Vascular Diseases Flashcards
Stroke caused by (6)
Atrial fib Atherosclerosis High BP Vasospasm FMD Radiation induced vasculopathy
Underlying condition of ISCHEMIC STROKE (1) OBSTRUCTION types (2)
Atherosclerosis
- central thrombosis (blood clot in brain)
- central embolism (blood clot breaks loose)
VASOSPASM
- what is it
- what is it associated with (in what time frame)
A blood vessel that contracts causing less blood flow
4-10 days after a subarachnoid hemorrhage
Arteriovenous malformation (AVM)
- what is it
- m/f dominance
- symptoms
An abnormal connection between arteries and veins, bypassing the capillary system
Bypasses normal brain tissue
Diverts blood from the arteries to the veins
- male predominance
- (20-25%) focal/generalized seizures, (15%) difficulty with movement, speech, vision
ANEURYSM CEREBRAL
- risk factors (2)
- m/f dominance
- complications (4)
RF: hypertension, drug abuse (alcohol, coke, smoking)
Female predominance
Complications: (serious: hemorrhagic stroke, permanent nerve damage, death) or a subarachnoid hemorrhage
What can ATRIAL FIBRILLATION cause? How? What can this lead to?
Atrial fib, (irregular heart beat) can cause cardiac thrombus
Blood pools in the atria and is not completely pumped into the ventricles - causes thrombus
Thus the source of emboli (in 1/4 pts)
T/F A. FIBRILLATION is the most common type of arrhythmia
True
LEFT VENTRICULAR DYSFUNCTION / CHF is associated with increased risk of (2) which can lead to _____
What is the treatment?
Thrombus formation
Stroke
Lead to Embolism
Tx: anti-coagulation therapy
CARDIAC THROMBUS - right heart indication
Doubles mortality up to 29%, requires more aggressive tx (embollectomy / lyric therapy)
Cardiac thrombi may be seen following (4)
Ventricular dysfunction
Cardiomyopathy
Myocardial infarction
Ventricular aneurysm
Non-atherosclerotic vascular disease (8)
Dissection Arteriovenous fistula (AVF) Fibromuscular disease (FMD) Takayasu’s arteritis Pseudoaneurysm Giant cell arteritis Buerger’s disease
What is the most common cause of STROKE in YOUNG ADULTS
Carotid artery dissection
CAROTID ARTERY DISSECTION - where does it ORIGINATE and EXTEND
Aortic arch, extends into the bifurcation
DISSECTION-SPONTANEOUS risk factors (2 + specifics)
Fam Hx stroke
Hereditary connective tissue disorder (Marfan syndrome, Ehlers-Danlos syndrome, ADPKD, Fibromuscular dysplasia, Osteogenesis imperfecta)
T/F
DISSECTION-TRAUMATIC is more common than SPONTANEOUS
True - of the head/neck
TRAUMATIC DISSECTION-how does it occur?
hyper extension/rotation of the neck stretches ICA over cervical vertebrae = intimal tear
Blood enters space between layers of the vessel = false lumen = stenosis/occlusion
What can cause emboli?
Dissection
Cardiac thrombi
Atrial fibrillation
DISSECTION TX
Prevent development/continuation of neurological deficits
Observation, anticoagulation, stent implantation, carotid artery ligation
DOUBLE LUMEN SIGN represents
Arterial dissection
ANEURYSM vs PSEUDOANEURYSM
True aneurysm = all artery wall layers are intact but stretched
Pseudoaneurysm = hematoma that forms from a leaking hole in arterial wall. Contained by the surrounding tissues. Communicates with the artery
A patient presents with a PULPABLE PULSALTILE MASS - what do you suspect?
Pseudoaneurysm
CCA PSEUDOANEURYSMs caused by (3)
Blunt/penetrating trauma
Infection and vasculitis
Iatrogenic
ICA PSEUDOANEURYSMS caused by (4)
Penetrating trauma
H/N surgeries
Carotid endarterectomies
Metastatic LN/neoplasms
DOPPLER PSEUDOANEURYSM
Bidirectional turbulent flow within the neck containing the vessel to the pseudoaneurysm
AVF almost always CAUSED by (1)
Trauma (violent/iatrogenic)
Common AVF is seen between which vessels? Where does a blood flow to/from?
Subclavian ARTERY to Internal Jugular VEIN
AVF FLOW pattern at
- prox AVF
- injured artery distal to AVF
- vein
Prox: AVF monophasic
Distal artery: normal pulsatility
Vein: ‘arterialized’ /pulsatile flow signal, lack of respiratory phasicity, high velocity
CAROTID BODY TUMOUR
- what are they
- sono appearance
- where are they located
- tx
Paragangliomas
Ovoid, 1-1.5 mm, ICA/ECA appear splayed
Adventitia of carotid (ICA/ECA) bifurcation
Resection
PALPABLE NECK MASS with HEADACHE suggests what?
Carotid body tumour
FIBROMUSCULAR DYSPLASIA
- m/f predominance
- most common site
- presentations (2)
- sono app
Female X3
Renal arteries, then ICA
Systemic hypertension (RA stenosis) or transient cerebral Ischemic (carotid involv)
Moderate flow disturbance, PSV 200cm/s
STRING OF BEADS on angiogram
FMD
YING-YANG sign
Pseudoaneurysm
Palpable THRILL
Traumatic AVF
Soft tissue motion induced by the turbulent flow through the fistula
TAKAYASU’s ARTERITIS
- aka
- form of
- m/f predominance
- presents as
- sonographic sings
- Mainly affects what sites
Aortic arch syndrome/ pulseless disease
Form of granulomatous vasculitis (inflammation of cutaneous vessels)
Females x9 (15-30 yrs)
Pulseless upper extremities (malaise, fever, night sweats, weight loss, fatigue, syncope, SSS)
Intimal fibrosis/vascular narrowing
Brachiocephalic, LT CCA, LT SCA, pulm A
GIANT CELL ARTERIRTIS
- aka
- m/f predominance
- pt presents
- serious complication
- sonographic apparearance
Temporal arteritis/ Horton disease
Female 2x
Inflammatory disease branches of the head (ECA)
Bruits, headaches, visual disturbances, scalp tender
Opthalmic artery occlusion
Halo sign
“HALO” SIGN represents what disease
Giant cell arteritis
BUERGER’S DISEASE
- aka
- m/f predominance
- caused by
- causes
- sono app
Thromboangitis obliterates (TAO)
Young males
Heavy cigarette addiction
Extremely painful affecting upper/lower digits
Normal smooth walled arteries to sudden/distal occlusion
WHO is at INCREASED risk for RADIATION-INDUCED arterial injury (3)
Lymphoma ca pts
Breast ca pts
HN ca pts
RADIATION THERAPY increases risk for (2)
Myocardial infarction
Stroke
A course of RADIATION THERAPY can initiate a chronic vascular process that leads to clinical events ________ (time frame) after treatment due to ______
Many years due to inflammation
