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The Case of RS

R.S. had a large ischemic stroke that was produced when thrombi that originally formed on the mitral valve (vegetations) broke loose and showered her brain with emboli of different sizes. She died about 10 days later. 

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This is a microscopic section of the patient's cerebral cortex. Can you find a small artery that is plugged up with an embolus composed mainly of fibrin and platelets?  Regions of the cortex that this vessel normally supplies are swollen and pale. This pathology indicates that the tissue is dead.

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This is a microscopic section showing a large artery that was also occluded by embolus. It was the failure of circulation produced by this embolus that caused brain swelling and led to her death.

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This is R.S.' brain.  Can you find indications of some brain swelling here? Swelling in additional regions was responsible for her death.  Note that the swelling has pushed some brain structures toward the opposite side.

A.B. suffered the occlusion of several arteries following cardiac catheterization that dislodged debris from an ulcerated atherosclerotic plaque in his aortic arch. Three weeks later he had a second myocardial infarction and died.

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This is A.B.'s aorta which has been opened up so that you are looking at its inner surface. You can see extensive atherosclerotic changes. Many large plaques protrude into the lumen giving the surface a bumpy appearance. When you mouse over it, the arrow will indicate one of the largest plaques which has broken open, rupturing the endothelium that normally lines the aorta and exposing the cellular debris and lipid in the core of the plaque. You can also see many areas where thrombus has formed over ruptured plaques. The pathologic changes that you are looking at here evolved over a period of many years. 

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Some debris from a ruptured plaque must have traveled up A.B.'s vertebral artery and lodged in one of its branches that supplies the cerebellum.  Part of A.B.'s cerebellum is shown at the right. You can see its numerous small neurons that are called granule cells (blue). The granule cells have disappeared in the lower part of the image because they have been killed by an ischemic injury. Now look at the blood vessels on the outer surface of the cerebellum. Can you see a vessel that is plugged with elongated unstained crystal-like profiles? This embolus is a fragment of an atherosclerotic plaque; the crystal-like profiles are accumulations of cholesterol.