Cerebrovascular Anatomy, Pathology, Patient History & Physical, Symptoms

Question 1

___ is the primary blood supply to the brain

Answer 1

ICA

Question 2

ECA has 8 branches that supplies the ___

Answer 2

face and scalp

Question 3

4 cerebrovascular collateral pathways

Answer 3

1. ECA-ICA via ophthalmic and orbital arteries
2. occipital branch of ECA - atlantic branch of the vertebral
3. cervical subclavian branches - vertebral artery branches
4. circle of Willis

Question 4

largest collateral pathway of the brain

Answer 4

circle of Willis

Question 5

circle of Willis consists of (5)

Answer 5

1. distal ICA
2. anterior cerebral arteries (ACA)
3. anterior communicating artery (ACoA)
4. posterior communicating artery (PCoA)
5. posterior cerebral arteries (PCA)

Question 6

posterior circulation of the brain consists of

Answer 6

vertebral arteries
basilar artery
circle of Willis

Question 7

most common pathology affecting the extracranial carotid vessels

Answer 7

atherosclerosis obliterans (ASO)

Question 8

5 types of atherosclerotic plaques

Answer 8

1. fatty steak
2. fibrous plaque
3. complicated lesion
4. ulcerative lesion
5. intraplaque hemorrhage

Question 9

fatty steak plaque is

Answer 9

thin layer of lipid material in intimal layer

Question 10

fibrous plaque is

Answer 10

accumulation of lipids

Question 11

complicated lesion is fibrous plaque that

Answer 11

includes fibrous tissue and collagen

Question 12

ulcerative lesion is plaque that

Answer 12

fibrous cap deteriorates
increased incidence of embolus

Question 13

intraplaque hemorrhage is a type of plaque that

Answer 13

rupture of the vaso vasorum with bleed inside the plaque

Question 14

fibromuscular dysplasis (FMD) primarily affects

Answer 14

cartoid and renal arteries

Question 15

FMD has increased risk of

Answer 15

aneurysm or dissection

Question 16

FMD exhibits ___ flow not associated with visualized stenosis

Answer 16

high velocity flow

Question 17

what is neointimal hyperplasia?

Answer 17

intimal thickening from rapid, smooth muscle cell growth

Question 18

neointimal hyperplasia is caused by

Answer 18

trauma or endarterectomy damages to the endothelium with subsequent regeneration

Question 19

neointimal hyperplasia occurs ___ months post-injury

Answer 19

6-24 months

Question 20

carotid body tumor is also known as ___

Answer 20

paraganglioma

Question 21

carotid body tumor is a highly vascular structure usually fed by branches of the ___

Answer 21

ECA

Question 22

2 treatment options of carotid body tumors

Answer 22

ligation of feeding vessels
and/or surgical excision

Question 23

carotid body is a small sensory organ just ___ the bifurcation

Answer 23

above the bifurcation

Question 24

carotid body tumor results in ___

Answer 24

splaying of the ICA and ECA

Question 25

carotid body tumor ECA may have ___ resistance due to vascularity of the tumor

Answer 25

decreased resistance

Question 26

carotid dissection typically has ___ resistance flow in the false lumen

Answer 26

high resistance flow

Question 27

___ are rare in extracranial carotid arteries

Answer 27

aneurysms

Question 28

cerebrovascular risk factors (7)

Answer 28

1. personal history of CAD, MI, known arterial disease 2. prior stroke or TIA 3. diabetes 4. HTN 5. hyperlipidemia 6. tobacco use 7. other - age, genetics, sex

Question 29

probability of stroke ___ for each decade of life after age 55

Answer 29

doubles

Question 30

2 theories - what causes cerebrovascular symptoms

Answer 30

1. as stenosis worsens, increased sheer stress from the flow acceleration and turbulent blood flow disrupts the intimal layer (fibrous cap) allowing the plaque components to escape into the blood stream 2. irregular surface allows platelet aggregation and thrombus formation which may then embolize to the brain

Question 31

transient ischemic attack (TIA) symptoms resolve

Answer 31

resolve completely within 24 hours

Question 32

resolving ischemic neurogenic deficit symptoms resolve

Answer 32

resolve completely but last longer than 24 hours

Question 33

completed stroke refers to

Answer 33

stroke that causes permanent neurological damage

Question 34

hemispheric symptoms are often

Answer 34

contralateral (right hemisphere damage affects left side of body)

Question 35

hemispheric damage is often due to ___

Answer 35

lesion affecting the anterior circulation

Question 36

hemispheric damage often affects (4)

Answer 36

1. ICA 2. middle cerebral (MCA) 3. anterior cerebral (ACA) 4. anterior communicating (ACoA)

Question 37

ICA embolizes to the ACA - likely to affect ___ MCA - likely to affect ___

Answer 37

ACA - leg MCA - arm

Question 38

dysphasia is more likely to be caused by ___

Answer 38

middle cerebral artery (MCA)

Question 39

what is paresthesia?

Answer 39

tinging

Question 40

what is paresis?

Answer 40

weakness, numbness, or paralysis

Question 41

what is hemiparesis?

Answer 41

weakness, numbness or paralysis on one side of the body

Question 42

what is hemiplegia?

Answer 42

paralysis on one side of the body

Question 43

what is aphasia?

Answer 43

inability to speak

Question 44

what is dysphasia?

Answer 44

difficulty speaking, loss of power of verbal expression

Question 45

what is dysarthria?

Answer 45

difficulty with speech due to dysfunction of the muscles or nerves

Question 46

what does nonlateralizing mean?

Answer 46

symptoms do not affect a specific hemisphere of the brain

Question 47

vertebrobasilar symptoms are caused by ___

Answer 47

lesions affecting the posterior circulation vertebral artery basilar artery posterior cerebral (PCA) posterior communicating (PCoA)

Question 48

what is dyssynergia (ataxia)?

Answer 48

lack of muscular coordination

Question 49

what is diplopia?

Answer 49

double vision

Question 50

what is drop attack?

Answer 50

sudden fall without loss of consciousness

Question 51

what is syncope?

Answer 51

sudden transient loss of consciousness

Question 52

5 D's of vertebrobasilar symptoms

Answer 52

1. dizziness 2. dyssynergia 3. diplopia 4. drop attack 5. dyslexia

Question 53

what is amaurosis fugax?

Answer 53

"fleeting vision" transient loss of vision in one eye

Question 54

amaurosis fugax is caused by

Answer 54

a lesion on the ipsilateral side right ICA embolus to right ophthalmic artery → right amaurosis fugax

Question 55

what is homonymous hemianopia?

Answer 55

loss of visual field of view that impacts both eyes

Question 56

right brain hemisphere damage may result in ___ homonymous hemianopia which is ___

Answer 56

right brain damage - left homonymous hemianopia loss of left field of view in both right and left eyes

Question 57

what is hemispatial neglect?

Answer 57

inattention or impaired body position or spatial orientation on one side of the body

Question 58

left hemispatial neglect may be the result of damage to the ___

Answer 58

right hemisphere

Question 59

the BIG three refers the symptoms highly associated with ___

Answer 59

carotid artery disease

Question 60

the BIG three symptoms

Answer 60

1. hemiparesis 2. aphasia/dysphasia 3. amaurosis fugax

Question 61

hollenhorst plaque is often an indication for ___

Answer 61

carotid duplex evaluation

Question 62

hollenhorst plaque is ___ embolus that typically originates from the ___

Answer 62

cholesterol embolus originates from the ipsilateral carotid artery

Question 63

hollenhorst plaque travels into the ___ and lodges in a blood vessel of the ___

Answer 63

travels into the ophthalmic artery lodges in a blood vessel of the retina

Question 64

hollenhorst plaque possible source (3)

Answer 64

ICA aorta heart

Question 65

hollenhorst plaque may totally occlude the ___

Answer 65

central retinal artery

Question 66

hollenhorst plaque may result in ___ eye pressure

Answer 66

decreased eye pressure

Question 67

___ carries significant risk of cerebrovascular symptoms

Answer 67

cardiac arrhythmia

Question 68

bruit noted higher on the neck is more likely

Answer 68

bifurcation etiology

Question 69

bruit noted lower in the supraclavicular region is more likely

Answer 69

arch disease

Question 70

bruit in multiple locations across the neck is likely transmitted bruit from ___

Answer 70

cardiac source