Other vascular diseases

Question 1

Majority of strokes are caused by? (3)

Answer 1

• atrial fibrillation
• hardening of the arteries
• High blood pressure

Question 2

Less common causes of stroke? (3)

Answer 2

1. Vasospasm
2. FMD
3. Radiation induced vasculopathy

Question 3

Ischemic stroke occur as a result of?

Answer 3

• an obstruction within a blood vessel supplying blood to brain

Question 4

Underlying condition for ischemic stroke?

Answer 4

Atherosclerosis

Question 5

Cerebral thrombosis?

Answer 5

This refers to a thrombus(blood clot) that develops at the clogged part of the vessel in the brain- from atherosclerosis

Question 6

Cerebral embolism?

Answer 6

• blood clot that forms at another location in the circulatory system
• Usually from the heart or large arteries of the neck such as the Carotids
• A portion of the blood clot breaks loose,enters the bloodstream and travels through the brains blood vessels until it reaches a vessel too small to let it pass

Question 7

Cerebral vasospasm?

Answer 7

• a blood vessel spasms or contracts causing less blood flow
• may happen after an operation for a bleed that occurs between the brain and the thin tissue covering the brain (subarachnoid hemorrhage)
• This type of vasospasm increases the risk of an ischemic stroke
• Vasospasm typically occurs 4-10 days after subarachnoid hemorrhage

Question 8

AVM-arteriovenous malformation?

Answer 8

a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins

Question 9

AVM risk factors?

Answer 9

• more common in males
• 50% of patients have an intracranial hemorrhage
• 20 to 25 % have focal or generalized seizures

Question 10

Cerebral aneurysm?

• what is it
• whos at risk

Answer 10

• a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood
• The bulging aneurysm can put pressure on a nerve or surrounding brain tissue
• More common in adults than in children
• Slightly more common in women than in men
• People with certain inherited disorders are also at higher risk
• between ages of 30-60

Question 11

Cardiac thrombus?

Answer 11

• A second important cause of embolism is an irregular heartbeat known as “atrial fibrillation”
• It creates conditions where clots can form in the heart and dislodge and travel to the brain
• 26% of patients with cerebrovascular events will have a cardiac thrombus as the source of emboli

Question 12

Atrial fibrillation-AF

Answer 12

• Most common type of arrhythmis

- The heart can beat too fast, too slow or irregularly-disorganized electrical signals are the cause

Question 13

Left ventricular dysfunction-CHF?

Answer 13

• Chronic heart failure is the inability of the heart to supply sufficient blood flow to meet metabolic needs of the body
• CHF is associated with increased risk of thrombus formation and risk of stroke due to a hypercoagulable state-leading to embolism
• CHF is treated with anticoagulation therapy

Question 14

Other non atheroscletoic vascular diseases? (8)

Answer 14

Dissection
Pseudoaneurysm
Arteriovenous fistula(AVF)
Carotid body tumor
Fibromuscular disease(FMD)
Buerger’s disease
Takayasu’s arteritis
Giant cell arteritis

Question 15

What is the most common cause of stroke in young adults?

Answer 15

• Carotid artery dissection

Question 16

2 classes of CA dissection?

Answer 16

1. spontaneous

2. traumatic

Question 17

CA dissection usually originated at?

Answer 17

• the aortic arch and extends to the bifurcation and may extend into the ICA

Question 18

Spontaneous dissection?

• Whos affected
• ages
• incidence
• risk factors (2)

Answer 18

• affects the middle aged population
• Incidence is low- 2.9 per 100,000
• 70% of patients are between ages 35 and 50

Risk factors:

• Family history of stroke
• Hereditary connective tissue disorder

Question 19

Dissection-Connective tissue disorders? (5)

Answer 19

Marfan syndrome
Ehlers-Danlos syndrome
ADPKD
Fibromuscular dysplasia
Osteogenesis imperfecta

Question 20

Traumatic dissection?

Answer 20

• severe trauma to the head or neck
• 0.67% of patients admitted to the hospital after major motor vehicle accidents were found to have blunt carotid injury
• These also include pseudoaneurysm, thrombosis or fistula
• Pseudoaneurysm may also occur simultaneously as the dissection may be through the tunica adventitia

Question 20

Traumatic dissection?

Answer 20

• severe trauma to the head or neck
• 0.67% of patients admitted to the hospital after major motor vehicle accidents were found to have blunt carotid injury
• These also include pseudoaneurysm, thrombosis or fistula
• Pseudoaneurysm may also occur simultaneously as the dissection may be through the tunica adventitia

Question 21

Pathophysiology of dissection?

Answer 21

• The intimal tear allows blood to enter the space between the layers of the vessel
• creates a false lumen causing stenosis or complete occlusion
• Complete occlusions may lead to ischemia
• Blood clots form and break away from the site of the tear
• They form emboli that travel to the brain causing a stroke(cerebral infarction)
• Causes irreversible damage to the brain

Question 22

Treatment of dissection?

Answer 22

• observation
• anticoagulation
• stent implantation
• carotid artery ligatio

Question 23

Double lumen sign is related to?

Answer 23

dissection

Question 24

Double lumen sign is related to?

Answer 24

dissection

Question 25

What is a fistula?

Answer 25

- an opening that connects two epithelialized structures - In the case of an arteriovenous fistula (AVF), communication occurs between an artery and a vein - An AVF almost always results from trauma- either violent or iatrogenic

Question 26

Carotid body tumor is known as?

Answer 26

Paragangliomas

Question 27

What is a carotid body tumor? - size? - located?

Answer 27

- component of the autonomic nervous system - Participates in control of arterial pH, blood gas levels, and blood pressure - Normally they are tiny ovoid structures 1-1.5mm in size - They are located in the adventitia of the carotid bifurcation

Question 28

What is the most common presentation of a carotid body tumor?

Answer 28

- palpable neck mass with headache | - neck pain is the 2nd most common presentation

Question 29

Paraganglioma- sono finding?

Answer 29

- Highly vascular masses nestled in between the ICA and ECA bifurcation - On 2-D and color Doppler -ICA and ECA appear splayed

Question 30

Fibromuscular dysplasia-FMD? | - commonly presents with

Answer 30

- Commonly presents with systemic hypertension caused by renal artery stenosis - With carotid involvement-transient cerebral ischemia is the usual presentation-stroke can also occur - 30% of FMD patients have an intracranial cerebral aneurysm presenting with cerebral hemorrhage

Question 31

Pathophysiology of FMD?

Answer 31

- Overgrowth of smooth muscle cells and fibrous tissue within the arterial wall - Tunica media involved in 85% of cases - This form presents with “string of beads” appearance on angiogram

Question 32

3 femoral artery vascular diseases?

Answer 32

1. pseudoaneurysm 2. traumatic arteriovenous fistulas 3. penetrating arterial trauma

Question 33

Takayasu’s arteritis AKA?

Answer 33

Also known as “aortic arch syndrome” and “pulseless disease”

Question 34

What is Takayasu’s arteritis?

Answer 34

- Form of large vessel granulomatous vasculitis-etiology unknown - Massive intimal fibrosis and vascular narrowing are signs - Affects young or middle aged women of Asian descent - Mainly affects aorta and its major branches-brachiocephalic,left CCA and left SCA and pulmonary arteries

Question 35

Giant cell arteritis?

Answer 35

Also known as temporal arteritis or Horton disease Inflammatory disease of blood vessels most commonly large and medium branches of the head,particularly external Carotid artery It can cause occlusion of arteries and ischemia Most serious complication is occlusion of the ophthalmic artery Treatment is with steroids

Question 36

Giant cell arteritis?

Answer 36

Also known as temporal arteritis or Horton disease Inflammatory disease of blood vessels most commonly large and medium branches of the head,particularly external Carotid artery It can cause occlusion of arteries and ischemia Most serious complication is occlusion of the ophthalmic artery Treatment is with steroids

Question 37

Giant cell arteritis, patient presents with?

Answer 37

The patient presents with bruits, fever, headache, visual disturbances, tenderness of the scalp

Question 38

What is halo sign associated with?

Answer 38

Giant cell arteritis

Question 39

Buerger’s disease? - AKA - What is it? - caused by? - seein in?

Answer 39

- AKA thromboangitis obliterans(TAO) - An extremely painful disorder affecting the digits of both upper and lower extremities simultaneously - It is caused by a heavy, almost pathological addiction to cigarette smoking - Particularly in young male

Question 40

Buerger's disease seen as?

Answer 40

- Onset is acute and is thought to start as progressive arterial wall inflammation leading to distal arterial occlusion angiographic appearance: - Revealing normal smooth-walled arteries to a point of sudden and distal occlusion - This disease can be arrested by the discontinuation of cigarette use - Some patients go on to amputation or sympathectomy