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Vascular technology boards > Cerebrovascular evaluation > Flashcards

Cerebrovascular evaluation Flashcards

1
Q

what is the first branch off of the ECA?

A

superior thyroid artery

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2
Q

your patient complains of increasing episodes of unilateral facial and arm weakness rather than leg problems and behavioral changes. which vessel do you most likely suspect has an obstruction? a. anterior cerebral artery b. middle cerebral artery c.basilar artery d. posterior cerebral artery

A

b. middle cerebral artery pg 219 table

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3
Q

a patient has contralateral weakness, paralysis, numbness and sensory changes; ipsilateral amaurosis fugax and or a bruit. where would you expect the obstruction to be?

A

internal carotid

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4
Q

a patient has aphasia or dysphasia; severe contralateral hemiparesis or hemiplegia ( more severe in the face and arm rather than leg ) where would you expect the obstruction to be?

A

middle cerebral artery

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5
Q

a patient contralateral hemiparesis ( in leg) incontinence, loss of coordination, impaired motor and sensory function. where would you expect the obstruction to be?

A

anterior cerebral artery

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6
Q

a patient numbness around lips and mouth diplopia, poor coordination, dysphagia, vertigo, amnesia and ataxia. where would you expect the obstruction to be?

A

vertebrobasilar

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7
Q

a patient has dyslexia, coma ( paralysis usually absent) where is the obstruction

A

posterior cerebral artery

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8
Q

symptoms usually last from a few minutes to a few hours but never more than 24 hours. what is this called

A

TIA Transient ischemic attack

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9
Q

what is the etiology of a TIA ? and where is the most common source?

A

embolic, heart or carotid artery

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10
Q

What does RIND stand for? and how long does it last? what does it mean for the brain tissue?

A

reversible ischemic neurologic deficit. takes slightly longer than 24 hours to resolve, damage to the brain but it recovers completely

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11
Q

if a patient has bilateral blurred vision or paresthesia and complains of vertigo, ataxia and drop attacks what would you expect them to have?

A

VBI vertebrobasilar insufficiency

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12
Q

when there is permanent neurologic deficit what happened to the patient

A

CVA cerebrovascular accident

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13
Q

name the parts of the circle of willis (8)

A

anterior communicating artery, anterior cerebral arteries,middle cerebral, ICA,posterior comminicating, posterior cerebral , basilar, vertebrals

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14
Q

where do the vertebral arteries originate from? which one is bigger? what do they unite for form?

A

subclavian, left, basilar

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15
Q

the supraorbital artery arrises from the?

A

ophthalmic artery

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16
Q

the supraorbital artery joins the ECA via what?

A

branches of the superficial temporal artery

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17
Q

where does the frontal artery arise from?

A

ophalmic artery

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18
Q

the nasal artery which branches from the____ to supply the nose.. it joins the ECA via what?

A

frontal artery, facial artery

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19
Q

the ICA and ECA connection via what?

A

ophthalmic and orbital arteries, the meningohypophyseal branches and the carotcotypmanic brance

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20
Q

bernoulli principle stated what?

A

the higher the velocity the lower the pressure

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21
Q

poiseuille law defines what?

A

pressure and radius

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22
Q

what is the conservation of mass? formula

A

V=Q/A

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23
Q

when perminanent neurologif deficit happens what is the cause

A

Ceverbrovascular accident

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24
Q

the two most common mechanisms of cerebrovascular insufficiency are _____ and ____

A

ischemia and hemorrhage

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25
Q

what are the 3 leading causes of ischemia?

A

atherithombilic pathologies, cardiogenic pathologies, and lacunar infarctions

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26
Q

what is ischemia?

A

blood dificency due to stennosis or occlusion

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27
Q

what is the second most common cause of cerebrovascular insufficiency?

A

hemmorhage

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28
Q

what is the accumulation of lipids that is covered by more lipid material, collegen and elasric fiber?

A

fibrous plaque

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29
Q

what does this represent?

A

intraplaque hemorrhage

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30
Q

what is the most frequent source of a emboli?

A

the heart

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31
Q
A
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32
Q

a pulsatile mass in the supraclavicular area of the neck is most often associated with what?

A

tortuous vessel

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33
Q

____ ___is most commonly caused by dusplasia of the media along with overgrowth of collagen

A

Fibromuscular displasia

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34
Q

_______ is most commonly caused by trama that resulta in a sudden tean. however you can have a connective disorder that can cause this what is the syndrome?

A

dissection, Ehlers-danlos

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35
Q

what does lateralizing mean?

A

indicates which side or hemisphere of the brain has been affected

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36
Q

what does nonlateralizing symptom mean?

A

symptoms e.g. vertigo, ataxia usually are associated with problems of the brainstem or posterior circulation

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37
Q

What is Dysphasia

A

impared speech

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38
Q

what is aphasia

A

inability to speak

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39
Q

a lesion in the______ ______ _____ artery may cause dysphasia or aphasia

A

left middle cerebral artery

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40
Q

the right hemisphere is dominant in a _______handed person

A

left

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41
Q

what is amaurosis Fugax?

A

temporary partial or total blindness usually only one eye

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42
Q

what is homonymous hemianopia?

A

the loss of vision in one half of the visual field or both eyes may be evident after a stroke affecting the cerebral cortex

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43
Q

what is vertigo?

A

difficulty in maintaining equilibrium

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44
Q

what is ataxia?

A

muscular incoordination

45
Q

what is diplopia?

A

double vision

46
Q

infarction of the ____________ artery is the most commin cause of stroke

A

middle cerebral artery

47
Q

T/F

a previously documented bruit that is no longer evident may indicate a lesion that has progressed from <90% diameter reduction to >90% diameter reduction

A

true

48
Q

for a carotid exam if the PSV is < 125 what does this indicate?

A

Normal PSV

49
Q

when peforming a carotid ultrasound and the PSV is >12 and EDVis <140 what does this suggest?

A

50%- 79% stenosis

50
Q

When peforming a carotid ultrasound and the PSV> 125 and EDV>140 what does this suggest?

A

80-99% stenosis

51
Q

When the PSV and EDV are completely absent during a carotid ultrasound what does this suggest?

A

occluded vessel

52
Q

______________ reflectsflow turbulence and consistent with flow turbulance and significant flow alterations

A

sprectral broadening

53
Q

The loss of diastolic component in the ipslateral common carotid artery usually is consistent with an offlision of?

A

ICA

54
Q

T/F

Poor cardiac output of stroke volume may result in bilaterally diminished flow velocities systemically

A

True

55
Q

What does diminished velocities unilaterally suggest when doing a carotid exam?

A

proximal disease e.g innominate or common artery occlusive disease

56
Q

Antegrade flow in systole with sustained reversal of flow during diastole may indicate what?

A

aortic regurgitation or insufficiency

57
Q

What does this represent?

A

fibromuscular displasia (FMD)

58
Q

if you were to see a high resistance rather than the expected low resistance flow in the ICA what would you expect to find?

A

distal obstruction e.g. blockage at the carotid siphon

59
Q

low velocities and increased acceleration time, resulting in a more rounded waveform of the CCA are consistent with what? if this was seen bilaterally what would you expect? unilateral what would you expect?

A

proximal disease. poor cardiac output, proximal disease

60
Q

if a patient has >230 ICA PSV and a ICA/CCA Ratio of >4.0 what would you expect the diameter reduction to be?

A

>=70%DR

61
Q

in general, stented vessels have ________ velocities

A

elevated

62
Q

the angle of insonation for transcranial doppler is assumed to be ?

A

0 degrees

63
Q

What can you see with the Transtemporal approach?

A

MCA, Terminal ICA, ACA/MCA bifurcation,ACA and PCA

64
Q

What can you view with the Transorbital approach?

A

Ophthalmic and Distal ICA at the carotid Siphon

65
Q

What can you view with the transforamenal apporach?

A

VA and BA ( basilar arteries)

66
Q

When is the Anterior communicating artery usually seen?

A

only when actively involved in collateral flow

67
Q

T/F Low flow velovities and poor angle of insonation make the posterior communicating arteries difficult to identify unless they are acting as a collateral

A

True

68
Q

What are the 3 segments of the Siphon aka cavernous carotid?

A

parasellar, Genu and supraclinoid

69
Q

using the Transtemporal window what way should flow direction be for the MCA?

A

towards, antegrade

70
Q

using the transtemporal window what way should the terminal ICA be flowing be flowing towards the transducer?

A

bidirectional

71
Q

using the transtemporal window what way should the ACA/MCA bifurcation be flowing towards the transducer?

A

towards and away, bidirectional

72
Q

using the transtemporal window what way should the ACA be flowing towards the transducer?

A

away, retrograde

73
Q

using the transtemporal window what way should the PCA be flowing towards the transducer?

A

towards antegrade

74
Q

using the transorbital window what way should the ophthalmic artery be flowing towards the transducer?

A

towards antegrade

75
Q

using the transorbital window what way should the Distal ICA at the carotis siphon be flowing towards the transducer? all three segments

A

Supraclinoid: away retro

Genu: simultaneously towards and away bidirectional

Parasellar: towards ante

76
Q

using the transforamenal window what way should the VA be flowing towards the transducer?

A

away, retrograde

77
Q

using the transforamenal window what way should the BA be flowing towards the transducer?

A

away retrograde

78
Q

__________ refers to the reversal of flow direction in the anterior cerebral artery ipsilateral to a proximal internal carotid stenosis or occlusion

A

Crossover collateralization. the flow is crossing over from the contralateral internal carotid artery

79
Q

_____________is evident when flow reversal ( awawy from the transducer rather than towards) in the ophthalmic artery ipsilateral to the proximal stenosis. What is this attrubited to?

A

External to internal collateralization. this abnomality can be attributed to flow from the external carotid artery branch that anastomose with the terminal branch of the ophthalmic artery

80
Q

with External to internal collateralization how can you confirm this type collateral? what will it show

A

compressing the external carotid branches such as the superficial temporal and facial arteries. there will be a reduction , obliteration or flow reversal

81
Q

__________ occurs when blood is shunted from the vertebrobasilar arteries through the ipsilateral posterior cerebral and posterior communicating arteries to supply the anterior circulation.

A

posterior-to anterior collateralization

82
Q

______ is a complication of subarachnoid hemorrhage related to rupture of an intracranial aneurysm, AV nalformatior, hypertension or head trama. It is a functional, transient narrowing of the intracranial arteries usually occuring and resolving within two weeks following the initial bleed

A

Vasospasm

83
Q

____________ aka ________ is a index used to differentiate between high velocities that are significant for vasospasm and hyperdynamic flow secondary to low hematocrit, volume expansion and increased blood pressure

A

Hemispheric ratio aka lindegaard ratio

84
Q

what is the degree of vasospasm in the MCA and ICA. what is normal?

A

<120

85
Q

what is the degree of vasospasm in the MCA and ICA. what is severe?

A

>= 200 ratio is >= 6

86
Q

patients with ______________ disease can develop intracranial narrowing/ stenosis.

A

sickle cell

87
Q

in a sickle cell patient..TAMVs in the MCA are considered to be wnl when they are ?

A

<= 170cm/sec

88
Q

in a Sickle cell patient TAMVS ____ cm/sec suggest the need for chronic blood transfusion to reduce hemoglobin S.

A

>= 200 cm/sec

89
Q

Death of brain tissue, intracranial bleeding and swelling can increase intracranial pressure when intracranial pressure exceeds systoluc arterial pressure what happens?

A

perfusion stops

90
Q

when blood is bring shunted away from the brain secondary to a stenosis or occlusion in the ipsilateral artery what is this an example of?

A

subclavian steal

91
Q

____________ is a disease involving inflammation in the walls of the largest arteries in the body of the AO and its main branches. this is aka as the pulseless disease why?

A

Takayasu’s arteritis,

Weak pluse or loss of pulses in the arms or legs

92
Q

Takayasu’s arteritis occurs more commonly in? sex and age

A

women/ young women/ teenage girls

93
Q

_______ is the inflammation of the distal segment of the superficial temporal atery or its frontal and parietal branches. patients experience headaches, tenderness on palpation and possibly ipsilateral visual changes including blindness

A

temporal arteritis

94
Q

When you see this being documented in the CCA what do you expect the patient to have?

A

left ventricular assist device. continuous flow pumps are used which will result in nonpulsatile flow

95
Q

you are requested to do a carotid duplex scan, you have not had the chance to go through the medical record. what is the conclusion you would most likely come to based on the image?

A

intra- aortic baloon pump wnl

96
Q

when peforming a Carotid exam and you have not looked at the patients chart what would you expect the patient to have with this type of flow pattern?

A

biventricular assist device

97
Q

When peforming a arteriograph, following the removal of the catheter pressure is applied to the puncture site and the patient is positioned supine for how long?

A

2-6 hours

98
Q

What is the percent of stenosis calculation aka diameter reduction?

A

[1-(d/D)] x100

subract from 1 the diameter of the residual lumen(d) divided by the diameter of the true lumen (D) then multiply by 100

99
Q

What is the calculation for percentage stenosis - AREA reduction?

A

[1-(d^2/D^2)]x100

100
Q

retrograde flow in a cerebral vessel indicated what?

A

collateral

101
Q
A
102
Q

which of the following is not a branch of the external carotid artery?

a. facial
b. maxillary
c. opthalmic
d. occipital

A

c opthalmic ICA

103
Q

what does the ophthalmic artery branch into 3?

A

frontal, nasal artery, supraorbital

104
Q

off of the ECA which of the 8 arteries connect to the ICA branches for collaterials

A

occipital, facial and superfcial temporal artery

105
Q

in the inrtacranial circulation what is the most important collateral pathway with a occluded ICA?

A

anterior communcating artery

106
Q

what becomes an extra to intracranial collateral route in the prescense of significant ICA disease?

A

supraorbital and ophthalmic arteries via ECA branches

107
Q

what is the rapid growth of intima following carotid endarterectomy?

A

neointimal hyperplasia

108
Q

using the transtemporal window, the normal flow in the ipsilateral posterior communicating artery is?

a. away
b. towards
c. not visualized
d. dependent on direction of VA

A

not visualized with temporal apprach but the PCA is not the communicating artery

Vascular technology boards (6 decks)

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