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Vascular > Intracranial Cerebrovascular Doppler TEST > Flashcards

Intracranial Cerebrovascular Doppler TEST Flashcards

0
Q

What is TCD (transcranial doppler) based on?

A

hemodynamics (how is the blood flowing)

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1
Q

What are they trying to evaluate in intracranial doppler?

A

The blood vessels in the Circle of Wilis

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2
Q

Why was TCD initially developed?

A

to detect vasospasm following a subarachnoid hemorrhage

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3
Q

Is TCD invasive?

A

non invasive

portable

painless

safe

inexpensive

REPEATABLE

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4
Q

What does TCD do?

A

measures velocity

Identifies direction of flow

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5
Q

What are the limitations of TCD?

A

operator dependent - steady hand

blind vessel identification

anatomic variants

skull difficult to penetrate

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6
Q

Why do we do TCD?

A

occlusive Disease

cerebral emboli

hemorrhage

sickle cell disease

subclavian steal

head trauma

cerebrovascular disease

stroke

migraine headaches

aneurysms

AV fistula

vasospasm

evaluation of brain death

eval of collateral flow

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7
Q

What are the two routes that blood is delivered to the brain?

A

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

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8
Q

What is the circle of Willis?

A

ring that permits communication between the rt and lt cerebral hemispheres

and between anterior and posterior systems

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9
Q

What does the circle of willis consist of?

A

A1 segments of the

two ACA’s

ACoA

two PCoA’s

two ICA’s

P1 segment of the two PCA’s

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10
Q

What does the circle of willis actually do?

A

polygon shaped vascular ring

at the base of the brain

communication between rt and lt cerebral hemisphere

communication between ant and post systems

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11
Q

What vessels are in the anterior circulation?

A

ICA

MCA (middle cerebral artery)

ACA (anterior cerebral artery)

ACoA

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12
Q

What is the first branch off of the ICA?

A

Opthalmic artery

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13
Q

Can the Opthalmic artery be scanned?

A

yes by TCD

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14
Q

Why is the Opthalmic artery important?

A

Role in collateral pathways

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15
Q

What is the carotid siphon?

A

portion of the ICA that forms two curves

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16
Q

The ICA bifurcates into two terminal branches…what are they?

A

anterior cerebral artery

middle cerebral artery

very curved branches

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17
Q

The anterior circulation is via the ___________ ___________ artery

A

anterior communicating artery ACOM

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18
Q

Posterior circulation via the _____________ ____________ artery

A

Posterior communicating artery PCOM

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19
Q

What is COW?

A

circle of willis

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20
Q

Which artery cannot be visualized by TCD?

A

anterior communicating artery ACoA

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21
Q

What do you use to perform TCD?

A

phased array

Pulsed doppler

CW can be used

2-5 MHz (for penetration)

0 degree angle

capture the entire circle of willis

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22
Q

The real time display of all doppler shift frequencies over ______ is the doppler _________ waveform

A

time

spectral

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23
Q

A ___________doppler shift is ___________the baseline

A

positive

above

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24
Q

a __________doppler shift is _________the baseline

A

negative

below

25
Q

During TCD imaging the doppler _________ should be _______ for adequate penetration

A

Power

Increased

26
Q

What is key information for TCD?

A

depth

27
Q

the flow toward and away is most important which color is which

A

Blue - away

Red- toward

28
Q

What are the four TCD windows?

A

transtemporal (above the ear)

transorbital (eye)

transoccipital, suboccipital

submandibular (under the chin)

29
Q

FRom the transtemporal window, what vessels can you see?

A

MCA

ACA

MCA/ACA (bifurcation - butterfly sign)

PCA

ICA

30
Q

MCA courses adjacent to the ____________ _________

A

sphenoid wing

31
Q

PCA wraps around the ____________ ____________

A

cerebral peduncle

32
Q

Decrease ________for slower flow in the PCA and ACA

A

PRF (scale)

33
Q

Opthalmic artery is __________resistance

A

high

34
Q

Transtemporal arteries are _______resistance

A

low

35
Q

What do you do with the power for transorbital?

A

decrease the power

ALARA - as low as reasonably acheivable.

36
Q

What artery gets reversed flow with stenosis in the ICA?

A

ophthalmic artery

37
Q

The trans/suboccipital window places the transducer….

A

on the posterior aspect of the neck inferior to the nuchal crest

38
Q

What do you see in the suboccipital area?

A

vertebral

basilar

distal ICA

Y sign

see slide 49 for picture

39
Q

How do you get good quality color doppler images?

A

increase color gain

small sector width and color box for highest possible frame rates

change color PRF

color sensitivity and persistence settings (makes the color come out more than gray scale)

40
Q

What kind of flow are you looking for in TCD?

A

mean flow velocity - not peak

41
Q

Why is the color display important?

A

assists in the proper placement of sample

42
Q

know slides….

A

54 -55

look in Ipad pictures

43
Q

describe stenosis

A

increased velocities

turbulence

44
Q

describe occusion

A

no flow

insonating (sweeping) the vessel is key

45
Q

What are the doppler findings for Stenosis? occlusion? vasospasm? sickle cell anemia?

A

stenosis: increased velocities - turbulence
occlusion: no flow - insonating vessel key
vasospasm: increased velocities - sequential doppler

sickle cell: increased velocities in the ICA MCA

46
Q

describe AV malformations and doppler

A

increase velocities

low pulsatility

turbulance

47
Q

how does age affect velocities?

A

lower with increasing age

48
Q

how does being female affect velocities?

A

slight increase

49
Q

What are the physiologic factors for non disease related intracranial changes in doppler?

A

age: lower velocities with ^ age
sex: slight ^ velocities with females

Hematocrit: velocities ^ with anemia

heart rate/cardiac output

50
Q

What is a stenosis?

A

focal ^ in velocity

local turbulence

poststenotic dtop

PRF ^

51
Q

antegrade means? retrograde means?

A

antegrade - up

retrograde - down

52
Q

What is vasospasm?

A

vasoconstriction of the arteries

complication of hemorrhage

^ velocity

53
Q

What can cause hemorrahge?

A

ruptured aneurysm

vascular tumor

head trauma

54
Q

If there is an aneurysm, what two things might you see with color doppler?

A

color flow appearing in an unexpected area

wider color area

55
Q

What is a subclavian steal?

A

associated with stenosis or occlusion of subclavian artery

vertebral becomes collateral

56
Q

When you have a subclavian steal, which artery get “stolen” from?

A

basilar

57
Q

What happens to the vertebral artery with a subclavian steal?

A

retrograde flow

causes patient to experience neurologic symptoms of brain stem ischemia

58
Q

If you have an innominate or subclavian artery obstruction, what is the difference in systolic pressure between arms?

A

> 20 mmHg

obstruction on the side of lower pressure

59
Q

If you have an emboli what will you hear/see?

A

high intensity signal

hear a chirp

see a spike

60
Q

What do you do to detect an emboli?

A

Use main MCA

transient signal

higher amplitude

unidirectional

audio sound - snap

61
Q

What is sickle cell disease?

A

inherited blood disorder

cerebral infarction associated with occlusion

Vascular (6 decks)

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