CNS 2

Question 1

Reduction or cessation of blood flow to a localized area of brain due to partial or complete arterial occlusion
clinical manifestations depend on the anatomic location of the lesion
Causes: thrombosis, embolism, inflammatory lesions

Answer 1

Focal Cerebral Ischemia

Question 2

• evident at 48 hours as pale, soft regions of edematous brain, with neutrophilic infiltration; tissue then liquefies, and a fluid-filled cavity containing macrophages is lined by reactive glia
• Acute: red neuron, cerebral edema, neutrophilic infiltration
• Subacute: liquefactive necrosis, influx of macrophages, reactive gliosis with neovascularization
• Healed: tissue loss surrounded by residual gliosis

Answer 2

Nonhemorrhagic infarcts (bland or anemic infarcts)

Question 3

exhibit blood extravasation and resorption

Answer 3

Hemorrhagic infarcts

Question 4

• ## occurs with generalized reduction of cerebral perfusion or decreased oxygen carrying capacity of the bloodclinical outcome varies with the severity and length of the insult
• Neurons are most sensitive to ischemia
  + Pyramidal layer of hippocampus (CA1: Sommer sector)
  + Cerebellar Purkinje cells
  +
  Pyramidal cells of cerebral cortex

Answer 4

Global Cerebral Ischemia

Question 5

• occur in the regions of the brain or spinal cord that lie at the most distal reaches of the arterial blood supply
• usually develop after severe hypotensive episodes and are most commonly seen in patients resuscitated after cardiac arrest

Answer 5

Border zone (“watershed”) infarcts

Question 6

Gross
- Edematous and swollen brain: widening of the gyri and narrowing of the sulci
Microscopic
- Early changes: dead red neurons
Subacute changes: tissue necrosis, influx of macrophages, vascular proliferation, and reactive gliosis
- Repair: removal of necrotic tissue, loss of normal CNS architecture, and gliosis
- Laminar necrosis in cerebral neocortex

Answer 6

Global Cerebral Ischemia

Question 7

• involves spontaneous rupture of a small intraparenchymal vessel
• “ganglionic hemorrhages” occurs in basal ganglia and thalamus
• “lobar hemorrhages” occurs in cerebral hemispheres
• Hypertension is the risk factor most commonly associated with deep brain parenchymal hemorrhages; occur in the putamen, thalamus, pons, and rarely the cerebellar hemispheres
• Cerebral amyloid angiopathy (CAA) is the risk factor most commonly associated with lobar hemorrhages

Answer 7

INTRAPARENCHYMAL HEMORRHAGE

Question 8

• Most common cause: ruptured saccular “berry” aneurysm
• Saccular aneurysm: most common intracranial aneurysm
  + Most common location: anterior circulation (90%)
• Associated with ADPKD, Ehlers-Danlos syndrome type IV, NF Type 1, Marfan syndrome, fibromuscular dysplasia, CoA
• Clinical manifestation: “worst headache of my life” and syncope
• Lesions are a few millimeters to 2 to 3 cm in diameter with a red, shiny, translucent wall. At the aneurysm neck, the muscular wall and intimal elastic lamina are absent or fragmentary; the sac wall is composed of only thickened hyalinized intima

Answer 8

SUBARACHNOID HEMORRHAGE

Question 9

Classification of Vascular Malformations that is enlarged tangled vessels with intervening brain tissue
as its common location is in the vessels of the subarachnoid space and brain

Answer 9

AV Malformation

Question 10

Classification of Vascular Malformations that is Enlarged vessels without intervening brain tissue
as its common location are in Cerebellum, pons, and subcortical regions

Answer 10

Cavernous malformation

Question 11

Classification of Vascular Malformations that is Small, thin-walled vessels with intervening brain tissue
as its common location are in the pons

Answer 11

Capillary telangiectasia

Question 12

Classification of Vascular Malformations that is Ectatic venous channels
as its common location are variable

Answer 12

Developmental venous anomalies (venous angiomas)

Question 13

is caused by multi-focal vascular disease of several types, including

(1) cerebral atherosclerosis,
(2) vessel thrombosis or embolization from carotid vessels or from the heart, and
(3) cerebral arteriolosclerosis from chronic hypertension.

Answer 13

vascular dementia

Question 14

When the pattern of injury preferentially involves large areas of the subcortical
white matter with myelin and axon loss, the disorder is referred to as

Answer 14

Binswanger disease (subcortical white matter dementia)