Pathology 3500 Lecture Notes - Lecture 37: Embolization, Thrombosis, Perfusion
1 May 2018
School
Department
Course
Professor
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)
find more resources at oneclass.com
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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
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Tends to improve over time (variable degree) 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. 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. Loss of arterial supply from thrombosis or embolization vessels. Typically occur at branch points of the circle of willis. Unce herniations can produce a gland infarct and a hemorrhage. The brain moves and compress the vessels against a fold of the dura.
