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VASC 4 > Intracranial Arteries > Flashcards

Intracranial Arteries Flashcards

1
Q

List the basal vessels in the Circle of Willis:

A

ACA, MCA, PCA

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2
Q

What is the most common pitfall of TCD?

A

Misidentification of vessels

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3
Q

Vessel identification with TCD is aided by knowing what following parameters: (7)

A
  • Depth of insonation
  • Flow velocity
  • Direction of beam angle
  • Response to carotid compression
  • Direction of flow
  • Probe position (window used)
  • Traceability of vessels
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4
Q

What is the difference of TCI compared to TCD?

A

TCI has a larger footprint and decreased Doppler sensitivity

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5
Q

What are the segments of the ICA?

A

Cervical, petrous, and cavernous

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6
Q

What is known as the carotid bifurcation to the carotid canal of the petrous portion of the temporal bone?

A

Cervical ICA

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7
Q

What is known as the vessel that runs through the petrous portion of the temporal bone?

A

Petrous ICA

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8
Q

What is also known as the carotid siphon?

A

Cavernous ICA

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9
Q

What are the segments of the cavernous ICA?

A 
Parastellar portion (proximal)
Genu (the bend)
Supraclinoid portion (distal)
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10
Q

What is the first major branch of the ICA?

A

Opthalmic artery

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11
Q

Where does the opthalmic artery arise from?

A

Cavernous portion of the ICA

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12
Q

What bifurcates from the terminal ICA?

A

MCA and ACA

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13
Q

The most common variations of the Circle of Willis involve what?

A

The communicating arteries

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14
Q

Where are the velocities higher in the Circle of Willis?

A

Anterior circulation (ICA distribution)

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15
Q

List the highest velocities to lowest in terms of the Circle of Willis:

A

MCA, ACA, PCA, BA, VERT

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16
Q

What percentage of the population have an intact and functioning circle of willis?

A

50%

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17
Q

What percentage of the population has the classic configuration of the Circle of Willis?

A

18-25%

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18
Q

Up to 25% of the PCA arises from where?

A

ICA

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19
Q

Up to 25% of the A1 segment of the ACA is what?

A

Atretic or hypoplastic

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20
Q

How does the MCA course?

A

Laterally towards the temporal bone with several branches

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21
Q

What is considered the M1 segment of the MCA?

A

From MCA origin to the first branch (medial)

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22
Q

What is considered the M2 segment of the MCA?

A

MCA distal to the first branch (closest to the transducer)

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23
Q

What is the normal velocity for the MCA?

A

<90 cm/s

Typically 55 cm/s

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24
Q

Describe the flow direction and the depth of the MCA:

A

Antegrade flow, depth of 3-6cm

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25
Describe the flow direction and the SV depth of the MCA/ACA:
Bidirectional flow, depth of 5.5-6.5cm
26
How does the A1 segment of the ACA course?
Medially towards the midbrain
27
How does the A2 segment of the ACA course?
Anteriorly to supply the anterior segments of the brain
28
The ACA gives rise to what?
Anterior communicating artery (ACCA, AcoA)
29
Describe the flow direction, mean velocity, and depth of the ACA A1 segment:
Retrograde flow, mean velocity of 50 cm/s, depth of 6-8
30
The PCA perfuses which part of the brain?
Posterior hemispheres (wrap around cerebral peduncles)
31
The PCoA is a route for what?
Collateralization
32
The P2 segment is distal to what?
The PCoA
33
What direction of flow is in the P1 and P2 segments of the PCA?
P1: flow towards P2: Flow away
34
What is the mean velocity of the PCA?
40cm/s
35
Where do the vertebral arteries arise from?
Subclavian arteries
36
Where do the vertebrals enter the skull?
Foramen magnum
37
What are the intracranial branches of the vertebrals?
Anterior spinal artery and the posterior inferior cerebellar artery
38
The basilar artery is formed by what?
Two intracranial vertebral arteries
39
The basilar artery bifurcates into what?
Two posterior cerebral arteries
40
What are the four different approaches or window to allow insonation of the arteries?
Transtemporal, transorbital, transforamenal (suboccipital), submandibular
41
What is the time-averaged mean velocity used for?
Flow volume calculation
42
What is the time-averaged peak velocity?
Mean of the peak velocities over time
43
Which window is the most promising site for transcranial doppler
Transtemporal window
44
Anterior angulation of the transtemporal window would interrogate what?
MCA, portion of the carotid siphon (ICA), ACA and ACCA
45
Posterior angulation of the transtemporal window interrogates what?
PCA, basilar, and PCCA
46
The flow of the opthalmic artery through the transorbital window has what velocity and direction of flow?
21 cm/s antegrade
47
What kind of collateral path would the ACoA take?
Crossover
48
What kind of collateral path would the PCoA take?
Posterior to anterior
49
What kind of collateral path would the OA take?
Internal/external
50
Aneurysmal disease results from what?
Weakening of the structural proteins within the media
51
Large aneurysms have the risk of what three things?
Rupture, subsequent SAH, cerebral infarct
52
What is the most common site for intracranial aneurysm?
ACoA
53
A stenosis in the large basal arteries would show what?
Increased velocity, disturbed flow, increased spectral broadening, bruit
54
What are the four collateralization pathways?
1. Crossover right to left 2. External to internal 3. Posterior to anterior 4. Vertebrobasilar
55
Arteries supplying an AVM have what?
Increased systolic and diastolic velocities
56
What is the most frequent application of transcranial Doppler?
Vasospasm
57
What are symptoms of vasospasm?
Confusion, decreased levels of consciousness, and stroke
58
Vasospasm usually occur 4-14 days post what?
Hemorrhage
59
MCA velocity >120 cm/s indicates what?
Reaction to a documented hemorrhage
60
MCA icrease of >20cm/s per day indicates what?
Poor prognosis
61
MCA velocity >200cm/s is associated with what?
Critical reduction in cerebral blood flow
62
Determination of brain death is based on what?
Clinical status, EEG results, angiographic demonstration of absent intracranial circulation
63
Spectral signals processing toward brain death show what?
Decrease in diastolic flow, eventually reaching zero
64
Just prior to brain death, the spectral signals show what?
Reversed flow with a "to and fro" motion that is easily detected on a TCD spectral tracing
65
What does functional reserve testing or vasomotor reactivity test evaluate?
The reserve mechanism of cerebral vasculature in the presence of carotid occlusive disease
66
What should the peripheral vascular do in response to hypoxia?
Dilate, flow to the MCA should increase
67
Patients with sickle cell anemia have increased risk for what?
Stroke
68
TCD is used to monitor sickle cell anemic patients by doing what?
Screening MCA velocities
69
Velocities >200cm/s in the MCA for sickle cell anemic patients indicate what?
Risk of stroke
70
Air or particulate emboli are also known as what?
Micro-embolic signals (MES) or high intensity transient signals (HITS)
71
>50 HITS over a 10 minute period is considered to be what?
Serious and increases the patient's risk of stroke
72
The signal of the Doppler velocity spectrum with emboli detection is accompanied by what?
Snap or "chirp" on the audible output
73
When the foramen ovale is closed, microbubbles will go where?
Lungs
74
When the foramen ovale is open, microbubbles will do what?
Cause HITS in the MCA after a few seconds

VASC 4 (6 decks)

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