{"id":6686,"date":"2021-09-13T21:46:08","date_gmt":"2021-09-13T19:46:08","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/pathology\/nervous-system\/infarction-ischemia\/"},"modified":"2021-09-13T21:46:15","modified_gmt":"2021-09-13T19:46:15","slug":"infarction-ischemia","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/pathology\/nervous-system\/infarction-ischemia\/","title":{"rendered":"Infarction, ischemia"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Reasons for cerebral hypoxia<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Functional hypoxia (anemia, high altitude)<\/li><li>Ischemia (transient or permanent)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h2 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Ischemic encephalopathy<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">The brain is highly dependent on blood supply.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Neurons are far more sensitive than glial cells to ischemia<ul><li>Do not have glycogen stores<\/li><li>Some regions of the brain are more sensitive<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Morphology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Swelling and cerebral edema are seen<\/li><li>Red neurons &#8212; dying neurons<\/li><li>Liquefactive necrosis that is resolved within several weeks and replaced by gliosis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Types<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Global<\/li><li>Focal<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Global<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Due to systemic hypotension (&gt;50mmHg), seen in cardiac arrest and shock.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>If the ischemia is short-lasting, there will be a complete recovery<\/li><li>If the ischemia is long-lasting, there will be widespread neuronal death<\/li><li><strong>&#8220;Brain death&#8221;<\/strong> refers to individuals who lost all of their voluntary and reflex brain function<\/li><li><strong>&#8220;Respirator brain&#8221;<\/strong> refers to the autolysis of the brain that requires a ventilator, since even the respiratory center is damaged<ul><li>The ventilator comes after the brain damage! It does not induce brain damage<\/li><\/ul><\/li><li><strong>Watershed infarcts&nbsp;<\/strong>refer to infarcts formed in vulnerable regions, such as the border between the anterior and middle cerebral arteries<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Focal and multifocal<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Embolisms<\/strong><ul><li>More common<\/li><li>Due to systemic embolisms:<ul><li>Paradoxical embolisms (patent foramen ovale)<\/li><li>Intramural thromboemboli<\/li><li>Complicated atherosclerotic plaques<\/li><\/ul><\/li><\/ul><\/li><li><strong>Thrombosis<\/strong><ul><li>Often are superimposed on atherosclerotic plaques<ul><li>Carotid bifurcation<\/li><li>Basal artery<\/li><\/ul><\/li><li><strong>Lacunar infarcts&nbsp;<\/strong>describe thrombosis of small penetrating vessels, usually due to long-lasting hypertension<ul><li>After the infarct resolves, there will be a small pool (&#8220;lacuna&#8221;) of necrosis left<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The damage depends on the location and severity of the ischemia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>If circulation can be maintained, such as in case of collateral flow through the circle of Willis, the damage can be limited. Occlusion of deep penetrating vessels (such as that of the thalamus) do not enjoy this privilege.<\/em><\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h2 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Infarctions<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Types<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Non-hemorrhagic<\/strong><ul><li>Due to acute vascular occlusions<\/li><li>Can transform into hemorrhagic if there is reperfusion<\/li><\/ul><\/li><li><strong>Hemorrhagic<\/strong><ul><li>Usually, multiple petechiae can be seen<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h2 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Intracranial hemorrhage<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Location<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Epidural<\/strong><\/li><li><strong>Subdural<\/strong><\/li><li><strong>Subarachnoid<\/strong><\/li><li><strong>Intraparenchymal<\/strong><\/li><li><strong>Intraventricular<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Epidural<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<ul class=\"wp-block-list\"><li>Between the cranium and the dura<ul><li>Producing a hematoma<\/li><\/ul><\/li><li>Arterial<\/li><li>Associated with trauma &#8212; MMA<\/li><li>Manifest within hours<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_13\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Subdural<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_13\">\n\n\n<ul class=\"wp-block-list\"><li>Underneath (or within &#8212; &#8220;intradural&#8221;) the dura<\/li><li>Venous<\/li><li>Also associated with trauma<\/li><li>Manifest within days<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_14\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Subarachnoid<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_14\">\n\n\n<ul class=\"wp-block-list\"><li>Into the arachnoid space<\/li><li>&#8220;The worst headache I&#8217;ve ever had&#8221;<\/li><li>During abrupt increased in IcP (orgasm, strained defecation)<\/li><li>Berry (saccular) aneurysms<ul><li>Most commonly, in branching points of the anterior part of the circle of Willis<\/li><li>The saccule lacks the intimal and elastic membrane<\/li><li>Not present at birth, develop throughout time<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_15\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Intraparenchymal (cerebral)<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_15\">\n\n\n<ul class=\"wp-block-list\"><li>Charcot-Bouchard microaneurysms of lenticulostriae vessels<ul><li>Most commonly, in the basal ganglia<\/li><\/ul><\/li><li>Associated with hypertension<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_16\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Intraventricular<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_16\">\n\n\n<ul class=\"wp-block-list\"><li>In premature neonates<\/li><li>Involves the germinal matrix<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_17\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_17\">\n\n\n<ul class=\"wp-block-list\"><li>Congenital malformations<\/li><li>Hypertension and vascular disease<\/li><li>Tumors<\/li><li>Trauma<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_18\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Congenital malformations<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_18\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Arteriovenous<\/strong> &#8212; Most common, and most dangerous, as it tends to rupture and bleed. The lumen is increased and swollen, worm-like channels<\/li><li><strong>Cavernous<\/strong><\/li><li><strong>Capillary telangiectasia<\/strong><\/li><li><strong>Venous angiomas<\/strong><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_19\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title3\">Vascular disease<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_19\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Cerebral Amyloid Angiopathy<\/strong> (Amyloid beta, just like in Alzheimer&#8217;s)<\/li><li><strong>Hypertensive Cerebrovascular Disease<\/strong> (hyaline arteriolar sclerosis, Charcot-Bouchard microaneurysms)<\/li><li><strong>Vasculitis<\/strong> (infectious &#8212; CMV and Aspergillus, non-infectious &#8212; <strong>primary angiitis of the CNS<\/strong>)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_20\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Other types of aneurysms<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_20\">\n\n\n<ul class=\"wp-block-list\"><li>Cirsoid &#8212; In the basilar and splenic arteries, due to atherosclerosis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_21\">\n<h2 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Trauma<\/h2>\n<\/span><span class=\"block-content\" id=\"contents_21\">\n\n\n<p class=\"wp-block-paragraph\">The point of impact is called a <strong>coup<\/strong>, while the opposite side is the <strong>counter-coup<\/strong>. An injury can occur in both points, and they are known as <strong>contusions<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A contusion is a wedge-shaped lesion occurring when the tissue is rapidly displaced, followed by hemorrhage and edema.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Concussion&nbsp;<\/strong>&#8212; Reversible altered brain function post-head injury, with or without the loss of consciousness.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Repeated injuries can result in NDDs (boxers)<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Reasons for cerebral hypoxia<\/h4><h2 class=\"wp-block-heading\" class=\"wp-block-heading\">Ischemic encephalopathy<\/h2><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Morphology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Types<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Global<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Focal and multifocal<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h2 class=\"wp-block-heading\" class=\"wp-block-heading\">Infarctions<\/h2><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Types<\/h4><h2 class=\"wp-block-heading\" class=\"wp-block-heading\">Intracranial hemorrhage<\/h2><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Location<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Epidural<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Subdural<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Subarachnoid<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Intraparenchymal (cerebral)<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Intraventricular<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Congenital malformations<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Vascular disease<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Other types of aneurysms<\/h3><h2 class=\"wp-block-heading\" class=\"wp-block-heading\">Trauma<\/h2><\/div>","protected":false},"excerpt":{"rendered":"<p>Reasons for cerebral hypoxia Functional hypoxia (anemia, high altitude) Ischemia (transient or permanent) Ischemic encephalopathy The brain is highly dependent on blood supply. Neurons are far more sensitive than glial cells to ischemia Do not have glycogen stores Some regions of the brain are more sensitive Morphology Swelling and cerebral edema are seen Red neurons [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":6651,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6686","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Infarction, ischemia &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/pre-clinical\/pathology\/nervous-system\/infarction-ischemia\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/pathology\\\/nervous-system\\\/infarction-ischemia\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/pre-clinical\\\/pathology\\\/nervous-system\\\/infarction-ischemia\\\/\",\"name\":\"Infarction, ischemia &#8211; 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