study guild for test 1

Question 1

What are the warning signs of stroke?

Answer 1

• Aphasia(inability to speak or express oneself dominant hemisphere ususally the left.
• Dusphasia- impairment of speech, lack of coordination and failure to arrange words in proper order-dominant hemisphere.
• Dysphagia- difficulty n swallowing
• dysarthria- imperfect articulation of speech due to disturbance of muscle control, slurring
• Lateralized paresthesis- tingling and numbness- contralateral hemisphere.
• Hemiparesis- lateralized weakness- contralateral hemisphere.
• Hemiplegia- lateralized paralysis- contralateral hemishpere
• Amaurosis fugx (AF) transient monocular blindness (TMB), related to ipsilateral carotid artery.
• Ataxia- gross incoordination of muscle movements, clumsiness of limb- contralateral hemisphere.

Question 2

A difference of greater than 20 degrees mercury pressure between arms suggests disease of what vessel?

Answer 2

Subclavian.?

Question 3

An ultrasound finding of the doppler signal of the ECA is what kind of flow?

Answer 3

Higher resistance than the CCA and ICA.

-often a prominent dicrotic notch is present in early diastole.

Question 4

What kind of flow pattern is displayed by the ICA?

Answer 4

Low resistance as cerebral vessels are vasodilated. There should be forward flow throughout the cardiac cycle. Flow becomes laminar and spectral broadening decreased as one scans distal to the bulb region. Blood velocity may increase in the distal ICA as the artery tapers to a smaller diameter.

Question 5

Which is not an ultrasound finding of an ICA occulsion…List the findings.

Answer 5

Bernoulli principle, significant velocity increase will occur over a lesion ≥ 50% diameter stenosis.
Turbulent, chaotic blood flow is almost always present immediately distal to a ≥ 50%. This appears as spectral broadening on the doppler waveform.

If a stenosis measures 50% or greater from the
B-mode image (using measurement calipers),
but there is no focal velocity acceleration over
the plaque, that stenosis is less than 50% in
diameter.
• If a stenosis measures or appears less than
50% by image/caliper method but velocity
acceleration with post stenotic turbulence
occurs, that lesion is greater than 50%.

Question 6

What is a TIA? Stand for and means?

Answer 6

Transient ischemic attack- symptoms resolve within 24 hours.

Question 7

Vertebral arteries bilaterally are typically very much the same? so they are?

Answer 7

.Often patients have a dominate vertebral artery with higher velocity on one side. If verterbra spectral waveform is abnormal or retrograde, evaluate the proximal subclavian artery for stenosis or occlusion. If retrograde flow is suspected comparte the flow directionin the ipsilateral CCA.

Question 8

When you take the doppler sample in a blood vessel it should be parallel to what?

Answer 8

vessel walls

Question 9

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

Answer 9

Peak systole and end dystole velocities

Question 10

What the most valuable tool for us for determining stenosis?

Answer 10

Image is superior to Doppler for stenosis of 60% diameter reduction.

Question 11

The innominate artery divides into 2 arteries, what are they?

Answer 11

RT subclavian a and the right common carotid artery.

Question 12

The doppler sample volume should be kept where during a doppler exam, where inside the vessel? Or what size?

Answer 12

small,center

Question 13

An abnormal spectral doppler waveform shape from the ICA suggests what?

Answer 13

Proximal, distal disease or occlusion.

Question 14

The contralateral ICA occlusion may cause the ipsilateral ICA velocities to do what?

Answer 14

Flow volume may increase in the side contralateral
to a high-grade ICA stenosis or occlusion
• Stenosis on this side may be overestimated due to
higher velocities

Question 15

When determining the ICC/CCA ratio, the CCA portion should be obtained from what portion of the CCA?

Answer 15

in a disease-free portion of the mid CCA.

intended to mean (PSV from the max stenosis region divided by a PSV obtained in a disease-free portion of the mid CCA.

Question 16

What are the characteristics of subclavian steal?

Answer 16

Retrograde flow of the vertebral arteries

Question 17

A systolic velocity recorded from the origin of the ICA is less than 125 cm/sec what does that tell us according to our carotid charts what does that tell us?

Answer 17

wnl or less than 50 % oclusion

Question 18

Transient,, partial or complete loss of vision, what is the term for that?

Answer 18

Amaurosis fugax (AF), transient monocular blindness (TMB- related to ipsilateral carotid artery.

Binocular blindness- a transient, bilateral blindness of acute onset.

Question 19

The carotid body assists in regulating all of the follow?

Answer 19

HR, Blood pressure, respiration.

Question 20

The most common visualized branch of the ECA is what?

Answer 20

Superior thyroid

Question 21

A normal flow disturbance along the posterior wall of the bulb, when the color changes, is called what? something separation?

Answer 21

There is a flow separation and often a HELICAL FLOW pattern occuring in this region. (sepatation?)

Question 22

The union of the vertebral arteries forms to join what vessel?

Answer 22

Basilar Artery

Question 23

The inability to speak or express ones self ( left hemisphere) is called what?

Answer 23

-Aphasia (inability to speak or express oneself dominant hemisphere ususally the left.

Question 24

North American symptomatic carotid endarterectomy trial, what is the abbreviation?

Answer 24

NASCET

Question 25

There is several causes for CVA, what are they?

Answer 25

Causes: - cardiac origin: Emboli (caused by atrial fib), or cessation of perfuson. -carotid origin: Thrombosis-occlusion, Atheroscleroti stenosis decreaeing perfusion, emboli ``` - cerebral Aneurysm rupture: Intracranial hemorrhage(aka suarachnoid hemorrhage from ruptured cerebral aneurysm or blunt trauma. Vasospasm- a spasm of the intracrainal arteries following subarachnoid hemorrhage that can lead to stroke. ``` - Miscellaneous: vasospasm brought about by sickle cell anemia, congenital cerebra arterial-venous malformation.

Question 26

Name the disorder which occurs with symptoms that resolve within 24 hours.

Answer 26

Transient ischemic attack- symptoms resolve within 24 hours.

Question 27

Which of the following have symptoms resolve but not within 24 hours?

Answer 27

Reversible ischemic Neurologic Deficit (RIND)- symptoms resove, but not within 24 hours.

Question 28

Vertebral basilar symptoms include what?

Answer 28

-Drop attacks- falling down without fainting. - syncope- wide definition applying to many conditions, but generally a transient state of being unconscious without losing consciousness ( the lights on but no ones home) - vertigo- a sensation that the environment is moving around the patient. A feeling of motion or spinning when the patient is stationary. - Dizziness- a sense of being off balance. - diplopia- double vision - binocular blindness- a transient, bilateral vlindness of acute onset.

Question 29

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

Answer 29

Intraplaque hemorrhage (IPH) • sonolucent or hypoechoic region with thin fibrous cap • eggshell pattern

Question 30

``` Identify the following images: Label CCA,ICA,ECA. Identify ECA flow. Retrograde vertebral flow and what causes it. Appearance of a vertebral artery. Torturous vessel Vertebral wave forms know what ICA flow, ECA flow and CCA flow look like ```

Answer 30

.

Question 31

tardus parvus

Answer 31

A “rounding” of the CCA waveform with loss of amplitude and delayed rise time (tardus parvus) suggests proximal stenosis or occlusion

Question 32

CCA stenosis and occlusion?

Answer 32

``` CCA stenosis: No established criteria • If the PSV increased over the stenosis by a factor of 2 (a doubling of velocity), it’s probably a >50% stenosis. ``` ``` CCA occlusion: Verify no flow in CCA. • Evaluate ICA and ECA and note direction. • The ICA often remains open with blood supplied by retrograde ECA flow. A vertebral artery branch communicates with ECA branches • Retrograde ECA flow supplies the ICA. ```