Cerebral vascular disease: Pathology review

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Cerebral vascular disease: Pathology review


Central nervous system disorders

Spina bifida

Chiari malformation

Dandy-Walker malformation


Tethered spinal cord syndrome

Aqueductal stenosis

Septo-optic dysplasia

Cerebral palsy

Spinocerebellar ataxia (NORD)

Transient ischemic attack

Ischemic stroke

Intracerebral hemorrhage

Epidural hematoma

Subdural hematoma

Subarachnoid hemorrhage

Saccular aneurysm

Arteriovenous malformation

Broca aphasia

Wernicke aphasia

Wernicke-Korsakoff syndrome

Kluver-Bucy syndrome

Concussion and traumatic brain injury

Shaken baby syndrome


Febrile seizure

Early infantile epileptic encephalopathy (NORD)

Tension headache

Cluster headache


Idiopathic intracranial hypertension

Trigeminal neuralgia

Cavernous sinus thrombosis

Alzheimer disease

Vascular dementia

Frontotemporal dementia

Lewy body dementia

Creutzfeldt-Jakob disease

Normal pressure hydrocephalus


Essential tremor

Restless legs syndrome

Parkinson disease

Huntington disease

Opsoclonus myoclonus syndrome (NORD)

Multiple sclerosis

Central pontine myelinolysis

Acute disseminated encephalomyelitis

Transverse myelitis

JC virus (Progressive multifocal leukoencephalopathy)

Adult brain tumors

Acoustic neuroma (schwannoma)

Pituitary adenoma

Pediatric brain tumors

Brain herniation

Brown-Sequard Syndrome

Cauda equina syndrome

Treponema pallidum (Syphilis)

Vitamin B12 deficiency


Friedreich ataxia

Neurogenic bladder


Neonatal meningitis


Brain abscess

Epidural abscess

Cavernous sinus thrombosis

Creutzfeldt-Jakob disease

Central and peripheral nervous system disorders

Sturge-Weber syndrome

Tuberous sclerosis


von Hippel-Lindau disease

Amyotrophic lateral sclerosis

Peripheral nervous system disorders

Spinal muscular atrophy


Guillain-Barre syndrome

Charcot-Marie-Tooth disease

Trigeminal neuralgia

Bell palsy

Winged scapula

Thoracic outlet syndrome

Carpal tunnel syndrome

Ulnar claw

Erb-Duchenne palsy

Klumpke paralysis


Myasthenia gravis

Lambert-Eaton myasthenic syndrome

Autonomic nervous system disorders

Orthostatic hypotension

Horner syndrome

Nervous system pathology review

Congenital neurological disorders: Pathology review

Headaches: Pathology review

Seizures: Pathology review

Cerebral vascular disease: Pathology review

Traumatic brain injury: Pathology review

Spinal cord disorders: Pathology review

Dementia: Pathology review

Central nervous system infections: Pathology review

Movement disorders: Pathology review

Neuromuscular junction disorders: Pathology review

Demyelinating disorders: Pathology review

Adult brain tumors: Pathology review

Pediatric brain tumors: Pathology review

Neurocutaneous disorders: Pathology review


Cerebral vascular disease: Pathology review

USMLE® Step 1 questions

0 / 18 complete


USMLE® Step 1 style questions USMLE

of complete

A 78-year-old right-handed man is brought to the emergency department following sudden-onset weakness in his right arm and inability to speak for twenty four hours. The patient’s daughter states she initially became concerned when he dropped his cup of coffee while walking to the kitchen table last night. The daughter states he has had a similar episode in the past that resolved spontaneously. He has a history of hypertension, for which he takes lisinopril. His temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 158/104 mmHg. The patient is alert and visibly frustrated by not being able to speak. Physical examination reveals 2/5 strength in the right upper extremity and 4/5 strength in the right lower extremity. He follows written and verbal commands but is unable to speak or write. MRI of the head demonstrates ischemic changes in the cerebral territory supplied by the left middle cerebral artery. Which of the following histopathological findings are most likely to be observed in this patient’s brain at the present time?



Maria Emfietzoglou, MD

Jerry Ferro

Tina Collins

Jessica Reynolds, MS

At the emergency department, 30-year-old Lydia presents with severe headache and confusion. Clinical examination reveals low grade fever and nuchal rigidity. Past medical history reveals she has polycystic kidney disease. Non-contrast CT reveals blood between the arachnoid and the pia mater. Lydia is treated supportively and sent home. Three days later she suddenly develops a severe headache, vomiting, and confusion.

Later that day, 70-year-old Amanda presents with left-sided weakness and numbness, with her foot and leg more affected than her arm. She can speak fluently and understands everything being said to her. Past medical history includes hypertension, hyperlipidemia, and a myocardial infarction last year.

Based on their presentation, the diagnosis is that both Lydia and Amanda had a cerebral vascular disease, most often referred to as a stroke. A stroke is when there’s a sudden focal neurological deficit due to a part of the brain losing its blood supply. Now, to safeguard the brain from hypoxia, the brain has a dual circulation called the circle of Willis, divided into an anterior and posterior circulation. The anterior circulation starts in the neck, where the common carotid artery splits into the external and internal branches. The internal carotid passes through the carotid canal of the temporal bone of the skull and into the cranial cavity. Once inside, the internal carotid artery gives off branches. First are the middle cerebral arteries that supply the lateral portions of the frontal, parietal, and temporal lobes. It’s also important to remember that the middle cerebral arteries supply the two language areas, Broca’s and Wernicke’s.

From the initial segment of the middle cerebral arteries, small perforating arteries called lenticulostriate arteries arise to supply a part of the basal ganglia called the striatum, which includes the caudate and putamen, as well as the internal capsule. And that’s something you absolutely must remember for the exams! The internal carotid artery also gives rise to the anterior cerebral artery, which supplies the medial portion of the frontal and parietal lobes. The two anterior arteries connect with one another via a short blood vessel called the anterior communicating artery, forming the anterior portion of the circle of Willis. An important area supplied by the anterior circulation is the cortical homunculus, which is kind of a neurological map of the areas and proportions of the brain that are in charge of the motor and sensory functions for different parts of the body.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Clinical pathology of the shock syndromes" Journal of Emergencies, Trauma, and Shock (2011)
  4. "Untreated brain arteriovenous malformation: Patient-level meta-analysis of hemorrhage predictors" Neurology (2014)
  5. "Intracranial Aneurysm and Hemorrhagic Stroke in Glucocorticoid-remediable Aldosteronism" Hypertension (1998)
  6. "ACR Appropriateness Criteria ® Cerebrovascular Disease" Journal of the American College of Radiology (2017)
  7. "Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms" Stroke (2015)

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