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Vascular Boards > URR Intracranial Arteries > Flashcards

URR Intracranial Arteries Flashcards

1
Q

indications for intracranial arteries?

A

-assess vasospasm/vasoconstriction cause by subarachnoid hemorrhage
-stoke
-TIA
-intracranial stenosis/occlusion
-collateral flow
-AV malformation
-vasospasms
-monitoring for surgery
-shunt detection
-sickle cell anemia for peds
-suspected brain death

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2
Q

limitations of intracranial arteries?

A

-hyperostosis
-time consuming
-incorrect vessel identification
-vasospasm can be mistake for stenosis
-cannot eval for aneurysm
-patient coooperation

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3
Q

thickening of cranial bones?

A

hyperstosis

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4
Q

most common type of indication for intracranial artery doppler?

A

assess vasospasm/vasoconstriction cause by subarachnoid hemorrhage

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5
Q

limitations of TCD?

A

-inacurate vessel identifcation
-no imaging capabilities
-requires experience
-hyperostosis

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6
Q

what is the transtemporal window used for?

A

-used to eval MCA, ACA, PCA, and terminal ICA
-patient supine
-notch towards patient nose

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7
Q

in the transtemporal window, how the the MCA flow?

A

towards the transducer

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8
Q

in the transtemporal window, how does the ACA flow? P1, P2?

A

away from transducer
-toward
-away

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9
Q

what does the suboccipital (transoccipital) window do?

A

-evals vertebral and basilar
-patient decub
-probe at the base of the neck and angle cephalad
-basilar flow away from transducer

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10
Q

what does the transorbital (opthalmic) window do?

A

-evals opthalmic artery and carotid siphon
-patient supine
-output should be at min
-notch should be medially towards the nose
-flow towards the transducer

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11
Q

what does the submandibular window do?

A

-evals dist ICA and siphon
-flow away from probe
-patient supine

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12
Q

flow velocities normally go how as people age?

A

decrease

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13
Q

MCA velocities?

A

10 years old=70 cm/sec
70 years old=41 cm/sec

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14
Q

normal ACA/MCA

A

<1.2

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15
Q

normal MCA/ICA

A

1.1-3.0

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16
Q

basilar a / extracranial vert a

A

<2.0

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17
Q

normal PI

A

.5-1.1

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18
Q

PI will do what prox to obstruction and what distal to obstrcution?

A

increase, decrease

19
Q

difference greater than what in the same vessel on opposite sides indicates disease?

A

30%

20
Q

stenosis is most common in what vessels?

A

MCA, siphon, and terminal ICA

21
Q

resistnance does what in flow prox to obstrcution?

A

increase

22
Q

periorbital doppler?

A

-CW doppler eval of the frontal artery ( a branch of opthalmic)
-8-10 MHz pencil probe in inner canthus of eye
-normal flow toward the probe
-compression of the infraorbital, facial, and superficial temporal As is performed on both sides while evaling flow

23
Q

in the periorbital doppler if the flow is away from the probe, what is going on?

A

obstruction in ipsilat ICA

24
Q

if compression of 1 artery causes decreased or reversed flow in the frontal artery, that vessel is what?

A

being used as collateral to fill the frontal artery
-can only determine if there are patent collaterals

25
Q

-most emerge during fetal development
-headache or seizures
-complications include hemorrhage, cerebral ischemia, cerebral aneurysm, brain damage or stroke
-risk factors include gender (more common in males) and fam hx

A

intracranial arteriovenous malformations

26
Q

Large AVM usually identified on fetal US or at birth

A

vein of galen defect

27
Q

Unilat vascular AVMs that involve brain, orbits, and facial structures

A

Wyburn Mason Syndrome

28
Q

treatment of Intracranial AVMs?

A

surgical resection, embolization, and radio therapy

29
Q

complication in patients with subarachnoid hemorrhage, usually slow bleed?

A

Vasospasm

30
Q

vasoconstriction of intracranial arteries?

A

vasospasm

31
Q

flow velocities in MCA, ACA, PCA usually do what with subarachnoid hemorrhage?

A

increase
-MCA mean velocity over 200 cm/sec and 120 cm/sec indicates severe reduction
-PI> 1.2 indicates vasospasm

32
Q

vasospasm usually occurs when during the start of a hemorrhage?

A

w/in 14 days of the start of the hemorrhage
-record highest mean MCA and terminal ICA

33
Q

vasospasm can be treated how?

A

vasodilator

34
Q

opening in the intercranial septum fails to close after birth

A

patent foramen ovale

35
Q

how to look at patent foramen ovale?

A

-patient supine, performs valsalva
-adjetated saline injected
-microbubbles enter lungs
-if ovale is patent , bubbles will cross into the left heart and enter arch, then cerebrovascular system

36
Q

if shunt present in patent foramen ovale, what happens?

A

emboli can be seen in MCA w/in few seconds after injection
-high intensity transient signals (HITS) are vis as bright spikes on doppler
-also may cause “chirping sounds”

37
Q

if bubbles are seen in the intracranial arteries with foramen ovale?

A

there must be a right ->left shunt in the heart to send the bubbles into the atrial system
-valsalva may be used to push flow across the PFO into the left atrium

38
Q

of HITS recorded is directly related to what in the patent foramen ovale?

A

size of shunt

39
Q

sickle cell anemia can cause what?

A

increase PSV in cranial vessels and increase risk of stroke
->200 cm/sec is abnorm for terminal ICA and MCA and indicates increase risk of stroke for children

40
Q

TCD monitoring during carotid endarterectomy ?

A

-CA clamed during procedure and ipsilateral MCA evaled
-used to monitor cerebral emboli and to help determine if shunt is necessary
-unilat monitoring of the ipsilat MCA
-if MCA flow present >10 cm/sec after clamping, adequate collat flow is present

41
Q

TCD monitoring used during open heart surgery with bypass?

A

used to assess cerebral flow during extracorporal bypass which can lead to hyperfusion of cerebral vessels
-bilat MCA monitoring
-microemboli monitoring

42
Q

TCD monitoring during ICU monitoring?

A

-monitor critically ill patients with head issues
-bilat MCA monitoringT

43
Q

TCD monitoring during brain death?

A

peaked MCA waveform with moderate flow regversal in diastole

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