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TCD > Class 4: Vasospasm/Stenosis/Clinical Criteria > Flashcards

Class 4: Vasospasm/Stenosis/Clinical Criteria Flashcards

1
Q

What is the incidence of cerebrovascular aneurysm ruptures?

A

It occurs in approx. 30,000 individuals annually.

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2
Q

What is the most common indication for a TCD exam?

A

SAH.

Subarachnoid Hemorrhage

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3
Q

What is the mortality rate for ruptured cerebrovascular aneurysms?

A

>50%

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4
Q

what is the percentage of people who develop vasospasm after a cerebralvascular aneurysm rupture?

A

20-30%

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5
Q

What is the most serious type of aneurysm?

A

Basilar.

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6
Q

What is the most common type of aneurysm shape?

A

Saccular.

aka “berry”

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7
Q

Where do subarachnoid hemorrhages typically occur?

A

In the distal area.

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8
Q

What does the EVD do?

A

It creates a pressure gradient.

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9
Q

What is the primary cause of cerebral vasospasm?

A

Cerebral artery anerysm rupture (SAH) or trauma.

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10
Q

What is the theory behind cerebral vasospasm?

A

The vessel contracts to limit hemorrhage.

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11
Q

What does a prolonged vasospasm lead to?

A

A stroke.

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12
Q

What does cerebral vasopasm primary affect?

A

It mainly affects the large cerebral arteries (M1 & M2)

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13
Q

What is the delayed onset of cerebral vasospasm?

A

2-10 days after bleed (1st week)

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14
Q

When does cerebral vasospasm typically resolve?

A

2-4 weeks.

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15
Q

What is involved in cerebral vasospasm?

A

It involves the entire length or a large portion of the vessel.

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16
Q

Difference between vasospasm and stenosis?

A

Vasospasm→ affects entire length or large portion

Stenosis→ Affects a focal area

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17
Q

What do patients complain of on day #1 of vasospasm?

A

Worst headache.

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18
Q

When is the peak of vasospasm?

A

7-10 days

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19
Q

When is the maximum severity of vasospasm?

A

7-14 days

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20
Q

How long can vasospasm last?

A

up to 4 weeks.

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21
Q

When does vasospasm usually present when after initial headache?

A

day 4.

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22
Q

What does the degree of vasospasm depend on?

A

It depends on the amount of blood.

> RBC= increase vasospasm

<rbc>
</rbc>

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23
Q

What does the vessel affected by vasospasm depend on?

A

It depends on the location of blood.

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24
Q

What is the main imaging for cerebral vasospasm?

A

Angiography

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25
Q

What is angiography in relation to cerebral vasospasm?

A

It is the gold standard for diagnosis of severe vasospasm (insensitive for mild/moderate)

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26
Q

What is the most common screening tool for catching early vasospasm signs?

A

TCD

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27
Q

What is the goal of TCD?

A

To identify early development of significant (high/moderate) vasospasm

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28
Q

Wha charactersitics does a vessel in vasospasm have?

A

It is inflammed and has lumen reduction.

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29
Q

What is the Lindegaard index?

A

It is a method of correcting for increases in hyperdynamic systemic flow.

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30
Q

What does the Lindegaard index take into account?

A

MCA mean velocity compared with ipsilateral ICA mean velocity.

LI=MCA/ICA

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31
Q

What is considered hyperemia?

A

Increased mean velocity & increased LI ratio

32
Q

What is considered vasospasm?

A

Increased mean velocity & decreased LI ratio.

33
Q

What is the MCA vasospasm MFV and ANGIO correlation?

A
  • MFV 120 CM/SEC→ANGIO <25%
  • MFV 160 CM/SEC→ANGIO 25-50%
  • MFV >200 CM/SEC→ANGIO >50%
34
Q

What is considered to be mild MCA vasospasm?

A

120 cm/sec

35
Q

What is considered to be a moderate MCA vasospasm ?

A

160 cm/sec

36
Q

What is considered to be severe vasospasm?

A

>200 cm/sec

37
Q

What is the cerebral vasospasm criteria for hyperemia?

A

Velocity→80-120 cm/sec

Lindegaard Ratio→<3.0

38
Q

What is the mild cerebral vasospasm criteria ?

A

Velocity→120-160 cm/sec

Lindegaard Ratio→>3.0

39
Q

What is the moderate cerebral vasospasm criteria?

A

Velocity→160-200 cm/sec

Lindegaard Ratio→>3.0

40
Q

What is the severe cerebral vasospasm criteria?

A

Velocity→>200 cm/sec

Lindegaard Ratio→>6.0

41
Q

What is the MFV and ANGIO correlation with BA vasospasm?

A
  • MFV 60 CM/SEC→ANGIO <25%
  • MFV 90 CM/SEC→ANGIO 25-50%
  • MFV 120 CM/SEC→ANGIO >50%
42
Q

What is considered to be mild BA vasospasm?

A

60 cm/sec

43
Q

What is considered to be moderate BA vasospasm?

A

90 cm/sec

44
Q

What is considered to be severe BA vasospasm?

A

>120 cm/sec

45
Q

What are two types of endovascular treatments for vasospasm?

A
  1. Balloon angioplasty
  2. Intra-arterial vasodilators
46
Q

What is the primary cause of ischemic cerebral disease?

A

Athersclerosis or emboli (from the heart)

47
Q

What is the gold standard for ischemic cerebral disease?

A

Angiography

48
Q

What is involved in ischemic cerebral disease?

A

It involves a focal portion of the vessel.

49
Q

What does the patient require with ischemic cerebral disease?

A

Patient require urgent reperfusion (thrombolysis)

50
Q

When can TCD be used for ischemic cerebral disease?

A

TCD can be used to assess acute ischemia (<12 hrs) or reperfusion after IR

51
Q

What are the characteristics of a cerebral stenosis?

A
  • Bruit
  • Tardus parvus
  • High resistance
52
Q

What can TCD assist in?

A

It can assist in supporting confirmation of cerebral circulatory arrest.

53
Q

What type of waveform does brain death have?

A

To-and-Fro.

AKA staccato

54
Q

What are other test used to confirm brain death?

A
  1. EEG
  2. NMPT
55
Q

When confirming brain death, what are the primary vessels assessed?

A
  • MCA
  • ACA
  • BA
56
Q

What type of pulsatility indices is significant?

A

High PI

57
Q

What does a high diastole indicate?

A

Low PI

58
Q

What does a low diastole indicate?

A

High PI

59
Q

What does a high PI indicate?

A
  • Intracranial athersclerosis
  • Increased intracranial pressure
60
Q

What is sickle cell disease a risk factor for?

A

It increases the risk for a stroke

61
Q

What is the TCD’s vital role in sickle cell disease?

A

Evaluating children as a preventative measure.

62
Q

How is sickle cell disease treated?

A

It is treated with blood transfusions.

63
Q

What is the current approach for all children with sickle cell disease?

A
  1. Get baseline TCD as early as possible (usually 2-5 years old)
  2. Routine annual TCD screenings
64
Q

What is the primary vessel assessed in sickle cell disease?

A

MCA

65
Q

What is considered normal MCA velocity for sickle cell disease?

A

<170 cm/sec

66
Q

What is considered borderline MCA velocity for sickle cell?

A

200-170 cm/sec

67
Q

What is considered abnormal MCA velocity for sickle cell?

A

>200 cm/sec

68
Q

What is patent foramen ovale (PFO)?

A

It is a right to left shunt.

Blood goes from the right to the left atrium.

(embryologic origin)

69
Q

What type of test is done to confirm PFO?

A

HITS study aka bubble study.

TCD preformed with injection of agitated saline mixed with air.

70
Q

When is PFO confirmed?

A

When the TCD machine detects HITS while continuously monitoring MCA

71
Q

What does it mean if there are more HITS detected?

A

Increased shunt severity

72
Q

Besides TCD, what other test is used to detect PFO?

A

Echocardiogram.

73
Q

What is the primary vessel assed in a HITS study?

A

MCA

74
Q

When assessing HITS, what should you have the patient do?

A

Valvsalva

75
Q

Where is an aneurysm most common?

A

Anterior circulation

76
Q

Where do aneurysms typically occur?

A

At bifurcations

77
Q
A

TCD (5 decks)

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