Chapter 17: Cerebrovascular Testing Flashcards
What is the TIA time frame?
Less than 24 hours
What is the RIND time frame
More than 24 hours
Which strokes are transient?
TIA and RIND
What is the time frame for CVA?
More than 24 hours, complete recovery does not occur.
When hematocrit drops what happens to blood flow?
It increases because resistance decreases.
Where does atherosclerosis form
Within or beneath the intima
What is atheromatous plaque
A form of arteriosclerosis; localized accumulations of lipid-contains material(atheroma), smooth muscle cells, collagen fibrin and platelets.
What causes thickening, hardening, and loss of elasticity if walls in arteries?
Atherosclerosis
What can result from atherosclerosis
Decreased perfusion to the brain
What is a fatty streak in atheromatous plaque?
A thin layer of lipid material on the intimal layer
What is fibrous plaque
The accumulation of lipids
What is a complicated lesion
A fibrous plaque that includes fibrous tissue, more collagen.
What is an ulcerative lesion
When a fibrous cap deteriorates-emboli
Types of atheromatous plaque
Fatty streak
Fibrous plaque
Complicated Lesion
Ulcerative Lesion
Intra-Plaque Hemorrhage
Where is the most likely location for plaque to form?
At bifurcations
What is a thromboembolic
The obstruction of a blood vessel by a piece of thrombus
What is a thrombus
Large amounts of red blood cells trapped within a fibrin network; clumps of playlets may also be evident
What is an embolism
A piece of thrombus that breaks loose and travels until it lodged in a small vessel
What is an aneurysm
Localized dilation of a blood vessel due to congenital defects or weekends of the wall
Where is an aneurysm rarely seen?
Cervical carotid artery
What is the usual culprit for a pulsating neck mass?
A very tortuous CCA
What is a dissection
A sudden tear that can be spontaneous or the result of trauma
What does a dissection create
A false lumen that may extend prodigally or distally
What may form in the false lumen of a dissection
Thrombus
What kind of flow is seen in the blind pouch of a dissection
High resistant flow
What is the most common cause of fibromuscular dysplasia
Dysplasia(abnormal cellular growth) in the media of the mid/distal ICA
What appearance is characteristic of fibromuscular dysplasia on angiography
Bead-like
What demographic is fibromuscular dysplasia typically seen in?
Young women
What is a carotid body tumor
A small structure located just above the carotid bifurcation that is highly vascular and usually fed by the ECA
What is the treatment for a carotid body tumor
Ligation if the feeding vessel (usually the ECA)
What is Neointimal hyperplasia
Intimal thickening from rapid production of smooth muscle cells
What can be a response to vascular injury or reconstruction E.g. post carotid endarterectomy
Neointimal hyperplasia
With Neointimal hyperplasia significant stenosis May occur within ______
6-24 months
With Neointimal hyperplasia, denuding of endothelium leads to…
Platelet accumulation, endothelium regeneration, and smooth muscle cell proliferation.
What are common arterial sites to palpate
Common carotid, superficial temporal, subclavian, and axillary arteries
Which finger are used to palpate
2nd,3rd, and sometimes 4th
What is auscultation
Listening through a stethoscope
What is a bruit
A noise heard during auscultation that is the result of turbulent flow
Bruit may not be evident with a stenosis of what caliber?
A tight stenosis, > 90%
What are common sites for bruit evaluation?
Carotid and subclavian
What on physical examination is associated with a hemodynamics significant lesion
Bruit
What is recommended to detect proximal obstruction
Bilateral pressures
Left hemispheric CVA results in neurological deficits on the____ side of the body
Right
Specifics eye symptoms like amaurosis fugax are suggestive of
Ipsilateral ICA disease
Unilateral paresis
Unilateral parethesia
Aphasia
Amaurosis fugax
ICA lesions
Aphasia or dysphasia
More severe facial or arm hemiparesis or hemiplegia
Behavioral changes
Think arm/face
MCA lesions
More severe leg hemiparesis or hemiplegia
Incontinence
Loss of coordination
Think leg
ACA lesions
Myopia is commonly referred to as
Nearsightedness
What is homonymous hemianopia?
Defective vision or blindness in the right or left half of the visual fields. ( not always relates to ICA lesions)
Vertigo Ataxia Bilateral visual blurring or double vision( diplopia) Bilateral parenthesis or anesthesia Drop attack
Vertebrobasilar lesions
Dyslexia
Coma
PCA lesions
Dizziness
Syncope
Severe headache
Non-localizing symptoms
