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