Cerebrovascular (TCD, disorders, interventions)

symptoms for ICA

contralateral weakness

unilateral paresis

unilateral paresthesia

numbness\ipsilateral amaurosis fugax

aphasia

altered level of conciousness

what makes up the circle of willis

ACA

PCA

terminal ICA

PcOA

AcOA

MCA flow direction

antegrade

MCA TAMV (cm/sec)

55 +- 12

MCA

window-

depth-

flow direction-

velocity-

transtemporal

30-60mm

antegrade

55+- 12

ACA/MCA bifurcation window

transtemporal

ACA/MCA bifurcation depth

55-65mm

ACA/MCA bifurcation flow direction

antegrade/retrograde (butterfly)

ACA/MCA bifurcation TAMV

variable

ACA/MCA

window-

depth-

flow direction-

velocity-

transtemporal

55-65mm

antegrade/retrograde (butterfly)

variable

ACA window

transtemporal

ACA depth

60-80mm

ACA flow direction

retrograde

ACA TAMV (cm/s)

50 +- 11

ACA

window-

depth-

flow direction-

velocity-

transtemporal

60-80mm

retrograde

50 +- 11

PCA window

transtemporal

PCA depth

60-70mm

PCA flow direction

antegrade

PCA TAMV (cm/s)

39 +- 10

PCA

window-

depth-

flow direction-

velocity-

transtempral

60-70mm

antegrade

39 +- 10

OA window

transorbital

OA depth

40-60mm

OA flow direction

antegrade

OA TAMV (cm/s)

21 +- 5

OA

window-

depth-

flow direction-

velocity-

transorbital

40-60mm

antegrade

21 +- 5

VA window

transforamenal

VA depth

60-90mm

VA flow direction

retrograde

VA TAMV (cm/s)

38 +- 10

VA

window-

depth-

flow direction-

velocity-

transforamenal

60-90mm

retrograde

38 +- 10

BA window

transforamenal

BA depth

70-120mm

BA flow direction

retrograde

BA TAMV (cm/s)

41 +- 10

BA

window-

depth-

flow direction-

velocity-

transforamenal

70-120mm

retrograde

41 +- 10

symptoms for MCA

aphasia or dysphasia

severe contralateral hemiparesis or hemiplegia

dysarthria

confusion

agitated delirium if lower mca occluded

symptoms for ACA

contralateral hemiparesis or hemiplagia

incontinence

loss of coordination

impaired motor and sensory functions

symptoms for PCA

dyslexia

coma

symptoms for vertebrobasilar

numbness of lips and mouth

diplopia

poor coordination

dysphagia

vertigo

amnesia

ataxia

drop attack

syncope

prone to having stoke involving MCA and ACA

sickle cell patients

sickle cell disease

_____ normal

_____ borderline

_____ abnormal

<170 cm/s

170-200 cm/s

>200 cm/s

less invasive procedure than surgical clipping (most commonly done in circle of willis for aneurysms)

endovascular coiling

what should be suspected in young patients who presents with stroke symptoms

dissection

carotid body tumor is fed by

ECA (superior thyroid)

common sites for FMD

renal arteries

distal ica

common symptom of FMD renal arteries

systemic hypertension

common symptoms of FMD distal ica

TIAs, although stroke can occur

FMD usually occurs in the ____ to ____ segments of vessels (whereas atherosclerosis is seen in the origin of the vessels)

mid, distal

most common location for FMD

renal arteries

type 1 of FMD appearance

string of beads

neointimal hyperplasia aka

myointimal hyperplasia

significant stenosis may occur within 6-24 months

neointimal hyperplasia

gold standard for giant cell diagnosis ?

biopsy

signs and symptoms of takayasu arteritis

Claudication of arms

No radial pulses

TIA and stroke symptoms

Multiple bruits

signs and symptoms of temporal arteritis

Headaches

Low-grade fever

Jaw claudication

Tenderness in temporal region

Visual problems/blindness

a genetic disease causing abnormal fibrillin

marfan syndrome

(brittle bone disease) - caused by insufficient production of good quality collagen to produce healthy, strong bones.

osetogenesis imperfecta

an inflammation of the connective tissues, - can afflict organ system.

systemic lupus erythematosus

systemic disorder in which immune cells attack and inflame the membrane around joints

rheumatoid artheritis

an activation of immune cells that produces scar tissue in the skin, internal organs, and small blood vessels

scleroderma

is considered the gold standard for imaging of the carotid artery.

conventional angiography

does not use ionizing radiation

contrast does not contain iodine and is less likely to cuase reaction (gadolinium)

what type of angiography

MR

anticoagulant medicines, often called blood thinners, do not actually thin the blood but increase the time it takes a blood clot to form.

T/F

T

most common medication used for ischemic stroke

tPA

tpa used to treat _____ or _____ stroke

embolic, thrombotic

tPA mostly used what an _____ stroke

ischemic

balloon catheter guided to the area of the blockage or narrowing.

angioplasty

atherosclerosis treated by (asymptomatic <60% stenosis)

antiplatelet agents

complications of carotid endarterectomy

stroke

death

pain or numbness at the wound site

bleeding at the site of the wound

wound infection

nerve damage

narrowing of the carotid artery again

common indications for carotid endarterectomy include

-persons who have had a TIA or mild.moderate stroke within the past 6 month and have carotid artery stenosis around 60% or greater

- presence of severe degrees of blockage without any warning symptoms

common contraindications for CEA

- advanced age or have serious disease (cancer)

- surgically inaccessible atherosclerotic plaques

- problems with other blood vessels in the head, such as a cerebral aneurysm

reduces neointimal hyperplasia afteer endarterectomy

surgical patches

CEA risks

stroke

myocardial infarcation

death

cranial nerve injuries

narrowing in the first 24 months considered _______, after 2 years, stenosis considered ______

neointimal hyperplasia (myointimal hyperplasia), atherosclerosis

carotid stenting evaluated how -

inflow artery

prox anastomosis

mid graft

dist anastomosis

outflow artery

recognized a deformed stent.

slide 64

medical imaging methodology using a specially designed catheter with. a miniaturized ultrasound probe attached to the distal end the catheter.

IVUS

MCA window

transtemporal

MCA depth

30-60mm

carotid aneurysm are rare

T/F

T

dissections can be either traumatic or spontaneous

T/F

T

carotid body tumor aka

chemodectoma

highly vascular structure usually 1-1.5mm in size and is located in the adventitia of the carotid bifurcations

carotid body tumor

carotid body tumor causes splaying of what two vessels

ica and eca

fibromuscular dysplasia is an unknown etiology

T/F

T

_____ arteritis typically affects younger individuals

takayasu

____ ____ arteritis typically affects the elderly

giant cell

causes progressive deterioration of collagens, with different EDS types affecting different sites in the body, such as joints, heart valves, organ walls, arterial walls

ehlers-danlos syndrome

tPA is effective in ischemic stroke, it must be administered as early as possible after the onset of stroke symptoms

T/F

T

surgical incision in the neck, opening up the carotid artery and "coring out" fatty plaque deposits and in some cases, a section of the artery itseld.

endarterectomy

Still learning (77)

You've started learning these terms. Keep it up!