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Surgery II > Vascular: Carotid Disease > Flashcards

Vascular: Carotid Disease Flashcards

1
Q

anatomy of the vasculature of the brain

A
  • 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
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2
Q

what is a TIA?

A
  • transient ischaemic attack

- symptoms last less than 24hrs

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3
Q

what is a stroke?

A
  • symptoms last longer than 24hrs
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4
Q

what is amarousis fugax?

A
  • result of retinal artery being embolised

- temporary monocular loss of vision on the ipsilateral side as the embolisation

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5
Q

signs and symptoms of anterior infarct

A
  • facial drooping
  • weakness of the contralateral arm
  • dysphasia or aphasia
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6
Q

where are expressive and repressive aphasia?

A
  • expressive: cannot speak but can understand

- receptive: cannot understand (assess them by asking them to do something)

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7
Q

what is global aphasia?

A

cannot understand nor speak

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8
Q

what is nominal aphasia?

A

you cannot remember the particular word of the object in mind

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9
Q

what is a TACI?

A

total anterior cerebral infarct

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10
Q

what symptoms does a TACI patient have?

A
  • 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)
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11
Q

what is a PACI?

A
  • partial anterior cerebral infarct

- these have 1/2 symptoms of the TACI

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12
Q

symptoms of a posterior infarct

A
  • problems with coordination, balance and proprioception
  • blindness with macular sparing
  • diplopia
  • vertigo
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13
Q

symptoms of a lacunar infarct

A
  • ataxia
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14
Q

cause of lacunar infarct

A

small vessel disease

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15
Q

possible investigation methods for stroke

A
  • duplex scanning
  • MRA
  • CT angiography
  • angiography
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16
Q

disadvantages of angiography

A
  • risk of stroke
  • nephrotoxicity due to contrast
  • contrast allergy
  • radiation exposure
17
Q

indication of endartrectomy

A
  • aymptomatic with a very stenotic artery
  • CVA/TIA
  • amarosis fugax
18
Q

management of stroke

A
  • medical (treat underlying cause)
  • surgical
  • endovascular
19
Q

how do you do an endartrectomy

A
  • 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
20
Q

complications of enarterectomy

A
  • further embolisation
  • MI
  • haematoma
  • infection
  • CNX and CNXII damage
  • wound complications
21
Q

why is it important to check CNX and CNXII

A
  • 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
22
Q

indication for carotid stenting

A
  • hostile neck (one which has been intervened on multiple times)
  • someone who has had radiation to the neck
  • patient is a poor surgical candidate
23
Q

symptoms of giant cell arteritis

A
  • headaches

- blindness

24
Q

cause of ischaemic stroke

A
  • thromboembolism

- small vessel disease

25
Q

causes of embolisation

A
  • 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

Surgery II (19 decks)

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