TCD Exam 2

what are the warnings signs of a stroke, there is a Sudden onset of ? (NAME 5)

1. Numbness/weakness of extremities or face (especially unilateral)

2. Trouble walking-dizziness, loss of balance or coordination

3. Confusion, trouble speaking or understanding

4. Trouble seeing in one or both eyes

5. Headache with no known cause

Carotid TIA, first where is the affects and what part of circulation?

Anterior, unilateral

name me all the symptoms of the Carotid TIA name 5

Symptoms: 

1. Motor dysfunction

Weakness, Paralysis- monoparesis, Clumsiness of extremities and/or face

2. Amaurosis fugax- loss of vision in the ipsilateral eye 

3. Aphasia- inability to speak 

4. Dysphasia- difficulty saying words in their proper order 

5. Dysarthria- difficulty articulating speech

Monoparesis = weakness in one limb.

• Paralysis (-plegia): The complete loss of voluntary motor function, where the affected muscle group cannot move or contract at all.

• Monoparesis: A form of paresis that refers to partial, mild, or moderate weakness in only one limb (an arm or a leg), where some motor control remains

whats the difference bewteen Dysphasia vs. Dysarthria

Dysphasia- difficulty saying words in their proper order

Dysarthria- difficulty articulating speech

Dysphasia (Aphasia)

Dysphasia = a language problem.

The brain has trouble with understanding or producing language.

This happens when the language centers of the brain (usually the left hemisphere) are affected.

A person may:

• Have trouble finding words

• Speak incorrect words

• Have trouble understanding speech

• Have trouble reading or writing

Example:
They want to say “water” but say “wa… uh… thing”.

So the problem is language processing.

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Dysarthria

Dysarthria = a speech muscle problem.

The brain knows what it wants to say, but the muscles used for speech are weak or poorly controlled.

The words are correct, but the speech sounds:

• Slurred

• Slow

• Hard to understand

Example:
They say “water”, but it sounds like “waaah-ter”.

So the problem is muscle control of speech.

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Simple Comparison

Term	Problem	Cause
Dysphasia	Language problem	Brain language centers
Dysarthria	Speech muscle problem	Motor control of speech muscles

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Easy way to remember

• Dysphasia → language problem

• Dysarthria → articulation (muscle) problem

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✅ One-sentence summary:
Dysphasia is difficulty understanding or producing language, while dysarthria is slurred or unclear speech caused by impaired control of the speech muscles.

Vertebrobasilar TIA Affects which part of circulation? and what side of the body

Affects the posterior circulation

Symptoms usually bilateral

what is the Vertebrobasilar TIA Symptoms referred to as?

Symptoms referred to as “drop attacks”

A drop attack is when a person suddenly falls to the ground because their legs lose strength, but they usually remain conscious.

So:

• Sudden loss of postural control

• No warning

• Person collapses

• Often no loss of consciousness

• Symptoms referred to as “drop attacks”

A drop attack is a sudden fall caused by temporary loss of muscle control due to reduced blood flow to the brainstem from vertebrobasilar circulation problems, usually without losing consciousness.

Why It Happens in Vertebrobasilar Disease

The vertebrobasilar system supplies the:

• Brainstem

• Cerebellum

These areas control balance, posture, and muscle tone.

If blood flow to these areas is temporarily reduced (vertebrobasilar insufficiency), the brainstem can't maintain posture, so the person suddenly drops.

Vertebrobasilar TIA, name all the symptoms (4)

1. Vertigo- surroundings seem to whirl 

2. Ataxia- defective motor coordination 

3. Paresthesia/anesthesia bilaterally (paritial or complete loos of sensation with or without loss of concenessions, loss of balance, vertigo, unsteadiness and disequilibrium)

4. Visual disturbances- bilateral blurring or double vision

The combination of partial or complete loss of sensation (numbness/paralysis), loss of balance, vertigo, unsteadiness, and potential loss of consciousness indicates a severe disruption to the neurological system, particularly the brainstem, cerebellum, or the vestibular nerve.

Paresthesia is abnormal sensation such as tingling, while anesthesia is complete loss of sensation.

TIA signs and symptoms, the chart of the affected artery and what is frequently seen signs and symptoms

Pulsatility Index, what system automatically calculate pulsatility index (PI)? and what is the equation?

Imaging systems automatically calculate pulsatility index (PI)

what does Pulsatility Index provide data on?

PI provides data on the relative resistance to flow of the vascular bed

Pulsatility Index (PI) is a Quantitative assessment: what does this mean

Quantitative assessment: comparing velocities and angle not needed

High PI =

High resistive waveform

Low PI =

Low resistive waveform

Interpretation:

Vessel identification is based on several observations, name 5

1. Direction of flow with dependence on transducer

2. Probe orientation- sonographic window

3. Depth of vessel

4. Spatial relationship to other vessels

5. Bony landmarks

what are the TCD Limitations? name 10

1. Operator experience

2. Improper instrument control settings

3. Arterial misidentification

4. Patient movement

5. Absent or poor temporal window

6. Anatomic variations

7. Distal branch disease

8. Distal basilar artery

9. Misinterpretation of collateral channels or vasospasm as stenosis

10. Displacement of intracranial arteries by an intracranial mass

Pathology, go back and know what they are and what waveforms, name 5

1. Vasospasm

2. Stenosis

3. Sickle Cell Anemia

4. Brain Death

5. Subclavian Steal Syndrome

1. What is amaurosis fugax? 

A. Sudden loss of hearing 

B. Temporary loss of vision 

C. Loss of Balance 

D. Difficulty speaking

B. Temporary loss of vision

2. Why does Amaurosis fugax affect the ipsilateral eye? 

A. The optic nerve crosses sides 

B. The ophthalmic artery supplies the same side as the diseased carotid 

C. The brain controls both eyes 

D. The vertebral artery is affected.

B. The ophthalmic artery supplies the same side as the diseased carotid

3. What is a sudden onset symptom of stroke? 

A. Gradual Headache 

B. Numbness/ Weakness of extremities or face 

C. Slow speech 

D. Chronic fatigue

B. Numbness/ Weakness of extremities or face

4. What is Aphasia? 

A. Difficulty walking 

B. Loss of vision 

C. Inability to speak 

D. Loss of sensation

C. Inability to speak

5. What is Dysphasia? 

A. Difficulty saying words in their proper order. 

B. Difficulty walking 

C. Loss of sensation 

D. Inability to speak

A. Difficulty saying words in their proper order.

6. What is Dysarthria? 

A. Difficulty articulating speech 

B. Loss of vision 

C. Loss of sensation 

D. Difficulty walking

A. Difficulty articulating speech

7. What are “drop attacks” associated with? 

A. Carotid TIA 

B. Vertebrobasilar TIA 

C. Sickle Cell anemia 

D. Subclavian steal syndrome

B. Vertebrobasilar TIA

8. How is pulsatility index (PI) calculated? 

A. Max + min / mean 

B. Max - min / mean 

C. Max / min 

D. Mean / max

B. Max - min / mean

What does a high PI indicate? 

A. Low resistive waveform 

B. High resistive waveform 

C. Normal flow 

D. Absent flow

B. High resistive waveform

10. What is a limitation of a TCD exam? 

A. Patient age 

B. Operator experience 

C. Weather conditions 

D. Blood pressure

B. Operator experience

11. What can cause an absent or poor temporal window in TCD exams?

 A. Instrument malfunction

 B. Anatomic variations 

C. Patient movement 

D. Operator experience

B. Anatomic variations

12. What pathology can cause displacement of intracranial arteries?

 A. Sickle cell anemia

 B. Intracranial mass

 C. Vasospasm

 D. Stenosis

B. Intracranial mass

13. What syndrome involves blood flow reversal in the subclavian artery?  A. Sickle cell anemia

 B. Subclavian Steal Syndrome

 C. Vasospasm 

D. Brain death

B. Subclavian Steal Syndrome

14. What is the main purpose of vessel identification in sonography? 

A. To measure blood pressure 

B. To diagnose diabetes 

C. To determine direction of flow and anatomical relationships 

D. To assess heart rate

C. To determine direction of flow and anatomical relationships

15. What are some areas of interrogation for a stenotic lesion? 

A. Only distal to the lesion

 B. Only at the lesion 

C. Only proximal to the lesion 

D. Proximal, at, and distal to the stenosis

D. Proximal, at, and distal to the stenosis

16. What is a possible misinterpretation in TCD exams? 

A. Vasospasm as normal flow 

B. Collateral channels or vasospasm as stenosis 

C. Stenosis as normal flow 

D. Sickle cell anemia as vasospasm

 B. Collateral channels or vasospasm as stenosis

17. Name two pathologies that can be evaluated with TCD.

 A. Heart failure and stroke

 B. Asthma and pneumonia

 C. Vasospasm and sickle cell anemia

 D. Diabetes and hypertension

C. Vasospasm and sickle cell anemia

18. What is a key factor in vessel identification during sonographic exams?  A. Patients age 

B. Blood Pressure 

C. Heart rate 

D. Probe orientation and spatial relationship to other vessels

D. Probe orientation and spatial relationship to other vessels

19. What condition can be misinterpreted as stenosis during a TCD exam?  A. sickle cell anemia

 B. Vasospasm 

C. Brain Death 

D. Subclavian steal syndrome

B. Vasospasm

20. What is a common warning sign of stroke that should not be ignored?  A. Sudden confusion or trouble understanding speech 

B. Gradual loss of appetite 

C. Chronic back pain 

D. Slow heart rate

A. Sudden confusion or trouble understanding speech

Transtemporal where is notched pointed too

the nose

suboccipital where is the notched pointed too

to the pt right