Vascular Class #6
Terms in this set (54)
how is ultrasound used in treating cerebrovascular disease?
-duplex ultrasound imaging detects predisposing risks
-ultrasound testing impacts clinical decision making in at risk patients
what does TIA stand for?
transient ischemic attack
what is a TIA? (transient ischemic attack)
-a neurologic deficit that reverses within 24 hours (usually in minutes)
-ischemic deficit affecting anterior circulation (ICA)
what causes a TIA?
temporary blood clot in an artery
how is the risk of stroke affected after someone has a TIA?
-10% in the next 3 months
-increased by 17 times in next 5 years
what are possible symptoms of TIA?
-blindness in one eye (side of affected artery)
-dysphasia or aphasia (difficulty or inability to speak)
-contralateral paralysis (opposite side of blockage)
what does RIND stand for?
reversible ischemic neurologic deficit
what is RIND? (reversible ischemic neurologic deficit)
-a neurologic deficit that lasts longer than 24 hours, but less than 72 hours
-occurs when blood flow to brain is temporarily restricted
-sudden onset of symptoms
what is amaurosis fugax?
-transient blindness in one eye
-lasts from seconds to minutes
-attacks may be occasional or repeated many times per day
-affected eye will be the same side as the affected artery
what causes amaurosis fugax?
caused by temporary blockage of small blood vessels in eye (opthalmic or supraorbital)
what does hearing bruits over the carotid artery indicate?
-tortuous vessels (normal)
what is bruits?
abnormal low rumbling sound heard using a stethoscope over the carotid artery
what causes bruits?
caused by turbulent blood flow as it rushes by an obstruction (stenosis or tortuous vessels)
what is aphasia? which hemisphere controls it?
inability to speak-left hemisphere
what is dysphasia? which hemisphere controls it?
difficulty speaking- left hemisphere
what is dysarthria? which hemisphere controls it?
slurring and speech distortion due to lack of muscular control- left or right hemisphere
what is lateralized paresthesia? which hemisphere controls it?
numbness or tingling- right or left hemisphere
what is hemiplegia? which hemisphere controls it?
paralysis on one side of the body, contralateral hemisphere of brain of the arterial issue
what is lateralized weakness? which hemisphere controls it?
weakness, contralateral hemisphere of brain
what does VBI stand for?
what is a VBI? (vertebro-basilar insufficiency)
-posterior circulation affected
-flow in vertebral or basilar arteries disturbed
what are symptoms of a VBI?
-vertigo (most common)
-ataxia (lack of muscle coordination)
-weakness in limbs
-numbness around lips and mouth
what are non-localized symptoms of a stroke?
-difficulty with speech
-syncope (fainting due to inadequate flow to the brain)
what is a "stroke in evolution"?
-neurologic effects increase progressively with time (growth)
-worsening may occur for up to 2 weeks
what is a "completed stroke"?
-neurologic effects do not continue to worsen
-stroke effects are complete
what is another word for a stroke?
CVA- cerebrovascular accident
what are predisposing risk factors for stroke?
#2- age (rare to uncommon less than 60 years)
-males (1.5 times more common in men)
-use of estrogen (oral contraceptives)
-polycythemia vera (increased clot risk)
what are the 3 types of strokes?
-cerebral thrombosis (blood clot)
-cerebral embolism (liquid, solid, gas)
-hemorrhage (bleeding in brain)
what is a cerebral thrombosis? % of strokes?
-blockage by clot within artery of brain
-40-50% of strokes
what is a cerebral embolism?% of strokes?
-blockage by embolus swept into brain
-30-35% of strokes
what is a hemorrhage? % of strokes?
-rupture of blood vessel with bleeding within or over surface of brain
-20-25% of strokes
what are some complications with stroke?
-pneumonia, related to patient age and immobility
-deep vein thrombosis, immobility leads to formation of thrombus in veins, possibility of pulmonary embolus
what are typical stroke symptoms?
-confusion and dizziness
-slurred or loss of speech
-difficulty in swallowing
-hemiplagia (paralysis on one side)
what are severe stroke symptoms?
-loss of consciousness
-severe mental handicap
-severe physical handicap
what is an aneurysm?
dilation of all 3 layers of the arterial wall, lack of blood supply distally can cause ischemia
what is a carotid artery aneurysm?
-dilation of blood vessel
-reduced blood flow to the brain
what can cause carotid artery aneurysm?
what does FMD stand for?
what is FMD?
-dysplasia of the media with overgrowth of collagen
-reduced blood supply to the brain
-part of collagen vascular system disorder group
what does FMD look like on ultrasound?
bead like appearance
what is a carotid body tumor?
tumor on the carotid body; carotid body is a small mass of vascular tissue located next to the carotid sinus between the ECA and ICA.
what do the chemoreceptors in the carotid body do?
they are sensitive to the partial pressure of carbon dioxide in the blood; they signal the respiratory center in the brain to increase or decrease the rate of breathing.
where does the blood supply for a carotid body tumor come from?
what is the treatment for a carotid body tumor?
Surgical; may require ligation of ICA or ECA
what is carotid dissection?
-separation of the intima from the media
-separate flow channel within the dissected wall
-type of aneurysm, takes the blood that would normally travel distally and keeps it between the dissection of the intima and media
what are the causes of carotid dissection?
-trauma to neck
-congenital weakness of the media
what are some types of therapeutic intervention for the prevention of stroke?
-blood pressure meds
-weight control/low cholesterol diet
-anticoagulant therapy (aspirin,persatine)
what is endarterectomy?
surgical removal of the intraluminal atherosclerotic material
why is endarterectomy not performed with complete occlusion of cervical CCA or ICA?
because collaterals have already developed and are working
how do dr's decide when to perform endarterectomy?
decision based on extent of disease, severity of disease, patient symptoms, and patient's medical condition
what is a bypass graft?
provides alternative pathway around stenosis; acts as collateral circulation.
when are bypass graft's used?
may be performed for stenosis in;
rarely performed for ICA disease
although tortuous vessels can be normal and with no issues, is there anything that can be done if they do cause issues?
yes, surgical intervention for correction of coiling, kinking and tortuosity. vessels are sometimes shortened, procedure is sometimes performed with endarterectomy
what are the possible symptoms of RIND?
-aphasia (inability to speak)
-dysphasia (difficulty speaking)
-dysarthria (slurring and speech distortion due to lack of muscular control)
-lateralized paresthesia (numbness or tingling)
-hemiplegia (paralysis on side of body)
-hemiparesis (lateralized weakness)