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Flashcards in study guild for test 1 Deck (32)
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1
Q

What are the warning signs of stroke?

A
  • 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.
2
Q

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

A

Subclavian.?

3
Q

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

A

Higher resistance than the CCA and ICA.

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

4
Q

What kind of flow pattern is displayed by the ICA?

A

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.

5
Q

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

A

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%.

6
Q

What is a TIA? Stand for and means?

A

Transient ischemic attack- symptoms resolve within 24 hours.

7
Q

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

A

.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.

8
Q

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

A

vessel walls

9
Q

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

A

Peak systole and end dystole velocities

10
Q

What the most valuable tool for us for determining stenosis?

A

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

11
Q

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

A

RT subclavian a and the right common carotid artery.

12
Q

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

A

small,center

13
Q

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

A

Proximal, distal disease or occlusion.

14
Q

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

A

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

15
Q

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

A

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.

16
Q

What are the characteristics of subclavian steal?

A

Retrograde flow of the vertebral arteries

17
Q

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?

A

wnl or less than 50 % oclusion

18
Q

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

A

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

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

19
Q

The carotid body assists in regulating all of the follow?

A

HR, Blood pressure, respiration.

20
Q

The most common visualized branch of the ECA is what?

A

Superior thyroid

21
Q

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

A

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

22
Q

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

A

Basilar Artery

23
Q

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

A

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

24
Q

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

A

NASCET

25
Q

There is several causes for CVA, what are they?

A

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.
26
Q

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

A

Transient ischemic attack- symptoms resolve within 24 hours.

27
Q

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

A

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

28
Q

Vertebral basilar symptoms include what?

A

-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.
29
Q

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

A

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

30
Q
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
A

.

31
Q

tardus parvus

A

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

32
Q

CCA stenosis and occlusion?

A
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.