Cerebro-Vascular Disease Dr. Raid Jastania

Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis – Emboli Hemorrhage – Global ischemia

Cerebrovascular Disease 3 rd leading cause of death Vascular diseases: – Congenital/Developmental, Acquired – Acquired: Localized – Thrombosis – Embolism – Hemorrhage Global ischemia

Hypoxia, Ischemia, Infarction Hypoxia: reduction in oxygen supply Ischemia: reduction in tissue perfusion Infarction: necrosis due to hypoxia/ischemia Brain receives 15% of cardiac output Brain consumes 20% of oxygen Autoregulation of vascular resistance Functional/Structural hypoxia

Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis – Emboli Hemorrhage – Global ischemia

Global Cerebral Ischemia Generalized reduction in perfusion Systolic pressure <50mmHg Mild: transient injury Moderate/Severe: permanent damage Persistent Vegetative state Brain Death Changes: – Swelling, necrosis, neutrophils, macrophages, giolosis, repair – Border zone (watershed) infarct

Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis – Emboli Hemorrhage – Global ischemia

Localized (Focal) Cerebral Ischemia Occlusion of artery Presence of collateral flow Circle of Willis Cortical-leptomeningeal anastomosis Thrombosis: in carotid athrosclerosis Emboli: – MI, valve disease, atrial fibrillation, cardiac thrombi, paradoxical emboli – Middle cerebral artery is the most frequent

Focal Cerebral Ischemia Infarction: – Non hemorrhagic – Hemorrhagic – Changes: <6 hours: normal 24 hours: necrosis, neutrophils, edema 48 hours: pale, soft, swollen 2-10 days: gelatinous, friable, macrophages 10days-3weeks: liquifaction >3 weeks: Gliosis, repair

Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis – Emboli Hemorrhage – Global ischemia

Intracarnial Hemorrhage Anatomical site: – Intraparenchymal – subarachnoid – Subdural – Epidural Cause: – Bleeding disorder – Primary vessel disease: Developmental: berry aneurysm Acquired: Vasculitis – Secondary vessel disease: Hypertension Amyloid angiopathy – Trauma, tumor, inflammtion

Subarachnoid Hemorrhage Causes: – Saccular (berry) aneurysm – A-V malformation – Trauma – Tumors

Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis – Emboli Hemorrhage – Global ischemia

Berry Aneurysm

Can be congenital Most appear later in life Risk of bleeding: if 10mm size, risk 50% bleed 20-30% have multiple aneurysms 90% in the anterior circulation at the circle of Willis 25-50% risk of death if rupture Headache, increase ICP, loss of consciousness

Vascular Malformation Arterio Venous Malformation (A-V malforamtion) Cavernous angioma Capillary telangeictasia Venous angioma

A-V malformation male > female years of age Seizure, hemorrhage, sometimes CHF

Intraparenchymal Hemorrhage Peak: 60 years of age Rupture of intraparenchymal vessels Hypertension: basal ganglia, thalamus, pons, cerebellum Cerebral Amyloid Angiopathy: leptomeningeal and cortical vessles

Hypertensive cerebrovascular disease Slit hemorrhage Lacunar infarct Intracerebral hemorrhage Hypertesive encephalopathy

Hypertensive cerebrovascular disease Changes: – Hyaline arteriolar sclerosis – Weak arteriols – Aneurysm (Charcot-Bouchard microaneurysm – Lacunar infarct: small cavity in basal ganglia, thalamus, pons – Encephalopathy: headache, confusion, vomiting, convulsions, coma

Vasculitis

Summary Cerebrovascular disease – Congenital/Developmental – Acquired – Localized lesion: Blockage – Thrombosis – Emboli Hemorrhage – Global ischemia

Intracarnial Hemorrhage Anatomical site: – Intraparenchymal – subarachnoid – Subdural – Epidural Cause: – Bleeding disorder – Primary vessel disease: Developmental: berry aneurysm Acquired: Vasculitis – Secondary vessel disease: Hypertension Amyloid angiopathy – Trauma, tumor, inflammtion