1. Recognize the territories of supply of the anterior, middle, and posterior cerebral arteries, and of the vertebrobasilar system.
2. Describe the gross and microscopic patterns of CNS focal infarcts, global hypoxic/ischemic encephalopathy, and watershed infarcts.
3. Compare and contrast the process of organization of an infarct in the CNS to the process that occurs in other organs.
4. Describe the relative roles of thrombosis and embolism in causing CNS infarcts. Identify three important sources of emboli.
5. Explain the basis of hemorrhage in a hemorrhagic infarct. Compare and contrast with primary intraparenchymal hemorrhage.
6. List common risk factors for, and major sites of, primary intraparenchymal hemorrhage.
1. (Robbins 5th Ed., p. 1308-1312, 1314) or (Robbins 6th Ed., p. 1306-1310, 1313-1314)
2. Images #1-9 relate to this case; Images #10-21 are for the study of other learning objectives.
This 81-year-old man awoke one morning unable to move his right arm or leg and unable to speak. He rang a bell with his left hand to summon his housekeeper. She telephoned the man's son and also called for an ambulance. The son met the ambulance at the hospital emergency room. The son said that his father had a "stroke" about a year before, involving profound weakness of his left arm and leg, but had regained nearly full use of them within a few months.
Physical examination was begun, but the patient suddenly arrested and could not be resuscitated. An autopsy was performed.
Upon removal of the brain at autopsy, patchy parenchymal loss (Image 1) and severe cerebrovascular atherosclerosis (Image 2) were noted. Coronal sections of the cerebral hemispheres revealed multifocal parenchymal lesions, some of which were centered at the depths of sulci. Some lesions were granular or crumbly (Images 3 & 4), and some were cystic (Images 5-7). A large lesion in the left lateral frontal lobe and nearly the entire pons were simply softened (Images 8 & 9).