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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
Q

Describe the flow direction and the SV depth of the MCA/ACA:

A

Bidirectional flow, depth of 5.5-6.5cm

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26
Q

How does the A1 segment of the ACA course?

A

Medially towards the midbrain

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27
Q

How does the A2 segment of the ACA course?

A

Anteriorly to supply the anterior segments of the brain

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28
Q

The ACA gives rise to what?

A

Anterior communicating artery (ACCA, AcoA)

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29
Q

Describe the flow direction, mean velocity, and depth of the ACA A1 segment:

A

Retrograde flow, mean velocity of 50 cm/s, depth of 6-8

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30
Q

The PCA perfuses which part of the brain?

A

Posterior hemispheres (wrap around cerebral peduncles)

31
Q

The PCoA is a route for what?

A

Collateralization

32
Q

The P2 segment is distal to what?

A

The PCoA

33
Q

What direction of flow is in the P1 and P2 segments of the PCA?

A

P1: flow towards
P2: Flow away

34
Q

What is the mean velocity of the PCA?

A

40cm/s

35
Q

Where do the vertebral arteries arise from?

A

Subclavian arteries

36
Q

Where do the vertebrals enter the skull?

A

Foramen magnum

37
Q

What are the intracranial branches of the vertebrals?

A

Anterior spinal artery and the posterior inferior cerebellar artery

38
Q

The basilar artery is formed by what?

A

Two intracranial vertebral arteries

39
Q

The basilar artery bifurcates into what?

A

Two posterior cerebral arteries

40
Q

What are the four different approaches or window to allow insonation of the arteries?

A

Transtemporal, transorbital, transforamenal (suboccipital), submandibular

41
Q

What is the time-averaged mean velocity used for?

A

Flow volume calculation

42
Q

What is the time-averaged peak velocity?

A

Mean of the peak velocities over time

43
Q

Which window is the most promising site for transcranial doppler

A

Transtemporal window

44
Q

Anterior angulation of the transtemporal window would interrogate what?

A

MCA, portion of the carotid siphon (ICA), ACA and ACCA

45
Q

Posterior angulation of the transtemporal window interrogates what?

A

PCA, basilar, and PCCA

46
Q

The flow of the opthalmic artery through the transorbital window has what velocity and direction of flow?

A

21 cm/s antegrade

47
Q

What kind of collateral path would the ACoA take?

A

Crossover

48
Q

What kind of collateral path would the PCoA take?

A

Posterior to anterior

49
Q

What kind of collateral path would the OA take?

A

Internal/external

50
Q

Aneurysmal disease results from what?

A

Weakening of the structural proteins within the media

51
Q

Large aneurysms have the risk of what three things?

A

Rupture, subsequent SAH, cerebral infarct

52
Q

What is the most common site for intracranial aneurysm?

A

ACoA

53
Q

A stenosis in the large basal arteries would show what?

A

Increased velocity, disturbed flow, increased spectral broadening, bruit

54
Q

What are the four collateralization pathways?

A
  1. Crossover right to left
  2. External to internal
  3. Posterior to anterior
  4. Vertebrobasilar
55
Q

Arteries supplying an AVM have what?

A

Increased systolic and diastolic velocities

56
Q

What is the most frequent application of transcranial Doppler?

A

Vasospasm

57
Q

What are symptoms of vasospasm?

A

Confusion, decreased levels of consciousness, and stroke

58
Q

Vasospasm usually occur 4-14 days post what?

A

Hemorrhage

59
Q

MCA velocity >120 cm/s indicates what?

A

Reaction to a documented hemorrhage

60
Q

MCA icrease of >20cm/s per day indicates what?

A

Poor prognosis

61
Q

MCA velocity >200cm/s is associated with what?

A

Critical reduction in cerebral blood flow

62
Q

Determination of brain death is based on what?

A

Clinical status, EEG results, angiographic demonstration of absent intracranial circulation

63
Q

Spectral signals processing toward brain death show what?

A

Decrease in diastolic flow, eventually reaching zero

64
Q

Just prior to brain death, the spectral signals show what?

A

Reversed flow with a “to and fro” motion that is easily detected on a TCD spectral tracing

65
Q

What does functional reserve testing or vasomotor reactivity test evaluate?

A

The reserve mechanism of cerebral vasculature in the presence of carotid occlusive disease

66
Q

What should the peripheral vascular do in response to hypoxia?

A

Dilate, flow to the MCA should increase

67
Q

Patients with sickle cell anemia have increased risk for what?

A

Stroke

68
Q

TCD is used to monitor sickle cell anemic patients by doing what?

A

Screening MCA velocities

69
Q

Velocities >200cm/s in the MCA for sickle cell anemic patients indicate what?

A

Risk of stroke

70
Q

Air or particulate emboli are also known as what?

A

Micro-embolic signals (MES) or high intensity transient signals (HITS)

71
Q

> 50 HITS over a 10 minute period is considered to be what?

A

Serious and increases the patient’s risk of stroke

72
Q

The signal of the Doppler velocity spectrum with emboli detection is accompanied by what?

A

Snap or “chirp” on the audible output

73
Q

When the foramen ovale is closed, microbubbles will go where?

A

Lungs

74
Q

When the foramen ovale is open, microbubbles will do what?

A

Cause HITS in the MCA after a few seconds

VASC 4 (6 decks)

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