Term
| Causes of nontraumatic intracerebral hemorrhage |
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Definition
- systemic htn
- vascular malformation
- cerebral amyloid angiography
- neoplasms
- dissem intravasc coag
- thrombotic thrombocytopenic purpura
- drug related: legal & illegal drugs
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Term
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Definition
- may/not be assoc w/ clinically doc hx of htn
- other autopsy findings can indicate htn such as left ventricular hypertrophy cardiomegaly nephrosclerosis
- Lacunar Infarcts
- Slit hemorrhages
- htn encephalopathy
- massive intracerebral hemorrhage
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Term
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Definition
- htn effects the deep penetrating arteries and arteiroles that supply the basal ganglia and hemispheric white matter
- the vessels develop arteriolar sclerosis which may lead to occlusion
- GROSS: dev mult or single small cabitary infarcts, resemble lakes
- occur in lentricular nuc, thalamus, int capsule, deep white matter, caudate nuc & pons
- MICRO: appear as areas of tissue loss w/ scattered lipid laden mphags & gliosis
- CLINIC: silent or cause neuro impairment
- may have widening of perivasc spaces w/o tisse infarcT
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Term
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Definition
- rupture of small caliber penetrating vessels & dev of small hemorrhages
- prod slit like cavity surrounded by brownish discoloration
- MICRO: show focal tissue destruction, pigment laden mphags and gliosis
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Term
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Definition
- seen in malig htn
- CLINIC: diffuse cerebral dysfxn headaches, altered mental status, vomiting, convulsions
- death may result
- over years indiv accum infarcts in white & gray matter --> gait abnorm & focal neuro deficits
- GROSS: brain is edmatous and may have herniation
- petechiae & fibrinoid necro of arterioles in gray and white matter
- Vascular multi infarct dementia: caused by cerebral atherosclerosis, vessel thrombosis, embolization from carotids/heart & cerebral atherosclerosis from chronic htn
- binswanger dz: when the pattern of injury inv large areas of the subcortical white matter w/ myelin & axon loss
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Term
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Definition
- Occur in:Putamen, Thalamus, Lobar white matter, cerebellum, Pons
- Vessels supplying the basal ganglia & thalamus are small caliber perforating end arteries which directly branch from the large caliber middle cereabral A & absorb high pressure
- CLINIC: each px w/ characteristic clinical signs
- Putamen Hemorrahage: contralateral hemiplegia w/ eyes directed toward the hemisphere containign the hemorrhage
- thalamic hemorrhage: hemiplegia & coma if it inv the midbrain
- cerebellar hemorrhage: ispilateral ataxia, vomiting, forced lateral gaze w/ possible brainstem compression & death
- Pontine hemorrhage: coma quadriparesis & dysconjuctive gaze
- Lobar white matter: px similar to infarct w/in that vasc territory
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Term
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Definition
- hemorrhages chronically resolve as slitlike subinsular cysts parallel to claustrum w/ cystic replacement of the lateral putamen
- spares the globus pallidus
- usu spare the overlying insular cortex
- may dissect into the lateral ventricle
- surgical resection of basal ganglia hematomas have a poor outcome
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Term
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Definition
- When large usu involve the post ventral nuclei and internal capsule
- often the precise point of vascular rupture is virtually never identified
- may see Charcot Bouchard Microaneurysm = occur in very small vessels
- Hemorrhage may occur in tortuous vessels and can mimic aneurysms
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Term
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Definition
- when in HTN setting oten centered in central white matter in or near the dentate nuc which suggests the oridin is in the superior cerebellar artery or the ant inf cerebelalr artery
- since the post fossa is small expasion --> tonsillar herniation, medullary compression & cardioresp arrest
- surgical evacuationof cerebellar hemorrhage = good outcome
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Term
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Definition
- devastating clinical px w/ coma
- located in midline basis pontis
- expands into tegmentum & dissects into the 4th ventricle
- usu incompatible w/ life due to interruption of autonomic systes reg cardioresp fxn
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Term
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Definition
- imp determinant of outcome
- >3.0 cm in cerebral hemisphere
- > 2.0 cm in cerebellum
- > 1.0 cm in brainstem
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Term
| Determinants of Hemorrhage Outcome |
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Definition
- volume
- generalized cerebral swelling & edema
- asym brain edema & mass effect w/ midline shift --> uncal-parahippocampal & cingulate herniations
- Caudal displacement of the rostral brainstem --> brainstem compression & duret's hemorrhage
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Term
| Secondary Changes of Cerebral Infarct |
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Definition
- changes result from thrombosis & embolization
- cerebral edema
- ischemic hypoxic injury
- spread of secondary infarct around primary lesion & remote sites
- various herniations
- secondary vascular compromise w/ poss hemorrhagic infarct
- Duret's Hemorrhage: poor prognosis
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Term
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Definition
- Occurs in several locations
- causes diff clinical syndromes
- thrombosis of the cavernous sinus often has an infectious etiology such as dental abscess, sinusitis, facial skin infx
- may involve the CN 3, 4 & 6 and the opthalmic division of CN 5 may causes sensory sx of the face
- Extension into the opthalmic veins can cause proptosis of the eye
- most thrombi involve the superior sagittal sinus
- seen in women on birth control, malnutrition, malignancy, hypercoagulable states
- px w/ headaches, hemiplegia, seizures, and inc intracranial pressure
- removal of the dura discloses parasagittal hemorrhagic cortical infarc & distended thrombosed superficial cortical veins draining into the sup sagittal sinus
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Term
| Cerebral vasc malformations |
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Definition
- arteriovenous malformations
- cavernous hemangioma
- venous angioma
- mixed angioma
- capillary telangiectasia: rarely of clinical importance
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Term
| cerebral vasc Malformations: AVM |
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Definition
- usu largest & most dangerous
- often clinically sx w/ seizures, headaches & focal neuro deficits
- mosrt are supratentorial
- GROSS: enlarged veins and arteries
- smaller ones may be diff to see grossly
- MICRO: composed of large bv of highly variable size & thickness
- abnormal vessel walls: extreme fibromusc thickening to thinned areas of fibrous CT which is vulnerable to rupture. elastic lamina= interrupted & frayed. focal calcifications.
- brain parenchyma btwn vasc channels is often atrophic & gliotic w/ hemosiderin deposits as evidence of prior hemorrhage
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Term
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Definition
- GROSS: occur most commonly in the cerebral subcortical white mater
- measures up to a few cm's in diameter
- frontal lobe is the most common site
- multiple, well circumscribed, dark red to brown
- MICRO: cavernous hemangioma consist of abundant closely approx small to large vasc channels w/ thin fibrous walls w/o a muscularis
- brain parenchyma btwn vessels is atrophic w/ hemosiderin depostis
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Term
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Definition
- GROSS: found in white matter of the cerebellum & cerebrum, meninges & spinal cord
- sudden unexpected death in the young
- MICRO: appears as a group of mildly thickened veins w/ walls of uniform thicknes sep by normal appearing white matter
- sturge weber syndrome: angiomatous masses in the cortical leptomeninges, mental retardation, seizures, hemiplegia, & skull radio opacities
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Term
| ruptures cerebral aneurysms |
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Definition
- CLINIC: px most commonly w/ subarachnoid hemorrhage
- often px w/ sudden death
- usu seen in middle aged and young adults
- other causes of nontraumatic subarachnoid hemorrage include: blood dyscrasias, anticoag & thrombolytic therapis & leukemias
- complications: vasospasm w/ ischemia & infarc, edema & herniation
- inc intracranial P from failed absorption of csf due to blockage by ventricular & subarachnoid hemorrhages contributes to mortality
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Term
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Definition
- most found near major arterial branch points in the ant circulation
- multiple aneurysms can exist
- inc incidenc in adult polycystic kidney dz, ehlers-danlos syndrom, marfan's
- PREDISPOSING FACTORS: cig smoking, htn
- Not px at birth bu dev over time due to a defect in the media of the vessel
- px at autopsy w/ marked basal subarachnoid hemorrhage
- assoc w/ an excruciating headache
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Term
| Cerebral amyloid angiopathy |
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Definition
- CAA
- disorder of the elderly usu occuring in 60s
- GROSS: hemorhage is superficially located in the intracortical or the subarachnoid blood vessels of any lobe
- MICRO: amyloidogenic peptides deposit in the wall of medium and small caliber meningeal and cortical vessels--> weak walls & inc rupture
- bv test + using congo red stain
- hemorrhage extend into subarachnoid space & sometimes produce a subdural hematoma resembling trauma
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