Notes in Cerebrovascular Disease

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Published	12/09/2024	Stroke stems from two major mechanisms:(1) {{c1::Ischemia and/or hypoxia}} resulting from impairment of blood supply and oxygenation of CNS Tissue(2) …
Published	12/09/2024	Although the brain accounts for only 1% to 2% of body weight, it receives approximately {{c1::15}}% of the resting cardiac output and a…
Published	12/09/2024	The brain is strictly dependent on aerobic metabolism to meet its constant energy demands, and it may be deprived of oxygen by either&n…
Published	12/09/2024	Ischemia in the CNS can result in inappropriate release of excitatory amino acid neurotransmitters such as {{c1::glutamate}}, which can damage ne…
Published	12/09/2024	In the region of transition between necrotic tissue and the normal brain, there is an area of "at-risk" brain, referred to as {{c1::penumbra}}&nb…
Published	12/09/2024	{{c1::Focal cerebral ischemia}} follows reduction or cessation of blood flow to a localized area of the brain due to partial or complet…
Published	12/09/2024	Focal Cerebral Ischemia The major source of collateral flow is the {{c1::Circle of Willis}}
Published	12/09/2024	Focal Cerebral Ischemia Occlusive vascular disease of severity sufficient to lead to cerebral infarction may be due to:{{c1::embolization from a …
Published	12/09/2024	Hypoxia and Ischemia Survival of tissue at risk depends on: presence of {{c1::collateral circulation }}duration of {{c1::ischemia}}&nbs…
Published	12/09/2024	Occlusion in Focal Cerebral Ischemia may be due to: Embolism type: {{c1::cardiac mural thrombi}}site of affectation: {{c1::middle cerebral a…
Published	12/09/2024	Occlusion in Focal Cerebral Ischemia may be due to: In situ thrombosis due to: acute change of vulnerable atherosclerotic plaques most …
Published	12/09/2024	{{c1::Global Cerebral}} Ischemia due to generalized reduction in cerebral perfusion or decreased oxygen carrying capacity of the blood
Published	12/09/2024	Brain infarctsBrain infarcts generaly start as nonhemorrhaghic; clinically, these nonhemorrhagic infarcts are called {{c1::ischemic}}
Published	12/09/2024	Brain infarctsSecondary hemorrhage can occur from ischemia-reperfusion injury following spontaneous or therapeutic dissolution or fragmentation of the…
Published	12/09/2024	Gross and Microscopic appearance of a nonhemorrhagic infarct {{c1::First 6 hours}}: {{c2::little change }}
Published	12/09/2024	Gross and Microscopic appearance of a nonhemorrhagic infarct {{c1::48 hours}}: tissue becomes {{c2::pale, soft, swollen}}, and gray white matter …
Published	12/09/2024	Gross and Microscopic appearance of a nonhemorrhagic infarct {{c1::2-10}} days: {{c2::gelatinous and friable}}, more {{c2::distinct boundary}} be…
Published	12/09/2024	Gross and Microscopic appearance of a nonhemorrhagic infarct {{c1::10 days to 3 weeks}}: {{c2::tissue liquefies}}
Published	12/09/2024	Brain Infarct Acute infarctAfter the first 6-12 hours, neurons in the affected area show {{c1::eosinophilic neuronal necrosis}}; "dead read neuro…
Published	12/09/2024	Brain Infarct Acute infarctboth {{c1::cytotoxic}} and {{c1::vasogenic}} edema are present
Published	12/09/2024	Brain Infarct Acute infarct{{c1::Endothelial and glial::2}} cells swell and myelinated fibers begin to disintegrate
Published	12/09/2024	Brain Infarct Acute infarctUp to 48 hours, {{c1::neutrophilic emigration}} progressively increases and then falls off
Published	12/09/2024	Brain Infarct Subacute infarct{{c1::Phagocytic}} cells, derived from circulating monocytes and activated microglia, are evident at {{c2::48 to 72…
Published	12/09/2024	Which of the following best describes the gross appearance of a nonhemorrhagic infarct 2-10 days after injury?a) Pale, soft, and swollenb) Gelatinous …
Published	12/09/2024	At what time point do phagocytic cells become the predominant cell type in the affected brain tissue?a) Within the first 6-12 hoursb) 24-48 hoursc) 48…
Published	12/09/2024	What is the primary feature of a healed cerebral infarct?a) Extensive neutrophilic infiltrationb) Dense meshwork of glial fibers with new capillariesc…
Published	12/09/2024	Which microscopic feature is observed during the acute phase of a nonhemorrhagic infarct?a) Formation of a fluid-filled cavityb) Eosinophilic neuronal…
Published	12/09/2024	What condition is most likely to increase the risk of venous infarcts?a) Vasogenic edemab) Hypercoagulable statec) Cytotoxic edemad) Subarachnoid hemo…
Published	12/09/2024	What happens grossly to the tissue of a nonhemorrhagic infarct 10 days to 3 weeks after the injury?a) Tissue becomes pale and swollenb) Tissue liquefi…
Published	12/09/2024	What type of cells are responsible for the phagocytosis of myelin breakdown products in subacute infarcts?a) Neutrophilsb) Astrocytesc) Macrophages an…
Published	12/09/2024	Which feature is NOT associated with hemorrhagic infarcts?a) Blood extravasationb) Formation of a dense glial meshworkc) Resorption of bloodd) Associa…
Published	12/09/2024	What is the appearance of neurons in the affected area within the first 6-12 hours of an acute infarct?a) Prominent glial fibersb) Eosinophilic necros…
Published	12/09/2024	What separates the cavity of a healed infarct from the meninges and subarachnoid space?a) Endothelial liningb) Gliotic tissue derived from the molecul…
Published	12/09/2024	Which arteries are primarily affected by hypertension in the brain?a) Cortical arteries and veinsb) Deep penetrating arteries and arteriolesc) Superfi…
Published	12/09/2024	What are lacunar infarcts, and how are they defined?a) Large areas of tissue necrosis caused by embolismb) Small cavitary infarcts, less than 15 mm wi…
Published	12/09/2024	Which region is most commonly involved in lacunar infarcts?a) Brainstemb) Internal capsulec) Putamend) Thalamus
Published	12/09/2024	What determines the clinical symptoms of infarctions caused by hypertension?a) The diameter of the affected vesselb) The anatomic distribution of the …
Published	12/09/2024	Why is early diagnosis of strokes critically important?a) To identify the cause of hypertensionb) To prevent progression to lacunar infarctsc) To enab…
Published	12/09/2024	Which of the following conditions can lead to global cerebral hypoxia or ischemia?a) Severe hypertensionb) Cardiac arrest and carbon monoxide poisonin…
Published	12/09/2024	Which neurons are most sensitive to hypoxia/ischemia?a) Motor neurons in the spinal cordb) Cerebellar Purkinje cells, hippocampal pyramidal neurons (C…
Published	12/09/2024	What is the clinical outcome in severe cases of global cerebral hypoxia/ischemia?a) Transient postischemic confusion with full recoveryb) Persistent v…
Published	12/09/2024	What is the primary characteristic of a border zone (“watershed”) infarct?a) Small cavitary lesions in deep brain regionsb) Wedge-shaped infarct locat…
Published	12/09/2024	What is a possible outcome in patients with diffuse cortical injury and absent cerebral perfusion who are maintained on mechanical ventilation?a) Comp…
Published	12/09/2024	Morphology of Global Ischemia Early changes: {{c1::6-12::time}} hours, seen in neurons (dead red neurons) Subacute changes: {{c1::24hrs-2 we…
Published	12/09/2024	Morphology of Global Ischemia {{c1::Laminar necrosis }}a pattern of injury wherein there is preservation of some layers and destruction of o…
Published	12/09/2024	What is the most common risk factor of deep brain parenchymal hemorrhages?a) Cerebral amyloid angiopathy (CAA)b) Hypertensionc) Vascular malformations…
Published	12/09/2024	Which brain regions are most commonly affected by hypertensive intraparenchymal hemorrhages?a) Frontal lobe and occipital lobeb) Putamen, thalamus, an…
Published	12/09/2024	What distinguishes cerebral amyloid angiopathy (CAA) from hyaline arteriolosclerosis on routine H&E staining?a) CAA features β amyloid deposits, w…
Published	12/09/2024	What genetic mutation is associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)?a) APP g…
Published	12/09/2024	Which imaging finding is characteristic of cerebral amyloid angiopathy (CAA)?a) Extensive white matter hyperintensitiesb) Numerous small brain hemorrh…
Published	12/09/2024	Intraparenchymal hemorrhages Acute primary intraparenchymal hemorrhages are characterized by a {{c1::central core of clotted blood}} that compres…
Published	12/09/2024	Morphology of intraprenchymal hemorrhages Once the edema resolves, {{c1::hemosiderin and lipd-laden}} macrophages appear, and proliferation of {{…
Published	12/09/2024	What is the most common cause of nontraumatic subarachnoid hemorrhage?a) Traumab) Rupture of a saccular aneurysmc) Vascular malformationsd) Tumors
Published	12/09/2024	Where are saccular aneurysms most commonly located?a) Posterior circulation arteriesb) Branch points in the anterior circulationc) Basilar artery bifu…
Published	12/09/2024	Which condition is not associated with an increased risk of saccular aneurysm formation?a) Marfan syndromeb) Autosomal dominant polycystic k…
Published	12/09/2024	What structural abnormality characterizes saccular aneurysms?a) Thickened arterial walls with excess smooth muscleb) Absence of smooth muscle and inti…
Published	12/09/2024	What is a common trigger for the rupture of a saccular aneurysm?a) Cardiac arrestb) Straining at stool or sexual orgasmc) Low blood pressure episodesd…
Published	12/09/2024	What percentage of patients die from the first rupture of a saccular aneurysm?a) 10–20%b) 25–50%c) 60–70%d) 75–90%
Published	12/09/2024	What is the primary acute risk following a subarachnoid hemorrhage?a) Meningeal fibrosisb) Vasospasm of vesselsc) Chronic hydrocephalusd) Repeat bleed…
Published	12/09/2024	Which layer is absent from the wall of a saccular aneurysm?a) Adventitiab) Mediac) Intimal elastic laminad) Endothelium
Published	12/09/2024	What is a major late complication of subarachnoid hemorrhage?a) Acute ischemic strokeb) Chronic vasospasmc) Obstruction of CSF flow due to meningeal f…
Published	12/09/2024	Which diameter of aneurysms has the highest risk of rupture?a) Less than 5 mmb) Between 5–10 mmc) Greater than 10 mmd) Size does not influence rupture…
Published	12/09/2024	Vascular malformations Classified into 4 principal groups:{{c1::AV}} malformations {{c1::Cavernous}} malformations {{c1::Capillary}} te…
Published	12/09/2024	Vascular malformations Arteriovenous malformations are frequently associated with activating somatic mutations in the {{c1::KRAS o…
Published	12/09/2024	What distinguishes arteriovenous malformations (AVMs) from cavernous malformations?A) AVMs occur most commonly in the cerebellum, while cavernous malf…
Published	12/09/2024	What is the typical age range for the presentation of arteriovenous malformations?A) Between birth and 5 years of ageB) Between 40 and 60 years of age…
Published	12/09/2024	Which of the following is a hallmark of familial cavernous malformations?A) Occurrence in the posterior branches of the middle cerebral arteryB) High-…
Published	12/09/2024	What is the most common clinical presentation of arteriovenous malformations?A) Stroke and sudden cognitive declineB) Congestive heart failure in adul…
Published	12/09/2024	In which of the following locations are cavernous malformations most frequently found?A) Cerebellum, pons, and subcortical regionsB) Middle cerebral a…
Published	12/09/2024	AV malformations commonly affects {{c1::males::males or females }}
Published	12/09/2024	What is the primary cause of vascular dementia?A) Infections affecting the brainB) Multifocal vascular diseaseC) Genetic mutations affecting white mat…
Published	12/09/2024	Which of the following is a hallmark of Binswanger disease?A) Extensive myelin and axon loss in subcortical white matterB) Bilateral infarcts limited …
Published	12/09/2024	What clinical symptoms are commonly associated with vascular dementia?A) Fever, weight loss, and night sweatsB) Dementia, gait abnormalities, and pseu…
Published	12/09/2024	Which of the following conditions is associated with the development of Binswanger disease?A) Chronic hypertensionB) Acute traumatic brain injuryC) Me…
Published	12/09/2024	Vascular dementia is caused by multi-focal vascular disease of several types, including: {{c1::cerebral atherosclerosis }}{{c1::vessel throm…
Published	12/09/2024	How does cerebrovascular disease affect individuals with neurodegenerative diseases?A) It reduces the risk of neurologic impairment by improving blood…
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