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Lecture 37

Pathology 3500 Lecture Notes - Lecture 37: Embolization, Thrombosis, PerfusionPremium

5 pages46 viewsSpring 2018

Department
Pathology
Course Code
Pathology 3500
Professor
Jessica Shepherd
Lecture
37

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Vascular Disease
Stroke
Rapid onset neurological deficit
Tends to improve over time (variable degree)
Why is there recovery of function over time after a stroke?
Reperfusion
A soft clot can break apart on its own or if the person is treated rapidly
faster onset
If perfusion is restored quickly (10-15 min later) the stunned neurons can
be recovered
Don’t want the reperfusion after 12 hrs
The neurotic vessels will not be able to deal with the restored
blood flow
Changes a gland infarct into a hemorrhage infarct
Other neurons can take over the function of the lost cells
Minor role
Penumbra
A zone of neurons that are stunned by the microenvironment of the stroke
but that have not actually been infarcted by the actual event
Will return to function after inflammation and swelling goes down
Infract
Loss of arterial supply from thrombosis or embolization vessels
Gland infarct
Blocked artery
Allows for reperfusion
Hemorrhage
Intraparenchymal
Usually due to hypertension
Fairly common in the pons
Bleed into the brain
Subarachnoid
Usually from aneurysm
Typically occur at branch points of the Circle of Willis
Usually come with a warning leak
Reported as the “worst ever headache”
Unce herniations can produce a gland infarct and a hemorrhage
The brain moves and compress the vessels against a fold of the dura
Reduce the blood flow
Not giving enough blood to that area to keep it viable (gland infarct)
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However there is enough blood provided to the necrotic tissue to lead to a hemorrhage
latter on
Both infractions and hemorrhage will both appreat as sudden neurological damage
Get imaging done to see which one
Infection of the CNS
Bacteria
Meningitis is most common form
Many pathogens
Symptoms
Fever
Neck stiffness
Prevent the strength of the inflamed meninges
Confusion
Due to increased cerebral pressure
Pus in the subarachnoid space
Sample CSH through a lumbar tap
CSF cloudy
Inflammatory cells
culture positive
Virus
Meningitis, encephalitis
Many type of virus can do this, especially if you are immune compromised
HIV
Smoldering, chronic
West Nile Virus
Caused by many pathogens
Selective regions affected at times (polio)
HIV most common nowadays
Microglia response
Forms microglia nests/nodules
Fungi and Parasites
Meningitis, encephalitis abscess
Developing countries
Lack food inspection
Immunocompromised patients are at higher risk
Prions
CJD
BSE
Crossover of BSE
Eating contaminated cattle infected humans
Just proteins
No genome
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