Vascular and Cerebrovascular Pathology

Comprehensive vocabulary flashcards covering vascular pathology, stroke classification, ultrasound grading for carotid stenosis, and non-atherosclerotic arterial diseases.

Atherosclerosis

A common pathological condition involving injury to the endothelium and deposits of Lipoprotein in the tunica intima, leading to arterial wall thickening, hardening, and loss of elasticity in the intima and media layers.

Non-modifiable Risk Factors for Stroke

Risk factors that cannot be controlled, specifically Age, Sex (higher incidence in males), Race (higher risk in African Americans), and Family History.

Thrombo-Embolism

A condition where plaque ulceration and loss of endothelial continuity leads to a thrombus that can break off and travel distally (embolize), resulting in stenosis or complete occlusion of an artery.

Aneurysm

A permanent localized dilation of all three layers of an artery due to localized weakening of the vessel wall, defined as an increase in diameter greater than $1.5$ times its normal diameter.

Subclavian Steal Syndrome

High grade stenosis or occlusion of the proximal subclavian or innominate artery resulting in retrograde (reverse) blood flow in the ipsilateral vertebral artery to supply the upper extremity.

Subclavian Steal Syndrome BP Finding

A decreased brachial artery pressure of $20\,mmHg$ or greater on the side of the disease.

Ischemic Stroke

A stroke caused by an interruption of blood flow to the brain, accounting for approximately $80\%$ of all known strokes.

Transient Ischemic Attack (TIA)

An ischemic neurologic deficit that lasts less than $24$ hours where the patient recovers completely with no residual deficit.

Reversible Ischemic Neurologic Deficit (RIND)

A neurologic deficit that resolves in more than $24$ hours.

Amaurosis fugax

A transient partial or complete loss of vision in one eye, often described as a shade or curtain over the eye, associated with anterior circulation involvement.

Homonymous Hemianopia

Blindness in one half of the visual field, which can be unilateral or bilateral.

Ataxia

A symptom of posterior circulation involvement characterized by gait disturbances and loss of muscle coordination.

Vertigo

A sensation of objects moving around or a person moving around in space.

Thrill

Vibrations produced by flow disturbance or turbulence that can be palpated, possibly indicating post-stenotic turbulence, a fistula, or a patent dialysis graft.

Bruit

Abnormal sounds heard via auscultation produced by vibrations in the tissues or blood vessels, related to post-stenotic turbulence.

Soft Plaque

Plaque with low echogenicity composed of fibro fatty tissues (hypoechoic) that carries a high risk of ulceration, hemorrhage, and thrombo-embolism.

Calcified Plaque

Plaque with strong echogenicity that shows posterior acoustic shadowing.

Normal ICA Criteria

No visible plaque; ICA PSV $\leq 125\,cm/sec$; ICA EDV $< 40\,cm/sec$; and ICA/CCA ratio $< 2$.

ICA Stenosis $50\%$ to $69\%$ Criteria

Visible plaque; ICA PSV between $125\,cm/sec$ and $230\,cm/sec$; ICA EDV between $40\,cm/sec$ and $100\,cm/sec$; and ICA/CCA ratio between $2$ and $4$.

ICA Stenosis $\geq 70\%$ Criteria

Visible plaque with lumen narrowing; ICA PSV $> 230\,cm/sec$; ICA EDV $> 100\,cm/sec$; and ICA/CCA ratio $> 4$. (Excludes near occlusion).

Endarterectomy

The local surgical removal of extra cranial carotid plaque and thrombus; considered preferable to bypass graft.

Carotid Body Tumor

A highly vascular mass with low malignant potential located in the adventitia at the carotid bifurcation, receiving blood from the vasa-vasorum.

Fibromuscular dysplasia (FMD)

A non-atherosclerotic disease involving the media of medium-sized arteries, characterized by a 'series of ridges' on ultrasound and a 'string of pearls' appearance on angiography.

Neointimal hyperplasia

The proliferation and growth of intimal cells occurring post-endarterectomy or bypass graft, which may produce diffuse or local narrowing of the lumen.

Dissecting Aneurysm

An aneurysm characterized by a tear in the intima resulting in a cavity and a second lumen forming between the intima and media.

Pseudo aneurysm

Also called a pulsating hematoma; it occurs when blood escapes through a hole in the arterial wall into surrounding tissues but maintains a connecting neck with the original vessel.

Yin-yang sign

The color Doppler appearance of a back-and-fro fluid flow pattern within a pseudo aneurysm hematoma.