Cerebrovascular accident

Cerebrovascular accident, abbreviated CVA, is a common neurologic pathology. It is also known as a stroke.

General

• Very common.
• Leading cause of morbidity and mortality.

Etiologies:

• Atherosclerosis of the cerebral vessels or internal carotid artery.
• Embolism.
• Hemorrhage (ruptured berry aneurysm, cerebral amyloid angiopathy).
• Tumour.
• Others.

Clinical classification:

1. Hemorrhagic stroke.
2. Ischemic stroke.

Gross

• Soft/mushy brain.
• Older infarcts.
  • A "roof" is present - a thin submeningeal layer is preserved by the CSF.
    • "Roof" is absent in trauma.
  • Cavity - in older infarcts.
    • Multiple sclerosis does not cavitate.
• Laminar necrosis = (thin) chalky line replaces grey mater.
  • AKA pseudolaminar necrosis - as it is not localized to a specific layer of the cortex.

DDx:

• Cerebral contusion.

Images

• 

  Changes of CVA - right of image. (WC/Marvin 101)

Microscopic

Features:

• Ischemic neurons.
• +/-Neuronal loss.
• +/-Microglial.
• +/-Thrombosis.
• +/-Atherosclerosis.

DDx:

• Hypoglycaemic injury.

Images

• 

  Neuronal changes of an acute stroke. (WC/Martin Hasselblatt)

See also

• Neuropathology.