Lecture 6: Carotid Pathology Flashcards
stroke is the leading cause of permanent disability. T/F?
true
what is another name for transient ischemic attack?
mini stroke
what is a ministroke?
it is a neurological ischemic deficit that reverses within 24 hours (usually minutes)
which part of the brain does a TIA affect?
anterior circulation
what causes a mini stroke?
a temporary clot in the artery but will dissolve within 24 hours
what is the risk of getting a stroke after a TIA in 3 months?
10% increased risk
what is the risk of getting a stroke after a TIA within 5 years?
increased 17x
4 S&S of TIA?
- amaurosis fugax
- dysphasia/aphasia
- contralateral hemiparesis/monoparesis
- behavioral disturbances
what does RIND stand for?
reversible ischemic neurological deficit
what is RIND?
a neuro deficit that lasts more than 24 hours but less than 72 hours
patients get a sudden onset of symptoms with RIND. T/F?
true
what is amaurosis fugax?
transient blindness in one eye
what is the normal duration for amaurosis fugax?
transient – seconds to minutes
what causes amaurosis fugax?
a temporary blockage of small blood vessels in the eye
where is disease located when a patient has amaurosis fugax?
disease will be on the ipsilateral side as the affected eye
what is bruit?
an abnormal low rumbling sound heard on the stethoscope over the carotid artery
what causes a bruit?
blood rushing over an obstruction
2 normal reasons for a bruit
- bifurcation of CCA
- tortuous
what is aphasia?
unable to speak
what is dysphasia?
difficulty speaking
what is dysarthria?
slurring & speech distortion due to lack of muscle control
what is lateralized paresthesia?
numbness or tingling usually in the extremities
what is hemiparesis?
weakness on one side of the body
which hemisphere is affected when a patient has aphasia or dysphasia?
left hemisphere
which hemisphere is affected when a patient has dysarthria?
either left or right
which hemisphere is affected when a patient has lateralized paresthesia or weakness?
either left or right
which hemisphere is affected when a patient has hemiparesis?
the contralateral hemisphere of the side being affected
what does VBI stand for?
vertebro-basilar insufficiency
what is VBI?
when there is a disturbance in the flow of blood in the vertebral or basilar arteries
which part of the brain does VBI affect?
posterior circulation
what is the most common symptom of vertebro-basilar insufficiency?
vertigo
what is ataxia?
loss of muscle coordination
the following are S&S of what neurological disorder?
1. vertigo
2. ataxia
3. weakness in limbs
4. drop attacks
5. paresthesia
6. visual disturbances
7. numbness around lips & mouth
VBI
what is syncope?
fainting due to ischemia of brain
what is the duration of a stroke in evolution?
72 hours - 2 weeks
what is another name for a complete stroke?
cerebrovascular attack (CVA)
how is smoking a predisposing factor for strokes?
smoking irritates the endothelium lining, which can slough it off and lead to stroke
how is hypertension a predisposing factor for strokes?
hypertension irritates the endothelium lining, which can slough it off and lead to stroke
how does diabetes increase the risk for stroke? (2)
- diabetes increases the risk for hypertension, a predisposing factor for stroke.
- diabetes also increases the chance for atherosclerosis
females are more likely to have strokes than men. T/F?
false – men are 1.5x more likely to have a stroke
what age group is more at risk for strokes?
60+ years old
why is obesity a predisposing risk factor for strokes?
increased chance of atherosclerosis
how does birth control increase the chance for a risk of stroke?
increased estrogen use may lead to blood clots
what is polycythemia vera?
increased RBCs
how can polycythemia vera increase the chance for stroke?
increased RBC –> increased blood viscosity –> increased chance for arteries getting blocked
what is hyperlipidemia and how does it increase the risk for stroke?
it is an increase cholesterol & triglycerides in your blood – increases the risk of plaque being deposited in your arteries
what are the 3 types of CVA?
- cerebral thrombosis
- cerebral embolism
- hemorrhage
what is a cerebral thrombosis?
a blood clot within the brain’s arteries
what is cerebral embolism?
when an embolus blocks the brain’s arteries
what can an embolism be?
solid, liquid, or a gas
what is a hemorrhagic stroke?
when a blood vessel ruptures, leading to bleeding within or over the brain surface
what is the most common type of stroke? how often does it occur?
cerebral thrombosis causes 40-50% of strokes
what is the 2nd most common type of stroke? how often does it occur?
cerebral embolism causes 30-35% of strokes
how often do hemorrhages cause strokes?
20-25%
what are 2 complications of strokes?
- pneumonia
- DVT
how can pneumonia be a complication of stroke?
patient age & immobility can cause pneumonia
how can DVT be a complication of stroke?
patient is immobile –> thrombus formation in veins of legs
where do atypical carotid disease conditions occur in relation to the circle of willis?
they occur before the circle of willis, but there is still stenosis/ischemia somewhere
what is carotid artery aneurysm?
rupture of a dilated carotid artery
carotid artery aneurysms are common. T/F?
false – they are rare
the following are causes of which atypical disease?
1. congenital weakness
2. trauma
3. infection
4. atherosclerosis
carotid artery aneurysm
what is fibromuscular dysplasia?
an atypical carotid patho – dysplasia of media leads to overgrowth of collagen within the media
are women or men more at risk for FMD? why?
women due to more collagen production
how does FMD look like on angiography?
bead-like
what is a carotid body tumor?
a very vascular tumor between the ECA & ICA
how can a carotid body tumor become vascularized?
ECA & sometimes ICA develop branches to feed it blood supply
what is the treatment for a carotid body tumor?
surgical
a carotid body tumor functions as a ____
chemoreceptor
what is a carotid dissection?
a type of aneurysm where the intima and media are separated due to a tear in the lumen –> separate flow channel in the wall of the artery
where does a carotid dissection typically occur?
proximal & distal ICA
the following are causes to which type of atypical carotid pathology?
1. FMD
2. congenital weakness of media
3. trauma to neck
4. chiropractic treatment
5. idiopathic
carotid dissection
how do anti-hypertension drugs help treat carotid patho?
by decreasing the force of blood on the endothelium
what are two anticoagulants you can take to help treat carotid patho?
aspirin
persatine
what is an endarterectomy?
a surgical procedure where the artery is opened to remove atherosclerosis
why is endarterectomy not performed on patients with 100% occlusion of CCA or ICA?
if the patient is still alive not symptomatic, it means collaterals have successfully formed
how is the artery kept open after closing an endarterectomy?
surgeon places stent in artery
what is a bypass graft?
a surgical intervention where an alternative pathway around a stenosis is created using part of body’s vein or a synthetic material
which artery is a bypass graft more commonly used for?
prox CCA
why might surgical intervention be done for coiling, kinking, or tortuosity of a vessel?
shortening the vessel decreases the risk for ischemia
