Pathology of Stroke (Cerebrovascular accident) for undergraduate medical students.

1. “ The true measure of a man is how he treats someone who does him absolutely no good...” – Ann Landers True beauty lies in the Heart….

8. Education must award self-confidence, the courage to depend on one’s own strength. - Baba

9. Pathology of Cerebro-vascular Disease (Stroke) Dr. Shashidhar Venkatesh Murthy Associate Professor & Head of Pathology

13. Anatomy – Stroke.

16. Stroke location and incidence: Cause % Clinical presentation 30day mort(%) Pathogenesis Cerebral infarction 85 Slowly / sudden evolving signs and symptoms 15-45 Cerebral hypoperfusion Embolism Thrombosis Intracerebral hem. 10 Sudden onset of stroke with raised intracranial pressure 80 Rupture of micro-aneurysm or arteriole Subarachnoid haemorrhage 5 Sudden headache with meningism 45 Rupture of saccular aneurysm on circle of Willis

17. Hypertensive Intracerebral Hem: Sites 1. Putamen-Claustrum 2. Cerebral white matter 3. Thalamus 4. Pons 5. Cerebellum 55% 15 10 10 10

22. Morphology in Global Ischemia

23. Watershed/Boundary zone infarcts:

24. Lamellar necrosis in global ischemia. Carotid thrombosis

25. Local infarction: Cell death ~ 6min central infarct area or umbra , surrounded by a penumbra of ischemic tissue that may recover

28. Cerebral edema

29. Cerebral Edema: narrow sulci, flat gyri.

30. Axonal Injury: A, Hypoxic/ischemic injury in cerebral cortex - "red neurons." shrunken cell B, Axonal spheroids at points of axonal disruption C, Swollen cell body and peripheral dispersion of Nissl substance (chromatolysis) H&E Stain.

31. Cerebral Edema: Normal Edema

32. Edema, loss of demarcation:

33. Cerebral Infarct : Red Neurons

34. Acute Infarction: Oedema

35. Cerebral Infarct - 2 Weeks

36. Cerebral Infarct – 1-4 Week

37. Cerebral Infarction: Macrophages

38. Cerebral Infarct - Cyst formation

39. C. Infarct - Cyst formation

40. Cerebral Infarction - Late Cystic space

41. Specific focal Infarcts Coronary artery involvement MCA ACA PCA

42. MCA stroke.

43. MCA stroke. Wikipedia: GNU Free Documentation license

44. MCA stroke. Wikipedia: GNU Free Documentation license

45. Haemorrhagic - Arterial embolus

46. Infarct with Punctate hemorrhage

47. Cerebral Infarction - Late

48. Cerebral Infarction - Late

51. Central Pontine Hemorrhage - Herniation

52. Subarachnoid Hemorrhage:

53. Ruptured Berry Aneurism

54. Fusiform atherosclerotic aneurysm

55. Saccular(berry) Aneurysm:

57. Intracerebral Hemorrhage:

58. Intracerebral Hemorrhage:

59. Lacunar Infarct in pons

64. Cerebral Infarction: Microscopy Loss of Myelin Red Neurons Neutrophil Infil. Macrophages & early Gliosis Gliosis

65. “ The ultimate measure of a man is not where he stands in moments of comfort, but where he stands in time of challenge and controversy” – Martin Luther King Jr.

89. Cerebral Infarction  hemorrhage

90. Cerebral Infarction  hemorrhage

93. “ We must all suffer from one of two pains: the pain of discipline or the pain of regret” The difference is Discipline weighs ounces.. while regret weighs ton’s..! Jim Rohn

94. Anatomy – Stroke.

95. ’ Smile’ at each other, smile at your friends, smile at your partner, smile at strangers - it doesn't matter who it is – This will help you to grow up in greater love for each other. Mother Teresa 1910-1997, Roman Catholic Missionary