Cerebrovascular Test Q&A

Question 1

80-99% stenosis. critical

Answer 1

Peak systolic velocity: >250 cm/s

End diastolic velocity: >100 cm/s

Systolic velocity ratio: >3.7

Diastolic velocity ratio: >5.5

Question 2

A contralateral ICA occlusion may cause what to the ipsilateral side?

Answer 2

increased flow to the side with the lesser stenosis. causes PSV to be higher than expected. (pg 80)

Question 3

The carotid body assists in regulating all what?

Answer 3

blood to the internal and external carotid arteries

Question 4

What are the warning signs of a stroke?

Answer 4

aphasia

dysphasia- impairment of speech, arrange words

dysphagia

dysarthria- slurring due to lack of muscle control

lateralized paresthesia- tingling and numbness

hemiparesis- lateralized weakness

hemiplegia- lateralized paralysis

transient monocular blindness (TMB)

amaurosis fugax- shade being drawn (pg 33)

Question 5

Most common visualized branch of the ECA is what?

Answer 5

superior thyroid (pg 36)

Question 6

The inability to speak or express oneself?

Answer 6

aphasia (pg 33)

Question 7

The innominate artery divides into two arteries, what are they?

Answer 7

common carotid and subclavian (pg 35)

Question 8

60-79% stenosis, severe

Answer 8

Peak systolic velocity: >130

End diastolic velocity: >40

Systolic velocity ratio: >1.8

Diastolic velocity ratio: >2.6

Question 9

vertebral- basilar symptoms

Answer 9

drop attacks

syncope

vertigo

dizziness

diplopia

binocular blindness (pg 33)

Question 10

An abnormal spectral waveform from the ICA suggests what?

Answer 10

stenosis

Question 11

Vertebral arteries bilaterally are typically the same, this means they are____

Answer 11

antegrade (pg 92)

Question 12

The Doppler sample volume should be kept where in the vessel?

Answer 12

in the middle of the lumen (pg 55)

when plaque is present, sample at site of max stenosis (pg 75)

Question 13

Answer 13

Vertebral waveform

Question 14

A systolic velocity recorded from the origin of the ICA is < 125 cm/s, according to the chart, what does this tell us?

Answer 14

40-59% stenosis, moderate

Question 15

What is retrograde and what are the causes?

Answer 15

reverse of flow within a vessel

subclavian steal

occlusion

Question 16

What disorder has symptoms resolved but not within 24 hrs?

Answer 16

reversible ischemic neurologic deficit (RIND)

(pg 33)

Question 17

Answer 17

CCA waveform

Question 18

Transient partial or complete loss of vision is what?

Answer 18

binocular blindness (pg 33)

Question 19

What are ultrasound findings of an ICA occlusion?

Answer 19

Use color Doppler at normal and low PRF

Establish no flow in multiple sites

ICA may be contracted inappearence

Rule out technical problems

ECA may function as a collateral pathway to the distal ICA. Facial and superfical temporal arteries are well developed. Blood flow in a retrograde fashion to reconsitute. ECA waveform changes and may demonstrate low resistance. (pg 76)

Question 20

The union of vertebral arteries forms to join what vessel?

Answer 20

basilar artery (pg 35)

Question 21

What is CVA and what does it cause?

Answer 21

Cerebrovascular accident

completed brain stroke (pg 33)

Question 22

The degree of stenosis at the origin of the ICA is determined by?

Answer 22

NASCET (pg 69)

Question 23

A difference of 20 mmHg of pressure between both arms suggests disease of what vessel?

Answer 23

subclavian stenosis on the side with low pressure (pg 94)

Question 24

40-59% stenosis, moderate

Answer 24

peak systolic velocity: <130

End diastolic velocity: <40

systolic velocity ratio: <1.8

diastolic velocity ratio: <2.6

Question 25

ischemia

Answer 25

an inadequate blood supply to an organ or part of the body, especially the heart muscles

Question 26

An ultrasound finding of a Doppler signal from the ECA, what kind of flow?

Answer 26

high resistance (pg 53)

Question 27

contralateral

Answer 27

relating to the side of the body opposite to that on which a particular structure or condition occurs.

Question 28

ipsilateral

Answer 28

belonging to or occuring on the same side of the body

Question 29

0-39% stenosis, mild

Answer 29

Peak systolic velocity: \< 110 cm/s End diastolic velocity: \< 40 cm/s Systolic velocity ratio: \< 1.8 Diastolic velocity ratio: \< 2.6

Question 30

Name the disorder that symptoms occur and are resolved within 24 hrs?

Answer 30

transient ischemic attack (TIA) (pg 33)

Question 31

If you see a sonolucent area within plaque, what could it represent?

Answer 31

intraplaque hemorrhage (pg 84)

Question 32

When determing the ICA/CCA ratio, the CCA should be determined from what portion of the CCA?

Answer 32

mid/distal CCA (pg 52)

Question 33

100% occlusion

Answer 33

No flow

Question 34

What is there to know about tortuous vessels?

Answer 34

composed of twists and turns associated with fibromuscular dysplasia fibrous thickening of the intima, media, or adventa usually bilateral associated with hypertension prox and dist ICA spared more common in women

Question 35

A normal flow disturbance along the posterior surface of the bulb is what separation?

Answer 35

external and internal carotid

Question 36

What is TIA and what is the long term outcomes?

Answer 36

Transient Ischemic Attack Symptoms resolve within 24 hrs (pg 33)

Question 37

What is a characteristic of a subclavian steal?

Answer 37

* more common on left side * prox subclavian stenosis can cause ipsilateral vert flow to reverse to supply blood to arm. controlateral vert flow increases to provide flow to arm * usually does not cause neurological symptoms * with severe carotid disease, flow in basilar may reverse causing neurologic symptoms, subclavian steal syndrome * retrograde flow in rt vert and prox subclavian usually indicates innominate obstruction.

Question 38

when you put the doppler sample in a vessel it should be parallel to what?

Answer 38

the vessel wall

Question 39

What is the most valuable tool for us when determining a stenosis?

Answer 39

color and spectral doppler (pgs 49 & 51) duplex imaging

Question 40

The North American Symptomatic Carotid Endarterectomy Trial (NASCET)

Answer 40

Published in 1991 showed benefit from endartectomy vs medical treatment in patients with \> 70 % stenosis. Used a new standardized method of measuring stenosis on carotid angiograms. Residual lumen at max stenosis was measured with calipers and compared to the diameter of the distal lumen of the ICA. (pg 70)

Question 41

What kind of flow pattern is the ICA?

Answer 41

low resistance (pg 53)

Question 42

Answer 42

ICA waveform

Question 43

Answer 43

ECA waveform