Vascular: Carotid Disease Flashcards
anatomy of the vasculature of the brain
- the carotid bulb supplies the ICA which supplies the anterior portion of the brain
- at the back, there are the vertebral arteries which duse to form the basilar artery
what is a TIA?
- transient ischaemic attack
- symptoms last less than 24hrs
what is a stroke?
- symptoms last longer than 24hrs
what is amarousis fugax?
- result of retinal artery being embolised
- temporary monocular loss of vision on the ipsilateral side as the embolisation
signs and symptoms of anterior infarct
- facial drooping
- weakness of the contralateral arm
- dysphasia or aphasia
where are expressive and repressive aphasia?
- expressive: cannot speak but can understand
- receptive: cannot understand (assess them by asking them to do something)
what is global aphasia?
cannot understand nor speak
what is nominal aphasia?
you cannot remember the particular word of the object in mind
what is a TACI?
total anterior cerebral infarct
what symptoms does a TACI patient have?
- loss of power in limbs
- altered/loss of sensation in these areas
- homonymous hemianopia
- dysphasia
- visuospatial neglect (when you ignore the nonfunctional part of the body)
what is a PACI?
- partial anterior cerebral infarct
- these have 1/2 symptoms of the TACI
symptoms of a posterior infarct
- problems with coordination, balance and proprioception
- blindness with macular sparing
- diplopia
- vertigo
symptoms of a lacunar infarct
- ataxia
cause of lacunar infarct
small vessel disease
possible investigation methods for stroke
- duplex scanning
- MRA
- CT angiography
- angiography
disadvantages of angiography
- risk of stroke
- nephrotoxicity due to contrast
- contrast allergy
- radiation exposure
indication of endartrectomy
- aymptomatic with a very stenotic artery
- CVA/TIA
- amarosis fugax
management of stroke
- medical (treat underlying cause)
- surgical
- endovascular
how do you do an endartrectomy
- Incise in front of the sternocleidomastoid
- Underneath this, you find the external jugular vein, subcutaneous fat
- There is platysma
- Open platysma, push sternocleidomastoid aside
- Push the internal jugular vein and tie off the facial vein to gain access to the artery, which is found behind it
- Rubber bands around the CCA, ICA and ECA - surrounding the bad bit
- The shunt allows the blood through the artery into the brain, continuing to flow to there (Brener shaft)
- Once done, you take a piece of material which is stitched around the piece, to expand the artery - this reduces the restenosis rate
- Close the skin and leave the drain to drain any blood that accumulates in the neck
complications of enarterectomy
- further embolisation
- MI
- haematoma
- infection
- CNX and CNXII damage
- wound complications
why is it important to check CNX and CNXII
- superior laryngeal nerve (CNX): cannot sing high notes
- CNXII leads to tongue atrophy
- hoarseness from the recurrent laryngeal nerve
- due to the stimulation on the baroreceptors, they might cause hypotension and bradycardia 24hrs postop
indication for carotid stenting
- hostile neck (one which has been intervened on multiple times)
- someone who has had radiation to the neck
- patient is a poor surgical candidate
symptoms of giant cell arteritis
- headaches
- blindness
cause of ischaemic stroke
- thromboembolism
- small vessel disease
causes of embolisation
- cardiac: atrial fibrillation, post-MI mural thrombus, ventricular aneurysm, valves and infective endocarditis, heart vegetations, prosthetic heart valve, atrial myxoma, rheumatic fever, aortic disease
- aortic: iatrogenic
- haematological: polycythaemia, prothrombotic disorders
