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Extracranial Cerebrovascular Flashcards

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0
Q

What does spectrum analysis sort out?

A

the doppler frequencies FFT - giving us a velocity

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1
Q

What is extracranial?

A

outside the brain

carotid studies

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2
Q

What are we evaluating in spectrum analysis blood flow?

A

pulsatile

flow is slower at the periphery

vessels are not straight

vessels are not uniform

distorted by pathology

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3
Q

What is the proper doppler angle?

A

60 degrees or less to acquire accurate frequency and velocity information

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4
Q

What is a doppler spectrum

A

graph of doppler frequencies generated by moving blood

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5
Q

When do you have broad systolic peak and forward flow throughout diastole?

A

CCA, ICA, vertebral, renal and celiac

low peripheral resistance

entire waveform above or below baseline

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6
Q

When do you get tall, narrow sharp systolic peaks reversed or absent flow through diastole?

A

extremity artieries, ECA, SMA (fasting)

high peripheral resistance

Arterial flow

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7
Q

What varies depending on location, physiology and pathology alteration, status of cardiac function?

A

Pulsatility

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8
Q

When does flow velocity accelerate rapidly?

A

in systole

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9
Q

What might cause acceleration to be slowed?

A

severe arterial obstruction flow

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10
Q

What causes disturbed flow?

A

widening of the wave form

vascular disease

normal tortuous vessels

prominent area -bulb

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11
Q

What happens with arterial obstruction?

A

increase velocity

disturbed flow post stenotic

proximal pulsatility changes

distal pulsatility changes

indirect effects - collateralization

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12
Q

What is Poiseuille’s Law?

A

a statement of physics

the VELOCITY of the steady flow of a fluid through a narrow TUBE varies DIRECTLY as the PRESSURE and the 4th power of the RADIUS of the tube and INVERSELY as the LENGTH of the tube and the coefficient of VISCOSITY.

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13
Q

what law states: because volume flow is porportional to the 4th power of the radius, even small changes in radius can result in large changes in flow?

A

Poiseuille’s Law

calculates VOLUME FLOW

Radius is most important because its to the 4th power

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14
Q

According to Poiseuille’s Law what happens to flow rate when pressure, diameter, length and viscoisty is INCREASED?

A

increase pressure, increase flow rate

increase diameter, increase flow rate

increase length, decrease flow rate

increase viscosity, decrease flow rate

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15
Q

How does Bernoulli’s principle relate velocity and pressure?

A

they are inversely related

high velocity, low pressure

low velocity, high pressure

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16
Q

With Bernoulli’s principle if you have a stenosis, what happens to the pressure and velocity AT the stenotic segment, prox to stenosis and distal to stenosis?

A

Stenotic segment - pressure decreases, velocity increases

prox - pressure increase

distal - pressure increase

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17
Q

Flow moves along the path of _________resistance

A

least

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18
Q

What is a hallmark of high resistance vascular beds?

A

diastolic flow reversal

it doesn’t need a constant flow, it can hesitate….flow reversal

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19
Q

What is an ischemic stroke?

A

interruptions of blood flow to the brain

80% - ruptured intracraninal blood vessel

20% intracranial hemorrhage

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20
Q

What are two ways the blood flow gets interrupted to the brain causing a stroke?

A

Thrombus lodges in a cerebral artery

thrombus in the carotid artery breaks off and travels to a cerebral artery in the brain

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21
Q

What is responsible for more than 50% of all strokes?

A

extracranial carotid artery disease

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22
Q

What is the third leading cause of death in the USA?

A

Stroke (cerebrovascular diseases) 137,119

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23
Q

What can detect potential causes of stroke?

A

carotid imaging

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24
What is the definition of stroke or CVA?
permanent ischemic deficit (permanent damage)
25
What is the definition of TIA (transient ischemic accident)
temporary - reversible ischemic neurologic deficit resolves in <24 hr (usually less than one hour)(lasts 1-30 min until full recovery)
26
What is the definition of RIND?
reversible ischemic neurologic deficit resolves in >24 hrs (up to three weeks for complete restoration of function)
27
What is the leading cause of permanent disability?
strokes
28
What is the best treatment for stroke?
prevention
29
What is a thrombotic stroke?
clot in the artery in the brain
30
what is an embolic stroke?
piece of a clot is carried to the brain ( or anywhere)
31
What is a hemorrhagic stroke?
blood vessel in the brain breaks
32
What are the non-modifiable risk factors for stroke?
age - risk increases with age sex - males race - higher in african american previous stroke
33
What are the modifiable or controllable risk factors for stroke?
hypertension atrial fibrillation cardiac disease diabetes mellitus elevated cholestrol smoking sedentary lifestyle obesity
34
What are the warning signs for stroke?
sudden numbness or weakness sudden confusion, trouble speaking sudden vision issues sudden trouble walking, dizziness or loss of balance sudden headache
35
What does weakness/numbness of one side indicate?
disease on the contralateral carotid
36
if you have ocular symptoms where is disease indicated?
the same side - ipsilateral
37
What are some things you can ask people to do if you suspect a stroke?
smile talk raise both arms stick out tongue
38
What is FAST?
Face Arm Speech Time
39
Can a stroke be asymptomatic?
yes check for bruit if you have a risk factor but no symptoms
40
What is Amaurosis fugax?
transient vision loss
41
what is hemiparesis?
paralysis
42
what is dysarthria?
speech difficulty
43
what is aphasia?
inability to communicate (not making any sense)
44
What is dysphagia?
difficulty swallowing
45
what is ataxia?
what is gait disturbances
46
what is diplopia?
double vision
47
what is vertigo?
sensation of moving objects
48
What is another name for the brachocephalic?
innominate artery
49
What vessels come off of the aortic arch?
brachiocephalic Left common carotid left subclavian
50
where does the aorta branch out of?
left ventricle
51
the innominate or brachiocephalic artery divides into the _______
Rt CCA Rt Subclavian - gives rise to the Rt. vertebral
52
Which CCA is longer, left or right/
left is longer
53
the left subclavian gives rise to what?
the lt vertebral see slide 48
54
What are variants of the aortic arch?
L CCA forms a common origin with the innominate artery L vertebral artery arising from the arch R subclavian artery arises from the arch distal to the Lt Lt innominate may exist left innominant may exist
55
What vessels are enclosed in connective tissue called the carotid sheath?
carotid artery jugular vein vagus nerve
56
where is the common carotid artery found?
anterolaterally in the neck medial to the jugular vein lateral to the trachea lateral to the thyroid gland
57
where does the vagus nerve lie in relation to the artery and vein?
between
58
does the common carotid artery branch?
no it terminates at the bifurcation of the ICA and the ECA
59
Where is the external carotid artery found?
originates at the mid cervical level
60
What kind of waveform does the ECA have?
high resistance, low diastolic with a notch usually the smaller vessel
61
What are the identifying characteristics of the ECA?
smaller than ICA in diameter usually the anteriomedial vessel the ICA frequently has a mild dilatation at its origin termed the carotid bulb, the ECA has no bulb cervical portion has branches, the ICA rarely has cervical branches doppler signals normally more resistive in the ECA response to temporal percussions (tapping in front of the ear makes the waveform vibrate)
62
what is the first and most important branch off of the ECA?
superior thyroid
63
What may form when significant disease is present in the ICA?
collateral pathways
64
What does the ECA supply?
face scalp tongue neck runs medially and anteriorly to ICA
65
Where does the ICA arise from?
the CCA birfucation
66
where does the ICA enter the skull?
enters base of skull through petrous bone
67
which is the larger of the CCA terminal branches?
ICA
68
What is an unseen branch of the ICA?
opthalmic artery
69
what does the ICA supply?
brain eye forehead part of the nose
70
What is the bulb?
where the ICA and ECA branch includes distal CCA, proximal ECA and ICA may be curved or tortuous
71
Where does the ICA terminate?
at the circle of Willis distributes to the low resistance vascular bed see slide 78
72
What are the differences between ICA and ECA
ICA: ECA: lat/posterior med/anterior no branches in neck branches early in neck low resistance waveform high resistance waveform no response/temp tap alterations waveform w/t tap
73
What is the standard patient position for carotid scanning?
supine, head turned slightly (patient on your rt side) vascular lab approach: patient upside down no matter patient position, picture should be the same
74
What are you looking for when scanning a carotid?
location of stenosis extent of plaque and patency of the distal ICA presence tortuosity or kinking vessels plaque characteristics (smooth, irregular etc)
75
What transducer do you use for carotid?
high frequency linear array 7-10MHZ color with red being artery angle correct color display small doppler parallel to vessel walls
76
What needs to be adjusted throughout the carotid exam?
PRF or scale wall filter color box/gain
77
What is the spectral waveform of the CCA?
demonstrates high and low resistance flow from ICA and ECA CCA doppler signal will display + doppler shift throughout cardiac cycle color flow pattern will have continuous color throughout cardiac cycle
78
What is the boundary layer separation?
normal flow disturbance detected as a transient reversal of blood flow along posterior wall of the bulb sample volumes for ICA should start just distal to this area
79
What is the vertebral artery?
branch of the subclavian feeds cerebral part of the brain
80
what are the segments of the vertebral artery?
extravertebral - evaluated during carotid exam intervertebral horizontal intracranial
81
the subclavian artery blockage will cause reverse flow in ______
vertebral artery
82
What creates a 20mm hg difference in blood pressure between the two arms?
a subclavian artery blockage which causes the vertebral artery flow to go the wrong way
83
What is a subclavian steal?
reversal of vertebral artery blood flow direction secondary to a sig obstruction prox to the orgin of the vertebral artery in the ipsilateral subclavian or innominate artery a phenomenon
84
What is the normal carotid doppler of the CCA?
sharp upstroke clear doppler window diastolic flow
85
Why will the color pattern of the ICA have continuous color throughout the cardiac cycle?
due to low peripheral resistance of the brain
86
Why does the ECA demonstrate a more pulsatile doppler signal?
because it supplies blood to skin, and muscular bed of scalp of face has faster slope to peak systole and near zero in diastole normal color flow pattern will reflect higher resistance of scalp/face

Vascular (6 decks)

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