Other vascular diseases Flashcards
Majority of strokes are caused by? (3)
- atrial fibrillation
- hardening of the arteries
- High blood pressure
Less common causes of stroke? (3)
- Vasospasm
- FMD
- Radiation induced vasculopathy
Ischemic stroke occur as a result of?
- an obstruction within a blood vessel supplying blood to brain
Underlying condition for ischemic stroke?
Atherosclerosis
Cerebral thrombosis?
This refers to a thrombus(blood clot) that develops at the clogged part of the vessel in the brain- from atherosclerosis
Cerebral embolism?
- blood clot that forms at another location in the circulatory system
- Usually from the heart or large arteries of the neck such as the Carotids
- A portion of the blood clot breaks loose,enters the bloodstream and travels through the brains blood vessels until it reaches a vessel too small to let it pass
Cerebral vasospasm?
- a blood vessel spasms or contracts causing less blood flow
- may happen after an operation for a bleed that occurs between the brain and the thin tissue covering the brain (subarachnoid hemorrhage)
- This type of vasospasm increases the risk of an ischemic stroke
- Vasospasm typically occurs 4-10 days after subarachnoid hemorrhage
AVM-arteriovenous malformation?
a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins
AVM risk factors?
- more common in males
- 50% of patients have an intracranial hemorrhage
- 20 to 25 % have focal or generalized seizures
Cerebral aneurysm?
- what is it
- whos at risk
- a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood
- The bulging aneurysm can put pressure on a nerve or surrounding brain tissue
- More common in adults than in children
- Slightly more common in women than in men
- People with certain inherited disorders are also at higher risk
- between ages of 30-60
Cardiac thrombus?
- A second important cause of embolism is an irregular heartbeat known as “atrial fibrillation”
- It creates conditions where clots can form in the heart and dislodge and travel to the brain
- 26% of patients with cerebrovascular events will have a cardiac thrombus as the source of emboli
Atrial fibrillation-AF
- Most common type of arrhythmis
- The heart can beat too fast, too slow or irregularly-disorganized electrical signals are the cause
Left ventricular dysfunction-CHF?
- Chronic heart failure is the inability of the heart to supply sufficient blood flow to meet metabolic needs of the body
- CHF is associated with increased risk of thrombus formation and risk of stroke due to a hypercoagulable state-leading to embolism
- CHF is treated with anticoagulation therapy
Other non atheroscletoic vascular diseases? (8)
Dissection Pseudoaneurysm Arteriovenous fistula(AVF) Carotid body tumor Fibromuscular disease(FMD) Buerger’s disease Takayasu’s arteritis Giant cell arteritis
What is the most common cause of stroke in young adults?
- Carotid artery dissection
2 classes of CA dissection?
- spontaneous
2. traumatic
CA dissection usually originated at?
- the aortic arch and extends to the bifurcation and may extend into the ICA
Spontaneous dissection?
- Whos affected
- ages
- incidence
- risk factors (2)
- affects the middle aged population
- Incidence is low- 2.9 per 100,000
- 70% of patients are between ages 35 and 50
Risk factors:
- Family history of stroke
- Hereditary connective tissue disorder
Dissection-Connective tissue disorders? (5)
Marfan syndrome Ehlers-Danlos syndrome ADPKD Fibromuscular dysplasia Osteogenesis imperfecta
Traumatic dissection?
- severe trauma to the head or neck
- 0.67% of patients admitted to the hospital after major motor vehicle accidents were found to have blunt carotid injury
- These also include pseudoaneurysm, thrombosis or fistula
- Pseudoaneurysm may also occur simultaneously as the dissection may be through the tunica adventitia
Traumatic dissection?
- severe trauma to the head or neck
- 0.67% of patients admitted to the hospital after major motor vehicle accidents were found to have blunt carotid injury
- These also include pseudoaneurysm, thrombosis or fistula
- Pseudoaneurysm may also occur simultaneously as the dissection may be through the tunica adventitia
Pathophysiology of dissection?
- The intimal tear allows blood to enter the space between the layers of the vessel
- creates a false lumen causing stenosis or complete occlusion
- Complete occlusions may lead to ischemia
- Blood clots form and break away from the site of the tear
- They form emboli that travel to the brain causing a stroke(cerebral infarction)
- Causes irreversible damage to the brain
Treatment of dissection?
- observation
- anticoagulation
- stent implantation
- carotid artery ligatio
Double lumen sign is related to?
dissection
Double lumen sign is related to?
dissection
What is a fistula?
- an opening that connects two epithelialized structures
- In the case of an arteriovenous fistula (AVF), communication occurs between an artery and a vein
- An AVF almost always results from trauma- either violent or iatrogenic
Carotid body tumor is known as?
Paragangliomas
What is a carotid body tumor?
- size?
- located?
- component of the autonomic nervous system
- Participates in control of arterial pH, blood gas levels, and blood pressure
- Normally they are tiny ovoid structures 1-1.5mm in size
- They are located in the adventitia of the carotid bifurcation
What is the most common presentation of a carotid body tumor?
- palpable neck mass with headache
- neck pain is the 2nd most common presentation
Paraganglioma- sono finding?
- Highly vascular masses nestled in between the ICA and ECA bifurcation
- On 2-D and color Doppler -ICA and ECA appear splayed
Fibromuscular dysplasia-FMD?
- commonly presents with
- Commonly presents with systemic hypertension caused by renal artery stenosis
- With carotid involvement-transient cerebral ischemia is the usual presentation-stroke can also occur
- 30% of FMD patients have an intracranial cerebral aneurysm presenting with cerebral hemorrhage
Pathophysiology of FMD?
- Overgrowth of smooth muscle cells and fibrous tissue within the arterial wall
- Tunica media involved in 85% of cases
- This form presents with “string of beads” appearance on angiogram
3 femoral artery vascular diseases?
- pseudoaneurysm
- traumatic arteriovenous fistulas
- penetrating arterial trauma
Takayasu’s arteritis AKA?
Also known as “aortic arch syndrome” and “pulseless disease”
What is Takayasu’s arteritis?
- Form of large vessel granulomatous vasculitis-etiology unknown
- Massive intimal fibrosis and vascular narrowing are signs
- Affects young or middle aged women of Asian descent
- Mainly affects aorta and its major branches-brachiocephalic,left CCA and left SCA and pulmonary arteries
Giant cell arteritis?
Also known as temporal arteritis or Horton disease
Inflammatory disease of blood vessels most commonly large and medium branches of the head,particularly external Carotid artery
It can cause occlusion of arteries and ischemia
Most serious complication is occlusion of the ophthalmic artery
Treatment is with steroids
Giant cell arteritis?
Also known as temporal arteritis or Horton disease
Inflammatory disease of blood vessels most commonly large and medium branches of the head,particularly external Carotid artery
It can cause occlusion of arteries and ischemia
Most serious complication is occlusion of the ophthalmic artery
Treatment is with steroids
Giant cell arteritis, patient presents with?
The patient presents with bruits, fever, headache, visual disturbances, tenderness of the scalp
What is halo sign associated with?
Giant cell arteritis
Buerger’s disease?
- AKA
- What is it?
- caused by?
- seein in?
- AKA thromboangitis obliterans(TAO)
- An extremely painful disorder affecting the digits of both upper and lower extremities simultaneously
- It is caused by a heavy, almost pathological addiction to cigarette smoking
- Particularly in young male
Buerger’s disease seen as?
- Onset is acute and is thought to start as progressive arterial wall inflammation leading to distal arterial occlusion
angiographic appearance:
- Revealing normal smooth-walled arteries to a point of sudden and distal occlusion
- This disease can be arrested by the discontinuation of cigarette use
- Some patients go on to amputation or sympathectomy
