| Old Infarct
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Etiology
•Infarcts are due to the
occlusion of an artery of the
Circle of Willis or one of its branches or a vein by
a thrombus or embolus.
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Pathogenesis
•Atherosclerosis is the major cause of cerebral vascular
disease causing thickening and partial or complete
occlusion of arterial lumina leading to thrombosis,
due to low flow or sudden expansion of the arteriosclerotic
plaque by hemorrhage or rupture of the plaque.
•Emboli arise from diseases of the heart with thrombi
on abnormal heart valves or mural thrombi over
areas of transmural or subendocardial myocardial infarcts.,
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Epidemiology
•Cerebrovascular disease is the third leading cause of
death after heart disease and cancer.
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General Gross Description
•Old
infarcts appear as cystic spaces of varying size,
depending on the size of the artery occluded, which
contain portions of blood vessels and glial fibers.
•Examples:
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General Microscopic Description
•Microscopically
appear as a cyst containing blood
vessel remnants and macrophages
•The surrounding tissue shows a reactive and fibrillary
astrocytosis since astrocytes are the scar forming
cell as well as the stromal cell in the CNS.
•May also show some loss of myelinated fibers and
neurons in the surrounding tissue.
•Examples:
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Clinical Correlation
•Clinically an infarct appears as
the sudden onset of
loss of function in a focal area such as a hemiparesis.
•When the infarct is old, depending on its size, the
patient may have a fixed deficit if the lesion is
large or in a main tract or may have very little
neurologic deficit if it is small or away from tracts.
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References
• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 1309-1311.
• Poirer J et.al. Manual of basic neuropathology. Philadelphia: Saunders, 1990, pp.87-92.
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| Old Infarct
| | Synopsis by: M.L. Grunnet M.D. (TX2000M54750)[29]
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