CH 19: testing considerations, patient history, mechanisms of disease, and physical examination

Whose responsibility is it to make the determination that a diagnostic study is medically necessary?

Ordering physician

List the 4 integrations of outside data that the sonographer should take note of prior to non-invasive cerebrovascular testing.

• Obtain a good history

• Document relevant physical exam findings

• Identification of risk factors

• Knowledge of some differential diagnoses

What environment should the sonographer maintain prior to non-invasive cerebrovascular testing?

Warm

List the 2 interpretations and reportings that the sonographer should take note of prior to non-invasive cerebrovascular testing.

• All final reports must be standardized

• Accurately reflect the contents and interpretation of the noninvasive study

List the 4 testing considerations for non-invasive cerebrovascular testing.

• Appropriate indications

• Integration of outside data

• Environment

• Interpretation and reporting

List the 4 risk factors that will contribute to cerebrovascular diseases.

• Smoking

• Diabetes mellitus

• Hypertension

• Hyperlipidemia

What is the abbreviation for hyperlipidemia? 

HLD

Hyperlipidemia is the medical term for what?

High cholesterol

Which pathology learned in this lecture is considered a warning sign of a stroke?

Transient ischemic attack

Name the pathology:

“A fleeting neurologic dysfunction without lasting effects”

Transient ischemia attack

What does ‘TIA’ stand for?

Transient ischemic attack

What is transient ischemic attack?

Fleeting neurologic dysfunction without lasting effects

How long do symptoms last for a transient ischemic attack? (2)

• Anywhere from a few minutes to a few hours 

• Never more than 24 hours 

List the 3 symptoms of transient ischemic attack.

• Sensory and/or motor dysfunction of an arm or leg

• Speech impairment

• Visual disturbances

Etiology of transient ischemic attack is usually…

Embolic

In which 2 structures will the source of an emboli of a transient ischemic attack be found? 

• Heart

• Carotid artery

Label the crossed-out structures on this image and specify which side it is on. 

1. Right internal carotid artery

2. Right vertebral artery

3. Right common carotid artery 

If this was taken at the carotid bifurcation and there is atherosclerotic plaque seen in the internal carotid artery, how will that affect the internal carotid artery?

Reduces blood flow in the internal carotid artery

List the 3 symptoms of reversible ischemic neurologic deficit (RIND).

• Sensory and/or motor dysfunction of an arm or leg

• Speech impairment

• Visual disturbances

What does ‘RIND’ stand for?

Reversible ischemic neurologic deficit 

Between these 2 pathologies:

• Transient ischemic attack

• Reversible ischemic neurologic deficit 

Which will have symptoms that last longer?

Reversible ischemic neurologic deficit

How long will it take for the deficit to resolve with reversible ischemic neurologic deficit?

Longer than 24 hours

Is there complete recovery with reversible ischemic neurologic deficit?

Yes

What does ‘VBI’ stand for?

Vertebrobasilar insufficiency

What does ‘CVA’ stand for?

Cerebrovascular accident

What is another term for stroke? 

Cerebrovascular attack

What is another term for cerebrovascular attack?

Stroke

What kind of symptoms does a vertebrobasilar insufficiency present?

Fleeting symptoms

How long will symptoms last for vertebrobasilar insufficiency/VBI?

A few seconds or minutes

What kind of deficits will a cerebrovascular accident/stroke produce?

Permanent neurologic deficit

Name the pathology:

“Causes fleeting symptoms often lasting only seconds or minutes” 

Vertebrobasilar insufficiency 

Name the pathology:

“Produces permanent neurologic deficits”

Cerebrovascular accident/Stroke

Which vessels supply blood to the brain’s cerebral hemispheres?

• Anterior

• Posterior

Anterior

List the 4 anterior vessels that feed the brain’s cerebral hemispheres.

• Internal carotid artery

• Anterior cerebral artery

• Middle cerebral artery

• Anterior communicating artery 

Which hemisphere of the brain controls the right side of the body? 

Left

Which hemisphere of the brain controls the left side of the body? 

Right

The left hemisphere controls which side of the body?

Right

The right hemisphere controls which side of the body?

Left

A left hemispheric stroke results in neurologic deficits to the _______ side of the face and body. 

Right

A right hemispheric stroke results in neurologic deficits to the _______ side of the face and body. 

Left

In this lecture, what does the term ‘lateralizing’ refer to?

Indicating which side or hemisphere of the brain has been affected

Name the term:

“Indicating which side or hemisphere of the brain has been affected”

Lateralizing

In this lecture, what does the term ‘non-lateralizing’ refer to?

Non-specific to the right or left side of the brain

Name the term:

“Non-specific to the right or left side of the brain”

Non-lateralizing

List 2 examples of pathologies with non-lateralizing symptoms. 

• Ataxia

• Vertigo

Non-lateralizing symptoms are usually associated with problems in which 2 structures?

• Brain stem

• Posterior circulation

Problems with posterior circulation will be associated with what pathology?

Vertebral basilar insufficiency

List 2 pathologies that can result from an ICA lesion. 

• Significant stenosis 

• Occlusion

List the 5 neurologic deficits that may be associated with an ICA lesion.

• Unilateral paresis

• Unilateral paresthesia or anesthesia

• Aphasia

• Amaurosis fugax

• Homonymous hemianopia

Name the neurologic deficit:

“Weakness or slight paralysis on one side of the body”

Unilateral paresis

Name the neurologic deficit:

“Tingling, numbness, or lack of feeling on one side of the body”

Unilateral paresthesia or anesthesia 

Name the neurologic deficit:

“Inability to speak”

Aphasia

Name the neurologic deficit:

“Temporary partial or total blindness, usually of only one eye”

Amaurosis fugax

Name the neurologic deficit:

“The loss of vision in one half of the visual field of both eyes”

Homonymous hemianopia

Define ‘unilateral paresis.’

Weakness or slight paralysis on one side of the body

Define ‘unilateral paresthesia/anesthesia.’

Tingling, numbness, or lack of feeling on one side of the body

Define ‘aphasia.’

Inability to speak

Define ‘amaurosis fugax.’

Temporary partial or total blindness, usually of only one eye

Define ‘homonymous hemianopia.’ 

The loss of vision in one half of the visual field of both eyes

If a patient suffers from right arm paresis, which ICA would be affected with disease?

Left

If a patient suffers from left arm paresis, which ICA would be affected with disease?

Right

How is the visual loss with ‘amaurosis fugax’ described by patients?

“A shade coming down over the eye”

Which neurologic deficit is associated with this finding:

“A shade coming down over the eye”

Amaurosis fugax

Which artery is associated with vision and arises from the ICA?

Opthalmic artery

The ophthalmic artery arises from what artery? 

ICA

Where could the origin of an embolic process be that would cause temporary vision loss?

Ipsilateral internal carotid artery

If the patient is experiencing vision loss in the right eye, which ICA would be affected by disease?

Right

If the patient is experiencing vision loss in the left eye, which ICA would be affected by disease?

Left

Why would the right ICA be the source of temporary vision loss in the right eye?

Because the ophthalmic artery branches off the ICA

Homonymous hemianopia is not always related to what kind of lesions?

ICA lesions

Between these 2 options, which vision pathology most closely matches this description:

Temporary partial or total blindness, usually of only one eye

• Amaurosis fugax

• Homonymous hemianopia

Amaurosis fugax

Between these 2 options, which vision pathology most closely matches this description:

The loss of vision in one half of the visual field of both eyes

• Amaurosis fugax

• Homonymous hemianopia

Homonymous hemianopia

Which neurologic deficit pathology is associated with this image?

Amaurosis fugax

What does dysphasia refer to?

Impaired speech

Severe hemiparesis/hemiplegia from an MCA lesion is most commonly seen in which structure option?

• Face/Arm

• Leg

Face/Arm

Less severe hemiparesis/hemiplegia from an MCA lesion is most commonly seen in which structure option?

• Face/Arm

• Leg

Leg

List the 3 symptoms seen with an MCA lesion. 

• Aphasia/Dysphasia

• Severe facial and arm hemiparesis/hemiplegia

• Behavioral abnormalities

List the 3 symptoms seen with an ACA lesion. 

• Severe leg hemiparesis

• Incontinence

• Loss of coordination 

Define ‘hemiplegia.’

Paralysis affecting one side of the body including arm, leg, and trunk

List the 4 posterior vessels that supply blood to the brain stem, cerebellum, and occipital lobes.

• Vertebral artery

• Basilar artery

• Posterior cerebral artery

• Posterior communicating arteries

Which vessels supply blood to the brainstem, cerebellum, and occipital lobes?

• Anterior

• Posterior

Posterior

List the 5 symptoms of a vertebrobasilar lesion. 

• Vertigo

• Ataxia

• Bilateral blurry vision or diplopia

• Bilateral paresthesia

• Drop attack

Define ‘vertigo.’

Difficulty maintaining equilibrium

Name the symptom of vertebrobasilar lesion:

“Difficulty maintaining equilibrium”

Vertigo

Define ‘ataxia.’ 

Muscular incoordination 

Name the symptom of vertebrobasilar lesion:

“Muscular incoordination”

Ataxia

Define ‘diplopia.’ 

Double vision/seeing double 

Name the symptom of vertebrobasilar lesion:

“Double vision/seeing double”

Diplopia

Define ‘paresthesia.’

The sensation of prickling or tingling of the skin (Loss of sensation)

Name the symptom of vertebrobasilar lesion:

“The sensation of prickling or tingling of the skin (Loss of sensation)”

Paresthesia

Define ‘drop attack.’

Falling to the ground without a loss of consciousness

Name the symptom of vertebrobasilar lesion:

“Falling to the ground without a loss of consciousness”

Drop attack

List the 2 symptoms commonly seen with a PCA lesion.

• Dyslexia

• Coma

What does it mean for a symptom to be ‘nonlocalizing’?

Not associated with a specific area, just generalized symptoms

List the 5 non-localizing symptoms learned in this lecture. 

• Dizziness

• Syncope

• Difficulty with speech

• Headache

• Confusion

Define ‘syncope.’

A transient loss of consciousness

How is an ‘auscultation’ performed?

By a doctor listening with a stethoscope

Normal flow patterns are evident when listening through a…

Stethoscope 

1. What kind of abnormal sounds can be heard on auscultation with a stethoscope?

2. These abnormal sounds are a result of what?

1. Bruits

2. Turbulent flow

Bruits are associated with what pathology?

Hemodynamically significant lesion