull bones, papilledema, cerebral herniation, increased intra-cranial tension, decreased cerebral perfusion, cerebral ischemia
Hydrocephalus
- Definition: chronic accumulation of CSF inside the ventricular system, dilatation with subsequent atrophy of the brain parenchyma
- Causes: increased CSF production, obstruction of CSF outflow, interference of CSF absorption
- Effects: head changes, ventricular system dilatation, nervous tissue pressure atrophy, increased intra-cranial tension
This quiz covers the stages of pale infarction, including changes in the brain tissue over time, from opacity to liquefactive necrosis and eventually, repair by gliosis. Understand the progression of pale infarction and its effects on brain tissues.
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