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Summer 2014 - Intro to Vascular ✔️ > Intracranial Cerebrovascular > Flashcards

Intracranial Cerebrovascular Flashcards

0
Q

Intracranial doppler imaging is based on what

A

hemodynamics

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1
Q

what did intracranial imaging lag behind

A

it was difficult to penetrate the skull

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2
Q

intracranial imaging initally was developed to detect _________ following a what

A

vasospasm

subarachnoid hemorrhage

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3
Q

what is TCD

A

transcranial doppler

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4
Q

describe TCD

A 
non invasive
portable
painless
safe
inexpensive
repeatable
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5
Q

TCD measures and identifies what

A

measures velocity of flow

indentifies direction of flow

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6
Q

what was TCD imaging introduced

A

1982

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7
Q

TCD limitations

A

operator dependent - steady hand

blind vessel indentification - no image

anatomic variants - ex. incomplete circle of willis

skull difficult to penetrate

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8
Q

TCD clinical applications

A 
occlusive disease
cerebral emboli
hemorrhage
sickle cell disease
subclavian steal
head trauma
cerebrovascular disease
stroke
migraine headaches
aneurysms
AV fistulas
vasospasms
eval of brain death
eval of collateral flow
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9
Q

how is the blood delivered to the circle of willis

A

internal carotids and vertebrals form an anterior circulation and a posterior circulation respectively

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10
Q

what is the circle of willis

A

ring that permits communication between the right and left cerebral hemispheres and between the anterior and posterior systems

Thomas Willis in 1664

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11
Q

what does the circle of willis consist of

A

A1 segments of the 2 ACA’s, ACoA, 2 PCoA’s, 2 ICA’s, and P1 segment of the 2 PCA’s

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12
Q

describe the anterior circulation system

A

supplies majority of blood to both hemispheres

vessels: ICA, MCA, ACA, ACoA

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13
Q

describe the posterior circulation system

A

supplies the brainstem

vessels: vertebrals, basilar, PCA, PCoA

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14
Q

describe the internal carotid artery

A

origniates from the CCA

passes through the skull and gives off the FIRST major branch (ophthalmic artery)

gives off the posterior communicating arteries (PCoA) before dividing into middle cerebral arteries (MCA) and anterior cerebral arteries (ACA)

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15
Q

Internal carotid artery consists of what parts

A 
cervical
petrous
lacerum
cavernous
supraclinoid
ophthalmic
communication
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16
Q

describe the opthalmic artery

A

first branch of the ICA

important role in collateral pathways

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17
Q

what is the portion of the ICA that forms 2 curves

A

carotid siphon

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18
Q

ICA bifurcates into what two terminal branches

A

anterior cerebral artery (ACA)

middle cerebral artery (MCA)

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19
Q

anterior circulation connects via what

posterior circulation connects via what

A

anterior communicating artery - ACOM

posterior communicating artery - PCOM

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20
Q

which vessel can you not see when doing a TCD

A

anterior communicating artery

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21
Q

describe MCA

A

larger terminal branch of the ICA

branches turn upward to the Sylvian fissure

four segments - M1 to M4

M1 and origin of M2 eval - TCD

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22
Q

describe ACA

A

smaller terminal branch of the ICA

A1 segment eval - TCD

ACA connected by ACoA

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23
Q

describe ACoA

A

can not be visualized with TCD

24
Q

describe PCoA

A

courses from ICA to join the PCA

25
Q

describe PCA

A

origniates from basilar

P1 segment eval - TCD

26
Q

describe vertebral artery

A

branches of the subclavian

four segments

27
Q

describe basilar artery

A

union of the vertebral

divides into the PCA to form part of the circle of willis

28
Q

characteristics of TCD

A

phases array

PULSED doppler (cw can not be used)

2-5 MHz - for penetration - LOW FREQUENCY TRANSDUCER

assume 0 degree angle - shooting straight down the barrel

capture the entire circle of willis

29
Q

what is the real time display of all doppler shift frequencies over time

A

doppler spectral waveform

30
Q

______doppler shift = above the baseline, towards the transducer

______ doppler shift = below the baseline, away from the transducer

A

positive

negative

31
Q

during TCD imaging, the doppler power should be _________ for adequate penetration

A

increased

32
Q

what is the key for TCD

A

**depth

blue is away and red is towards

adjust power and gain

33
Q

what are the four TCD windows

A

transtemporal
transorbital
transoccipital, suboccipital
submandibular

34
Q

where is the transducer placed for a transtemporal scan

A

on the temporal bone cephalad to the zygomatic arch, and anterior to the ear

35
Q

transtemporal imaging may be difficult because why

A

tortuous vessels - not located in up to 30% of patients

36
Q

name the transtemporal vessels

A 
MCA
ACA
MCA/ACA bifurcation - "butterfly sign"
PCA
ICA
37
Q

______ PRF for slower flow in the ACA and PCA

A

decrease

38
Q

how is transorbital scanning done

A

patient is supine and the transducer is gently placed on the closed eyelid

39
Q

describe transorbital scanning

A

opthalmic artery - high resistance

carotid siphon

decrease power setting

ALARA principle

40
Q

how is transoccipital scanning done

A

transducer is placed on the posterior aspect of the neck inferior to the nuchal crest

41
Q

what vessels will be seen when scanning transoccipitally

A

vertebral

basilar

“Y sign”

42
Q

submadicular scanning consists of what vessel

A

distal ICA

43
Q

how do you achieve good quality color doppler images - TCD

A

increase color gain appropriately
maintain a small sector width and color box
change color PRF - depends on hemodynamics
be aware of color sensitivity and persistence settings
color and interpretation are important for TCD

44
Q

TCD measures ______ flow velocity, not peak

A

mean

45
Q

know charts for window, arteries, depth, mean velocity, and direction

A

slides 54-55

46
Q

what 2 things are important when interpreting TCD

A

experience - w/o is difficult

knowledge of anatomy - essential

47
Q

describe interpretations:

stenosis?
occulusion?
vasospasm?
sickle cell anemia?
vasoconstriction?
AV malformation?
brain death?
A

stenosis - increased velocities, turbulence

occulusion - no flow, insonating (angling) vessel key

vasospasm - increased velocities, sequential doppler

sickle cell anemia - increased velocities in the ICA and MCA

vasoconstriction - hemorrhage

AV malformation - increased velocities with low pulsatility, turbulence

brain death - suspected

48
Q

physiologic factors of TCD velocities

A

age - lower velocities with increasing age

sex - slight increase in velocities with females

hematocrit - velocities increase with anemia

HR and cardiac output

49
Q

describe stenosis

A

focal increases in velocity

local turbulence

poststenotic drop

PRF increased

50
Q

describe occulsion

A

TCD is limited

lack of reliable data

51
Q

describe vasospasm

A

vasoconstriction of the arteries

complication of hemorrhage

increase in velocity

52
Q

describe hemorrhage

A

ruptured aneurysm

vascular tumor

head trauma

53
Q

describe aneurysm

A

color flow appearing in an unexpected area

wider colo area

54
Q

describe subclavian steal

A

associated with stenosis or occlusion of subclavian artery

vertebral becomes collateral - reversed flow

pressure difference of greater than 20 means obstruction on side with lower pressure

55
Q

describe emboli detection

A

high intensity signal

hear a chirp/see a spike

56
Q

describe emboli

A

use main MCA

transient signal

higher amplitude

unidirectional

audio sound - snap

57
Q

describe sickle cell disease

A

inherited blood disorder

screen children

cerebral infarction associated with occlusion

Summer 2014 - Intro to Vascular ✔️ (7 decks)

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