Neurology and Vascular Pathology Flashcards

Flashcards covering key vocabulary terms from the Neurology and Vascular Pathology lecture.

CNS Selective Vulnerability

Only 5 minutes of ischemia is needed to cause damage to CNS neurons due to varying susceptibility depending on collateral blood supply, neurotransmitters, & pathway connections

CNS Herniation

Increased ICP results in shifting and protrusion of CNS tissue.

Subfalcine/Cingulate Herniation

Most common type of CNS Herniation; under falx causing compression of anterior cerebral artery, weakness, and/or abnormal posturing or coma

Transtentorial Herniation

Herniation under tentorium; Cranial Nerve III issues - ‘blown pupil; compression of descending motor fibers’- hemiparesis; compression of posterior cerebral artery; duret hemorrhage

Tonsillar Herniation

Most Lethal CNS Herniation, compression of cardiorespiratory centers/brain stem

Vasogenic Edema

Disrupted BBB d/t trauma, infection, inflammation, tumors; Increased ICP - Extracellular edema

Cytotoxic Edema

Injured CNS tissue d/t hypoxia - neurons/glial cells swell; Increased ICP - Intracellular edema (cellular swelling)

Saccular ‘Berry’ Aneurysm

Most common cause of Subarachnoid hemorrhage; associated with polycystic kidney disease. Circle of Willis branch points is most common location

TIA (Transient Ischemic Attack)

Transient cerebral dysfunction; does not mean cell death; may be indication of impending stroke; less than 24 hours ‘mini stroke’

Bell’s Palsy

Most common cause of Unilateral facial drooping, facial nerve paralysis - affects both forehead and lower face; typically temporary (2-8 weeks)

Cerebral Contusion

Cerebral capillary hemorrhage. Most common on gyri d/t head trauma

Cerebral Laceration

Tearing injury to CNS tissue

Upper Motor Neuron Lesion

1st neuron in motor pathway; lesion results in long term spastic paralysis and hyperreflexia

Global Ischemia

Shock, choke that blocks common carotids

Global Hypoxia

Altitude - low partial pressure of O2 and inability to oxygenate blood; carbon monoxide; severe anemia

Chiari Malformation Type I

Most Common. Low lying cerebellar tonsils in adults causing headaches

Chiari Malformation Type II

Congenital small posterior fossa and misshapen cerebellum; CSF obstruction, compression of brainstem, severe complications in utero or early in life

Hydrocephalus Communicating

Evenly increased CSF in ventricles and is communicating

Hydrocephalus Noncommunicating

Uneven distribution of CSF, blockage or compression; noncommunicating

Focal Cerebral Ischemia/ Cerebrovascular Accident ‘Stroke’ ISCHEMIC

Focal area of arterial blockage leading to ischemia and infarction. Most common from thromboembolism traveling through Middle Cerebral artery

Focal Cerebral Ischemia/ Cerebrovascular Accident ‘Stroke’ HEMORRHAGIC

Parenchymal hemorrhage causes neuronal damage and infraction . Caused by brain bleed Bleeding decreased perfusion, increases ICP, and is neurotoxic

Primary Brain Parenchymal Hemorrhage

Microbleeds that may be limited and silent or widespread and lethal

Subarachnoid Hemorrhage

Arterial bleeding in subarachnoid space causes Thunderclap Headache (aka worst headache ever), loss of consciousness

Arteriovenous Malformation (AVM)

Congenital malformation - often times weakening of arterial to venous connection without a capillary bed leading to increased risk for bleeding. Tangled network of malformed/weak vessels prone t rupture

Hypertensive Encephalopathy

Diastolic BP >130 = severe ICP; widespread cerebral edema; global cerebral dysfunction

Diffuse Axonal Injury

Traumatic injury of axons on a large scale due to twisting and stretching of brain. Common cause - coma after trauma. Mechanism may be whiplash-like rotation/ acceleration leading to widespread white matter damage and edema build up

Concussion (mTBI)

Reversible alteration in consciousness following head trauma (80% recover in 10 days). Possible d/t Altered metabolism and dysregulated synaptic activity

Epidural Hematoma

Traumatic brain bleed and hematoma in the epidural space. Dural ARTERY damage. Follows cranial fracture, is under arterial pressure

Subdural Hematoma

Traumatic brain bleed/hematoma in the subdural space. Rapid movements tear subdural VEINS, lower pressure than epidural

Abusive Head Trauma (Non-accidental head injury, Shaken Baby Syndrome)

Subdural hematoma, Cerebral edema, Bilateral retinal bleeding. Severe brain damage, 25% fatal

Decorticate Rigidity

arm flexion, internal rotation of legs - Injury between cortex and red nuclei (midbrain)

Decerebrate Rigidity

limbs extended, arms pronated with flexed wrists - Injury to brainstem (between red nuclei and vestibular nuclei)

Spina Bifida Occulta

‘Hidden’ asymptomatic failure of posterior arch to fuse completely at C1 and Lumbars

Spina Bifida Myelomeningocele

Severe and large incomplete closure of posterior arch in lumbar region. There is extension of meninges and spinal nerve roots through the openings. Lower Extremity motor(Flaccid)/Sensory deficits

Anencephaly

Congenital absence of forebrain - Still born with NO motor or sensory capacity

Encephalocele

Congenital incomplete closure of cranial/facial bones. Allows for CSF or CNS tissue to protrude through. Variable severity depending on the size and whether or no CNS tissue is involved.

Syrinx/ Syringomyelia

Fluid filled cavity within the spinal cord. May expand to compress decussating (crossing) fibers of spinothalamic which can decrease pain and temperature sensation in Upper Extremities

Wernicke-Korsakoff Syndrome

CNS in chronic alcoholics; leads to memory issues (hippocampus) and confusion caused by Thiamine deficiency

Cobalamin - B12 Deficiency

Subacute combined degeneration of the spinal cord; demyelination of motor and sensory tracts caused by Cobalamin deficiency

Hypoglycemia

Low blood sugar; mimics global hypoxia; may be fatal

Hyperglycemia

High blood sugar; may lead to cerebral edema if corrected too quickly and increase ICP

Multiple Sclerosis (MS)

Autoimmune attack on white matter of CNS; Type 4 hypersensitivity attack on myelin. Leads to variety of symptoms: optic nerve dysfunction, myalgia, hypertonicity, depression

Alzheimer Disease

Progressive CNS degeneration leading to dementia. Accumulation of beta-amyloid and Tau proteins form tangles and (decreased memory and cognition) interfere with synapses and are neurotoxic

Parkinson Disease

Degeneration of substantia nigra, leads to altered motor function (increased rigidity, decreased expression); later altered cognition. Decreases Dopamine alters basal ganglia ability to stimulate motor cortex

Huntington Disease

Inherited progressive degeneration of movement and cognition. Chorea movements involve spontaneous jerking of ALL parts of body. Degeneration of striatum of basal ganglia

Amyotrophic Lateral Sclerosis (ALS)

Degeneration of upper and lower motor neurons. Leads to combination of weakness and spasticity; begins with hands (clumsiness) and progresses to spasticity of the legs and leading to respiratory paralysis. Known to spare cranial nerves

Astrocytoma (Diffuse)

Most common CNS tumor/glioma - cerebral. Malignant - leads to seizures, headaches, focal neurological deficits. Space occupying lesion compresses neuro tissue

Meningitis

Infection of leptomeninges (arachnoid & pia). Similar symptoms: headache, fever, severe neck stiffness, rash, and malaise

Encephalitis (Viral)

Inflammation of the brain. Features include headache, fever, confusion, seizures. Inflammatory processes disrupts neural cell function

Poliomyelitis

Enterovirus that most commonly causes GI distress, small percent of cases develop weakness, flaccidity, decreased reflexes; severe cases = respiratory failure. Motor neuron damage due to inflammation of anterior horn of cord

Cerebral Palsy

Group of disorders that causes altered motor control from upper motor neurons (most common spasticity, may include ataxia or dyskinesia). May include cognitive issues, but not necessarily or commonly. Most common due to perinatal brain injury (hypoxia, infraction)

Epidural Abscess

Bacterial infection and puss in epidural space of cranium/spine that spread from bone, sinuses, or nearby surgery (Life Threatening)

Ischemic Stroke

Occlusion by thrombosis or embolism that causes permeant interruption

Hemorrhagic Stroke

Vascular tear and bleed that causes temporary interruption. Addition of neurotoxic effect of blood and increased ICP

Pericardial Tamponade

Accumulation of fluid within the pericardial space; vascular pathology

Endothelial Activation

Injury/Irritation to endothelium that causes a proinflammatory/procoagulant state - triggered by atherosclerosis, HTN, Diabetes, Autoimmune Vasculitis, and Injury

Fibromuscular Dysplasia

Narrowing of medium sized arteries that reduce blood flow producing commonly high BP. Causes stenosis of arteries (most common renal artery)

Hypertension (HTN)

Increases BP (>130/80). Essential = 90%, idiopathic. Renovascular = caused by fibromuscular dysplasia. Malignant = underlying condition, high spike in BP (+180/20)

Pheochromocytoma

Adrenal gland tumor increases BP (heart rate, headache, sweating). Catecholamines released by adrenal medulla stimulates SNS

Arteriolosclerosis

Hardening of Small Arteries/ Arterioles caused by High stress and injury to walls

Monckeberg Medial Sclerosis

Incidental finding on imaging with calcification of arteries. Doesn’t narrow vessel lumen

Atherosclerosis

Hardening of arterial walls due to atheromatous plaque build up. Slowly occludes lumen, risk for rupture (vulnerable plaque), weakens vessel wall (increased thickness restricts diffusion of O2 and nutrients to vascular wall)

Abdominal Aortic Aneurysm (AAA)

Increase 50% dilation and weakening of abdominal aorta (+3cm), commonly between Renal arteries and iliac bifurcation. Weakening and ballooning of vascular wall (all 3 layers)

Thoracic Aortic Dissections

Tearing of Tunica Intima and/or Media: with associated bleeding. Sharp, well-localized pain that varies on site of dissection (neck, chest, mid back, head)

Temporal Arteritis (Giant Cell Arteritis)

Autoimmune vasculitis of large/medium arteries of head/neck region causing headaches and visual disturbances. T cell mediated (Type IV) reaction produces chronic inflammation (patchy granulomas) of large/medium arteries

Takayasu Arteritis (Pulseless Disease)

Autoimmune vasculitis of medium/large arteries that branch from the aortic arch (50% involve pulmonary arteries). Decreases/Lowers Pulse

Polyarteritis Nodosa

Systemic autoimmune vasculitis affecting kidneys, heart, liver, GI tract. Causes episodes of fever, malaise, weight loss, myalgia

Kawasaki Disease

Pediatric Vasculitis - damages medium/large arteries (coronary). Auto-antibodies against endothelial cells and smooth muscle cells promote widespread inflammation, weakening of vascular walls; aneurysms in about 20%

Wegener Granulomatosis (Granulomatosis with polyangiitis)

Multiple site autoimmune vasculitis (Most common Lungs and Kidneys). Necrotizing granulomas damage vessels in many organs. Most common lungs (hemoptysis) and kidneys

Buerger Disease

Peripheral Vascular disease (Most common in hands/feet from radial/tibial arteries). Endothelial injury/ clotting from chemical toxins (smoking)

Raynaud

Exaggerated/ inappropriate vasoconstriction (likely due to autonomic dysfunction). Most common in hands/feet

Varicose Veins

Dilated tortuous veins (typically in lower extremity). Typically only cosmetic issue; severe cases can have venous congestion, decreased perfusion

Stasis Dermatitis

Chronic inflammation skin condition with discoloration, thickening, flaking, + erythematous appearance

Thrombophlebitis

Inflammation of a vein and associated with clotting (DVT).

Vena Cava Syndrome

Obstructed SVC leading to headaches, dizziness, jugular congestion and distention. Obstructed IVC leading to pitting edema and cyanosis in feet, dysfunctional kidneys and proteinuria

Primary Lymphedema (Milroy Disease)

Congenital and inherited agenesis/hypoplasia of lymphatics. Leads to edema development throughout body (lower extremities)

Secondary Lymphedema

Causes edema to build up in localizes areas. Lymphatic obstruction due to infection (filariasis), tumor growth, surgical scaring, removal of lymphatics (mastectomy)

Hemangioma

Benign tumor of capillary endothelial cells. Very common on skin. Typically self-resolve

Kaposi Sarcoma

Thought to be lymphatic endothelial malignancy. Characteristics: red, purple color through skin on back, face, and lower limbs. Herpesvirus no longer held dormant by immune system; Able to spread and stimulate tumor growth diffusely

Angiosarcoma

Aggressive malignant endothelial tumors Most common on skin with red nodules. Can progress to necrosis/ gangrene or hemorrhage. Spreads rapidly via blood to lungs and liver (poor prognosis)

Atheriosclerosis

Hardening of vessel walls

Atherosclerosis

Hardening of vessel due to plaque development in wall

Thrombus

Clot in vessel

Embolism

Object that travels and lodges in a vessel (Most common Thrombus)

Aneurysm

Dilation of an artery (weakening)

Dissection

Tearing in vessel (bleeding within)

Atheromatous Plaque

Abnormal accumulation of LDL cholesterol, calcium, macrophages (foam cells), fibrous connective tissue, and smooth muscle within the walls of an artery (hardening & weakening walls)

Stable Plaque

Atheroma with a thick fibrous cap and low inflammatory conditions

Vulnerable Plaque

Atheroma with a thin fibrous cap and high inflammatory conditions (High CRP)

Foam Cell

Dead macrophages that ingested LDL cholesterols (within atheromatous plaque)

Astrocytes

Most numerous glial cell; CNS Injury results in proliferation

Oligodendrocytes

Produce myelin in CNS; CNS Injury results in proliferation

Microglia

Phagocytes of CNS; CNS Injury results in proliferation

Ependymal Cells

Line ventricles, cord, and produces CSF; source of viral inclusions

Mydriasis

Pupillary dilation (transtentorial herniation)

Anisocoria

Unequal pupil size

Papilledema

Optic disc swelling due to increased ICP/Malignant HTN

Coup Injury

Brain Contusion at impact site

Contrecoup Injury

Brain contusion opposite of impact site