Cerebrovascular Disorders


Music to Aura Lee by W.W. Fosdick and George R. Poulton, Lyrics by Arie Perry, M.D.

Cerebral infarct, or a stroke, due to hypoxic/ischemic disease
From thromboembolic or atherosclerotic disease of large head and neck arteries
Red dead neurons, neutrophils, give way to sheets of histiocytes
Over time necrotic tissue liquefies, collapsing down to a cystic site

Intracerebral hemorrhage, from hypertension most commonly
Charcot-Bouchard aneurysms rupturing, from small vessel pathology
Basal ganglia, thalamus, and the pons, are the sites at greatest risk
Herniations and Duret hemorrhage, occur if mass effect is brisk

Selective vulnerability, due to global ischemic disease
Causes watershed infarcts, Purkinje cell death, and hippocampal neurons die with ease
The classic clinical history is a patient with cardiac arrest
Revived after several minutes down, but brain function remains suppressed

Subarachnoid hemorrhage usually, results from ruptured Berry aneurysm
Surgical clipping or vascular embolism, hopes to avoid potential cataclysm
In the U.S., strokes kill 200,000 annually, and there’s also much morbidity
Early treatment can be oh so critical, when there is some reversibility
Early treatment can be oh so critical, when there is some reversibility