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How much does the brain weigh?
How much total % of CO?
How much does the body's oxygen supply does the brain receive?
- 2% of total body weight
- Receives 15% of CO
- Consumes 20% of the body's oxygen supply
What four vessels supply blood directly to the brain?
2 internal carotid arteries - Anterior Circulation
2 vertebral arteries - Posterior Circulation
Where does the CCA bifurcate?
at the upper border of the thyroid or C4
What are three possible cerebral collateral pathways?
1.) Ophthalmic A via ECA branches
2.) Anterior Communicating A.
3.) Posterior Communicating A.
Does the ICA have any extracranial branches?
NO, only intracranial branch- Ophthalmic A.
What is a way to indentify ECA and ICA that is not 100% accurate?
Use the temporal tap.
If on ECA will detect augmentations in diastole because will be tapping on Superifical Temporal A.
What is intimal thickening?
What is the abbreviation for intimal thickening?
Who is affected by this?
What should you do when doing an ultrasound?
What is a way to fix this?
- *Small particles of plaque are deposited within intima that causes thickening.
- *Happens with aging
- *Measure the intimal thickness.
- *CEA- Carotid Endarterectomy
What does CIMT stand for?
Carotid Intima-Media Thickness
What does CAD stand for?
Coronary Artery Disease
What is fibromuscular hyperplasia?
happens after a CEA because the media feels naked b/c missing intima. So the intimal media begins to try to cover itself up and gets thicker. It's not plaque build up.
What is another name for fibromuscular hyperplasia?
What is a another name for Myointimal Hyperplasia?
What does FMD stand for?
What is it?
Who usually gets it the most?
What does it look like on ultrasound?
What is the most common place?
What is the most common place in the ICA?
- Fibromuscular Dysplasia
- Media has abnormal growth and swells.
- Seen more in women and Asian descent.
- String of pearls
- Distal Renal Artery
- Distal ICA
What does FMD stand for?
Why does it happen?
It just happens! Genetic?
Doesn't happen after CEA.
What does FMD stand for?
What does it look like on ultrasound? (2)
1.) String of beads - looks bumpy.
2.) Focal areas higher velocities
What are the two types of plaque and the descriptions of each?
- 1.) Uncomplicated
- Uniform between intima and media
- 2.) Complicated
- Edges, cap becoming irregular
What are 6 common causes of stroke?
- 1.) Atherosclerosis
- 2.) Embolis
- 3.) Hypertension
- 4.) Dissection
- 5.) Prethrombotic
- 6.) Vasospasm
How could Embolis cause a stroke? (2)
could be from heart from the left atrium.
How can hypertension cause a stroke? (2)
vessel walls can rupture.
Vessel walls are damaged, so intima wants to repair itself, so intima thickening.
How can a dissection cause a stroke?
Creates a false lumen so thrombosis formation.
How can Prethrombotic States cause a stroke?
What are some of these? (3)
- 1.) Protein C deficiency
- 2.) Protein S deficiency
- 3.) Antithrombin 3 deficiency
How can a Vasospasm cause a stroke? (2)
SAH- Subarachnoid hemorhage
So constricts, narrowing diameter causing higher resistance.
What is one way that can cause a Vasospasm? (3)
bleeding in the head- head trauma
extra pressure on the arterials
Patient will experience stroke like symptoms
How long does the symptoms of a TIA last?
What does a TIA stand for?
Chance of CVA?
less than 24 hours but usually only lasts a few minutes.
Transient Ischemic Attack
Almost a 10% chance of a CVA in 3 months.
What does RIND stand for?
What are the symptoms of RIND?
Reversible Ischemic Neurological Deficient
Symptoms lasts longer than 24 hours, but return back to totally normal after usually 3 weeks.
What does CVA stand for?
How long does the symptoms last?
Lasts greater than 24 hours.
Permanent neurological damage, never 100%
What vessels are in the anterior circulation?
- 1.) ICA
- 2.) ACA
- 3.) Anterior Communicating A.
- 4.) MCA
What vessels are in the posterior circulation?
- 1.) Vertebrals
- 2.) Basilar
- 3.) Posterior Cerebral A.
- 4.) Posterior Communicating A.
If you loose the forward flow component in the ICA Distal, What can it signify?
Could be a problem in the ACA or MCA.
What are the main symptom of Anterior Circulation?
1-sided issues - Unilateral
What is the main symptom of Posterior Circulation?
Both sided issues - Bilateral
What are the 6 signs and symptoms of anterior circulation?
- 1.) Monocular Visual Disturbance
- 2.) Amaurosis Fugax
- 3.) Aphasia
- 4.) Mono or hemiparesthesia
- 5.) Mono or hemiparesis
- 6.) Homonymous hemianopia?hemianopsia
What is monocular visual disturbance?
Complete loss of vision in one eye.
So if someone has monocular visual disturbance where should you look?
Focus on the ICA or Ophthalmic of the eye with problems.
What is Amaurosis Fugax?
What is it caused by?
Patient describes a shade being pulled over eye.
It is a emboli problem in the retinal or ophthalmic artery
What is general aphasia mean?
why does it happen?
without speech or unable to communicate
Dysfunction in the brain
What does mono or hemiparesthesia mean?
Where should you scan?
1 sided numbness, tingling sensation.
Scan opposite side as problem.
What is mono or hemiparesis?
1 sided paralysis
movement is impaired b/c of weakness but can still move
What does homonymous hemianopia mean?
partial loss of visual field in both eyes
What are the 9 sign and symptoms of posterior communication?
- 1.) homonymous hemianopia
- 2.) paraesthesia of any or all extremities
- 3.) paresis of any or all extremities
- 4.) ataxia
- 5.) drop attacks
- 6.) Diplopia
- 7.) Dysphagia
- 8.) Dysarthria
- 9.) Vertigo
What is homonymous hemianopia?
Partial loss of visual field in both eyes
What is paraesthesia of any or all extremities?
What causes it?
Numbness or tingling of both arms or both legs or one of each.
Caused by a reduced blood supply to nerves.
What does paresis of any or all extremities mean?
Paralysis or impaired movement or loss of voluntary movement.
What does ataxia mean?
Gait disturbance or trouble touching an article with the hand.
What are drop attacks?
Sudden musculature weakness, but do not lose consciousness.
What is diplopia?
Double vision- Bilateral visual blurring
Two images from one object.
What is dysphagia?
What is dysarthria?
What causes it?
people have difficultly speaking and pronouncing words.
due to impairment of the muscles that help people talk
What is vertigo?
dizziness or a spinning sensation
What are 6 non-specific signs and symptoms?
- 1.) Confusion
- 2.) Dizziness
- 3.) Headache
- 4.) Impaired mental status
- 5.) Loss of memory
- 6.) Syncope
Specifically --- when someone has aphasia, arm paralysis or arm paresis --- where is the problem usually at?
Disease in MCA.
Specifically --- when someone has leg paralysis or incontinence --- where is the problem usually at?
Specifically --- if someone in coma or has dysplexia --- where is the problem usually at?
What does kinking or coiled vessels cause?
causes higher velocites
can hear a Bruit
Is a bruit in the ECA or ICA more dangerous?
ICA more serious
bruit can signify a high grade stenosis in the ICA.
What are four possible shapes of vessels in ICA?
What should you do if ICA or ECA coils or kinks?
Need to document.
Need to know will hear Bruit b/c of shaped and possible not stenosis.
What are Lacunar Strokes?
Can you see in the ultrasound?
- Blockages in small arteries deep in the brain.
- Leukoaraiosis- scattered loss of white matter in the brain.
- NO vessels to small to see.
What does the FAST stand for?
F - facial dropping
A - arm weakness
S - Speech
T - Time