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Neuro Pathophysiology, 2 types: Anemic (occlusive)=75-80% Hemorrhagic infarction=15-20% -assoc. w/ HTN 10% of all strokes preceded by TIA Anemic (Occlusive) 1 in 10 death 1st 48 hours- edema, swelling, ischemic cell change -edema and ICP peak at 72-96 hrs -control w/ mannitol, low pCO2, tPA -phagocytes-neutrophils, macrophages -tissue w/ foamy appearance 10 days-liquefaction starts -MPs decrease, fluid fills cavity -glia, astros from scar around lacune -ONLY TYPE OF NECROSIS IN BRAIN, 2 types: Anemic (occlusive)=75-80% Hemorrhagic infarction=15-20% -assoc. w/ HTN 10% of all strokes preceded by TIA Hemorrhagic Infarction 1 in 3 death Blood extravasates into parenchyma -hemorrhage into entire zone -boundaries where there is poor anasts. -necrosis limited to vasc territory -highly correlated w/ HTN -often involves lenticulostriates -capsular stroke -if reaches ventricular system=100% mort, Neuro Pathophysiology Intracranial Aneuryms Cause due to: congenital or 2° acquired 2° acquired=atherosclerosis, aa. HTN, bruits 85% from carotid, 15% from basilar/vertebral, Neuro Pathophysiology Arteriovenous Malformations Congenital Lesions -vasc. tangles -cap beds bypassed -aa. att'd to vv. -Sx b/w 2nd, 4th decade -headache, seizure, stroke Risk factors for bleeds -size, prev. bleeds, HTN, smoking,congenital, Neuro Pathophysiology Stroke 2 types: Anemic (occlusive)=75-80% Hemorrhagic infarction=15-20% -assoc. w/ HTN 10% of all strokes preceded by TIA, Neuro Pathophysiology Intracranial Aneuryms Often bilateral, symmetrical Risk of hemorrhage->inc. ICP rebleeding->subarach hemorr. ->thunderclap/sentinel headache BBB breakdown-plasma pros cross -irritation NO inhibited by endoth injury-> vasoconstriction, superoxide release, Neuro Pathophysiology Stroke Thrombogenesis due to: -injury to endoth -atheromatous dz -weaken vessel wall -great vessel dz. -atherosclerosis-chief factor -70%reduction in X-sect area -yields signs/symptoms -blood flow altered -turbulence-dmg to endoth -Laplace's law, not laminar -changes in blood coag. -forms over ulcerated plaques -thrombus-not passive -lines of Zahn-platelets/fibrin, Neuro Pathophysiology Intracranial Aneuryms Pts have 4-5x more serum metaloproteinase -degrades vasc. collagen, weakens wall -alt. etiology to atherosclerosis Bleeding aneurysm->vasospasm -control w/ nimodipine, Ca++ blocker -antifibrinolytic therapy -must clip, coil, bypass aneurysm, or death, Neuro Pathophysiology Stroke Ischemia in brain -cerebral infarction -leads to necrosis Most extracranial 700K strokes/year, 164K fatal -#1 cause of disability, -#3 cause of death Intraparenchymal Bleeding-> increased ICP->uncal/tonsillar herniation->medulla compression ->duret hemorrhages -no blood to pons, Neuro Pathophysiology Stroke emboli cause most brain attacks -more common in distal aa. -old pts w/ fat emboli after falls HYGROMA-torn arachnoid