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Slide Chapt 2-Basic Pathology and Anatomy

Ischemia and hemorrhage are the two major categories of brain damage that occur in stroke patients. Ischemia can be caused by thrombosis, embolism, or decreased systemic perfusion. Hemorrhage can be intracerebral, subarachnoid, subdural, or epidural - each with different causes and treatments. The location of damage within the brain is also important to determine the appropriate treatment strategy, as treatments for ischemia could be dangerous for hemorrhage. During ischemia, reduced blood flow below 20 mL/100g/min affects brain cell function and metabolism. Various factors like collateral circulation, systemic conditions, and the obstructing vascular lesion influence the brain regions at risk. Brain edema

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96 views62 pages

Slide Chapt 2-Basic Pathology and Anatomy

Ischemia and hemorrhage are the two major categories of brain damage that occur in stroke patients. Ischemia can be caused by thrombosis, embolism, or decreased systemic perfusion. Hemorrhage can be intracerebral, subarachnoid, subdural, or epidural - each with different causes and treatments. The location of damage within the brain is also important to determine the appropriate treatment strategy, as treatments for ischemia could be dangerous for hemorrhage. During ischemia, reduced blood flow below 20 mL/100g/min affects brain cell function and metabolism. Various factors like collateral circulation, systemic conditions, and the obstructing vascular lesion influence the brain regions at risk. Brain edema

Uploaded by

Sheila Kristina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Basic Pathology, Anatomy, and

Pathophysiology of Stroke
Caplans Stroke A Clinical Approach 4th Edition
Chapter 2

PATHOLOGY:
MECHANISMS OF CEREBROVASCULAR DAMAGE TO
BRAIN TISSUE
There are two major categories of brain damage in stroke patients:
(1) ischemia
(2) hemorrhage

Ischemia can be further subdivided into 3 mechanisms:


Thrombosis,
Embolism,
Decreased Systemic Perfusion.

Thrombosis
Thrombosis refers to an
obstruction of blood ow due to
a localized occlusive process
within one or more blood
vessels.

Embolism
Material formed elsewhere
within the vascular system
lodges in an artery and blocks
blood ow.
Blockage can be transient or
may persist for hours or days
before moving distally.

Decreased Systemic
Perfusion
In decreased systemic
perfusion, diminished
flow to brain tissue is caused by
low systemic
perfusion pressure.

HEMORRHAGE

INTRACEREBRAL

SUBARACHNOID

different causes, pose


different clinical
problems, and have
different management.

SUBDURAL

EPIDURAL

11

Subarachnoid Hemorrhage
Arteriovenous malformations that cause
the syndrome of subarachnoid
hemorrhage are either located in the
brain, abutting on pial or ventricular
surfaces, or situated within the ventricular
system or the subarachnoid space.

12

Intracerebral hemorrhage
Intracerebral and parenchymal
hemorrhage describe bleeding directly into
the brain substance.
The cause is most often hypertension,
with leakage of blood from small
intracerebral arterioles damaged by the
elevated blood pressure
13

The most common brain locations for


hypertensive intracerebral hemorrhages
are as follows: lateral ganglionic and
capsular (40%), thalamus (12%), lobar
white matter (15% to 20%), caudate
nucleus (8%), pons (8%), and cerebellum
(8%)29,71.
14

Subdural & epidural


hemorrhage
These hemorrhages are almost always
caused by head trauma.
Subdural hemorrhages arise from injured
veins that are located between the dura
mater and the arachnoid membranes.

16

Epidural hemorrhages are caused by


tearing of meningeal arteries, most often
the middle meningeal artery.
Blood accumulates rapidly over minutes to
hours between the skull and the dura
mater

17

STROKE MECHANISM GUIDE


TREATMENT
The problems in these ve major subtypes
of stroke are quite distinct and require
different treatment strategies.
Some therapies suitable for ischemia would be
disastrous if the problem were hemorrhage

18

ANATOMY: COMMON ANATOMIC SITES


OF VASCULAR AND BRAIN LESIONS

A major important question in every stroke


patient iswhere is the brain and vascular
problem located?

19

PHYSIOLOGY AND PATHOPHYSIOLOGY


OF BRAIN ISCHEMIA
Ischemia
Normal Metabolism and Blood Flow
Cerebral blood ow (CBF) is normally approximately 50
mL for each 100 g of brain tissue per minute, and
cerebral oxygen consumption, usually measured as the
cerebral metabolic rate for oxygen (CMRO2), is normally
approximately 3.5 mL/100 g per minute

44

Local brain effects of ischemia


At blood ow levels of approximately 20
mL/100 g per minute,
electroencephalographic (EEG) activity is
affected.
CMRO2 also begins to fall when CBF is
diminished below 20 mL/100 g per minute.

45

Arterial occlusion and reaction


Vascular occlusion most often begins with
formation of atherosclerotic plaques within
extracranial and large intracranial arteries.
These plaques contain a mixture of lipid,
smooth muscle, brous and collagen
tissues, macrophages, and inammatory
cells
46

Atherosclerotic plaques and vascular


stenosis cause brain ischemia in a variety
of ways.
Progressive intimal thickening leads to
stenosis or occlusion of the artery,
resulting in reduced distal blood ow.
47

Trombus formation
Thrombi form in situ when the bodys
coagulation system has been activated
and the blood is hypercoagulable
Hypercoagulability can be a lifelong
hereditary problem. Systemic diseases,
such as cancer, regional enteritis, and
thrombocytosis, can cause increased
clotting.
48

The survival of the brain regions at risk


depends on a number of factors
(1) the adequacy of collateral circulation
(2) the state of the systemic circulation
(3) serologic factors
(4) changes within the obstructing
vascular lesion
(5) resistance within the microcirculatory
bed.

49

Brain edema and increased


intracranial pressure
There are two types of brain edema:
(1) water accumulation inside cells,
termed cytotoxic edema
(2) uid within the extracellular space,
often termed vasogenic edema

50

Intracranial pressure may also be increased,


leading to increased morbidity and decreased
CBF.
When intracranial pressure is increased, the
pressure in the venous sinuses and draining
veins must also increase if blood is to be drained
normally from the cranium.
Brain edema and increased intracranial pressure
also cause headache, decreased
51
consciousness, and vomiting.

52

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