Occlusive Cerebrovascular Disease

Question 1

(1) In the absence of atrial fibrillation, emboli are predominantly due to emboli from the proximal internal Carotid artery.

(2) Causes Stroke or Transient ischemic attack (TIA).

(3) TIA also known as a mini-stroke is one that causes neurological deficits lasting less then 24 hours and then returns to normal.

Answer 1

Occlusive Cerebrovascular Disease

Question 2

Neurological Deficits (if they last less than 24 hours then the diagnosis is a________, if last longer then 24 hours then diagnosed as a _________

Answer 2

1. TIA
2. stoke or CVA

Question 3

Neurological deficits

Carotid Bruits

Answer 3

Symptoms/Physical Exam Findings: Occlusive Cerebrovascular Disease

Question 4

(a) Blood glucose
(b) CBC
(c) PT, INR, PTT
(d) Lipid Panel
(e) Duplex ultrasonography
(f) CT Head
(g) MRI/MRA of the brain

Answer 4

Labs/Studies: Occlusive Cerebrovascular Disease

Question 5

Duplex ultrasonography is the imaging modality of choice looking for_________.

50% of stenosis is typically will get symptomatic and 80% of stenosis requires intervention.

Answer 5

A: Carotid stenosis
Occlusive Cerebrovascular Disease

Question 6

1) Life style modifications: increase exercise, improve diet.
2) Smoking Cessation
3) Weight reduction if obese

Answer 6

Non-Pharmacologic Treatment: Occlusive Cerebrovascular Disease

Question 7

1) Aspirin
2) STATINs to reduce lipids
3) Thrombolytics for those who present within 6 hours of the onset of symptoms.
4) Long-term anticoagulation with Warfarin or Direct Thrombin
> Inhibitors for patients with Atrial Fibrillation.

Answer 7

Pharmacologic Treatment: Occlusive Cerebrovascular Disease

Question 8

1) Surgical Intervention: Carotid Endarterectomy

2) Endovascular Intervention: Balloon Angioplasty or Stenting

Answer 8

Surgical: Occlusive Cerebrovascular Disease

Question 9

Patients with carotid stenosis who had a TIA or small stroke and no treatment have a ______ chance of a stroke within 1 year.

Answer 9

Complications: Occlusive Cerebrovascular Disease
A: 25%

Question 9

(a) Check glucose level to R/O hypoglycemia.
(b) It is okay to allow the blood pressure to be SBP of 180 in an acute stroke
(c) Head CT to evaluate for intracranial hemorrhage.
(d) Blood work to look for other etiologies of the neurological deficits.
(e) IF you cannot adequately evaluate the patient then immediate MEDEVAC.

Answer 9

Initial Care: Occlusive Cerebrovascular Disease