Week 4 Common Doppler Studies, Carotid/Vertebral Studies Flashcards
Commonly Performed Vascular Studies
stroke, atherosclerosis
carotid studies
Commonly Performed Vascular Studies
pulmonary embolism, thrombus
venous studies
Commonly Performed Vascular Studies
arterial occlusion, hematoma, arteriovenous fistula, bypass graft surveillance
lower extremity arterial studies
*artificial atriovenous fistula is normal for dialysis patient
Commonly Performed Vascular Studies
aorta, renal artery, mesenteric artery, portal system
abdominal doppler studies
Carotid Duplex Scan *landmark name of the bones
Visualization is limited to the vessels between the ___1__ and the __2___. Beyond the ___2__ - requires __3 __
- clavicle
- mandible
- transcranial scan (TCD)
What is the purpose of carotid duplex scan?
- Visualization and evaluation of the common carotid, proximal external and internal carotid arteries and the velocity flow
- Evaluate the vertebral flow
- Evaluate subclavian flow (required if vertebral waveform is abnormal) - detection of subclavian steal
- Visualizes & categorizes plaque
- Determines area of stenosis & quantitates the percentage of narrowing
Indications of carotid duplex scan? (3)
- TIA - transient ischemic attack
- RIND - reversible ischemic attack
- CVA - cerebrovascular accident *stroke
symptoms of TIA?
duration?
effect?
Where is the site of TIA normally occurs ?
- Neurological dysfunction without lasting effects
- Few minutes or a few hours(<24hours)
- Monocular (one eye) visual disturbances
- Speech impairment
- Arm, leg, facial numbness, paralysis
- Commonly caused by plaque at the carotid bifurcation
What is RIND?
Symptoms of RIND ?
duration?
Where is the site of RIND that usually occurs?
- Reversible ischemic neurological deficit (reversible ischemic attack)
- last longer than TIS - longer than 24 hrs but less than 72 hrs
- deficit that completely resolve in time
- brain tissue recovery
- commonly caused by plaque at the carotid bifurcation
What is CVA?
What is the cause?
What is the effect neurologically?
- cerebrovascular accident aka: Stroke - an interruption in the flow of blood to cells in the brain
- Can be caused by an aneurysm or a bleed
- Permanent neurological deficit
Stroke
Stroke- ___ leading cause of death in the United States
____ are ischemic, rather than hemorrhagic
In most cases, embolus or thrombus attack the vessels that derive from the _____ circulation
Cause some degree of ______ brain damage
Many patients are _______ when disease is present
5th
80%
carotid
irreversible
asymptomatic
What are the 2 types of stroke?
ischemic and hemorrhagic
ischemic stroke is commonly caused by ______ at ______
plaque at the carotid bifurcation
What are the risk factors of stroke? (5)
- diabetes
- HTN
- smoking
- hyperlipidemia
- genetic
what is the leading cause of stroke?
untreated HTN
If the patient is under the age of 50-55 with a stroke, there is usually a strong ______
family history
Symptoms of Carotid Insufficiency
anterior (carotid territory) vs posterior (vertebral territory)
severity?
chance of stroke?
carotid
- more threatening
- less common
- more likely to lead to stroke
vertebral
- less threatening
- more common
- less likely to lead to stroke
- may be cardiac in origin (syncope)
Reasons to Perform Carotid Duplex: Carotid/anterior Territory (7)
- dysphasia - speech disturbance *watch out spelling!
- aphasia - absence of speech
- amaurosis fugax (fyu:gax) - temporary, complete blindness in one eye
- hemiparesis - weakness on one side i.e. one arm, one leg, one side of the face
- hemiparesthesia - one sided tingling sensation
- hemiplegia - one sided loss of function, i.e. inability to move right upper extremity
- homonymous hemianopia - loss of half the visual field in both eyes
- lateralizing symptoms in general (localization of function or activity on one side of the body in preference to the other)
meaning?
- contralateral
- ipsilateral
contralateral - relating to or denoting the side of the body opposite to that on which a particular structure or condition occurs
ipsolateral - situated or appearing on or affecting the same side of the body
*Note:
Contralateral: Of or pertaining to the other side. The opposite of ipsilateral (the same side). For example, a stroke involving the right side of the brain may cause contralateral paralysis of the left leg.
If you have a stroke & the right arm is affected, the stroke occurred on the ____ of the brain
If you have a stroke & the left arm is affected, the stoke occurred on the _____ of the brain
left side
right side
Dysphasia or aphasia - Suggests _______ ischemia
Ex: right-handed patient, you would expect impairment of the left hemisphere/left carotid disease
dominant hemisphere
*Dominant hemisphere definition: the normal tendency for one half of the brain , usually the left cerebral hemisphere
left/right dominance varies depending on the person
Reasons to Perform Carotid Duplex: Vertebral Territory (6)
- vertigo/equilibrium disturbance
- syncope or presyncope
- nausea
- ataxia - loss of coordination)
- diplopia - double vision
- dysphagia - difficulty swallowing *watch out for spelling
Non-lateralizing symptoms in general
*Note: understand vertebral territory vs carotid territory how they affect the body differently
*carotid - affect one side of the body = lateralizing
*vertebral - effect not limited to one area = non-lateralizing
etiology of disease (stroke)?
atherosclerosis - the growth of lumen-restricting lesions in arterial walls
common site of atherosclerosis
vessel bifurcations
What are the 2 ways to cause cerebrovascular symptoms?
- stenosis - creating tension of adequate oxygen supply to the brain
- emboli - from ulcerated plaque
soft plaque
calcific plaque
*Note: shadow posterior to the plaque due to calcification
heterogeneous plaque
*combination of calcification and soft plaque
irregular plaque
*Irregular surface was defined when plaque surface was uneven with high and low fluctuation or plaque with surface ulceration
carotid Insufficiency
Etiology of Disease: Non-atherosclerotic causes (4)
- trauma
- carotid body tumor (*tend to form between the bifurcation)
- carotid dissection
- fibromuscular dysplasia
What is Fibromuscular dysplasia?
Fibromuscular dysplasia is a condition that causes stenosis and aneurysm of the medium-sized arteries in your body.
Fibromuscular dysplasia appears most commonly in the arteries leading to the kidneys and brain
- more common in female
- more common in ICA
- increased collagen in the vessel walls
- beaded appearance of the walls
These are the sagittal and transverse images of _____
carotid body tumor
What does this image indicate?
carotid artery dissection
Amaurosis fugax suggests thrombolytic activity from the ______________system
ipsilateral carotid
loss of half the visual field in both eyes
homonymous hemianopia
one sided loss of function, i.e. inability to move right upper extremity
hemiplegia
one sided tingling sensation
hemiparesthesia
weakness on one side i.e. one arm, one leg, one side of the face
hemiparesis
scan technique: Longitudinal Plane
4 common problems
- the end of the vessel are closed off - rotate
- the walls are unclear - angle
- the artery is tilted to the left or right - rock the beam
- stuck anterior - slide to a different approach, usually lateral
Spectral Analysis
what is “Walk through” technique?
continuously move the same line through the vessel from proximal to distal
keep angle 60 degree
anytime velocity is being measured, you need to angle correct
