The Anterior Circulation is made of up what Vessels?
ICA
ECA
and their branches
The significant curve of the Distal ICA is the?
Carotid Syphon
How many branches does the ECA have?
8
Superior Thyroid
Asscending Pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Superficial Temporal
Maxillary
First Branch off the ECA?
Superior Thyroid
What is the first Major branch of the ICA?
Opthalmic
What percentage of blood from the CCA goes to the ICA?
70-80%
Most important Branches of the Subclavian artery?
Vertebral
Thyrocervical
Internal Thoracic
Costocervical
What Vessels make up the Posterior Circulation?
Right and Left Vertebrals
Basilar Artery
Circle of Willis
What artery(s) courses through the Transverse Foramina?
The Vertebral artery(s)
The Vertebral Artery enters the skull through what structure?
Foramen Magnum
What two vessels come together to form the Basilar Artery?
Right and Left Vertebrals
What vessel divides into the Posterior Cerebral Arteries to form part of the Circle of Willis?
The Basilar Artery
The Circle of Willis connects what two Circulatory systems?
The Anterior and Posterior Circulatory Systems
The Posterior Cerebral Arteries of the Circle of Willis are connecte to the Distal ICAs by what vessels?
Posterior Communicating
The Distal ICA divides into what 2 vessels?
Anterior Cerebral Arteries
Middle Cerebral Arteries
The Middle Cerebral arteries are joined to the Anterior Cerebral arteries by what vessels?
Anterior Communicating Arteries
What is the most common anomaly of the Circle of Willis?
Absence or Hypoplasia of one or both Communicating arteries.
Peri-Oribital Circulation is made up of what artery and its branches?
Opthalmic artery
The branches of the opthalmic artery are?
Lacrimal
Supraorbital
Frontal
Nasal
The _______________ travels Anteriorly and Superiorly to the globe (eye)?
Supraorbital artery
The __________ exits the orbit medially to supply blood to the mid forehead?
Frontal Artery
What 2 vessels of th periorbital circulation join the ECA through various branches such as the Superficial Temporal Artery?
Supraorbital
Frontal
The _________ (which comes from the Frontal artery) supplies blood to the nose and becomes the Angular artery?
Nasal Artery
The _________descends along the lateral border of the nose.
Angular Artery
The Angular artery connects to the ECA via the ________artery.
Facial
The Anterior vessels (ICA, Anterior Cerebral, MCA and Anterior Communicating arteries) supply blood to what?
The Brain's cerebral hemispheres.
The Left Hemisphere of the brain controls what side of the body?
Right side.
The Right cerebral Hemisphere controls what side of the body?
Left side
Lateralizing symptoms indicate what about a stroke?
Which side of the brain or hemisphere was affected by a stroke.
ex. Lt arm numbness=right hemispheric stroke by the anterior circulation.
Non-lateralizing symptoms indicate problems with what?
The brain stem or posterior circulation
Amaurosis Fugax is what?
Temporary vision loss in one eye- related to disease of the ipsilateral ICA.
Define Unilateral Paresis
weakness or slight paralysis on one side of the body.
Define Unilateral Parasthesia or Anesthesia
tingling, numbness, or lack of feeling on one side of the body.
What is the term for impaired speech?
Dysphasia
What is the term for the inability to speak.
Aphasia
What hemisphere of the brain is dominant in Left handed people?
Right Hemisphere.
What is a patient describing when they say "it was as if a shade was being pulled down over one eye?"
Amaurosis Fugax
Posterior Circulation (vertebrals, basilar, posterior cerebral, and posterior communicating arteries) supply blood to what?
Brain stem
Cerebellum
Occipital lobe of the brain
Define Vertigo
Difficulty maintaining equilibrium-sensation of moving around in space or having objects move around the person. It is NOT Dizzingess or Lightheadedness
The lack of muscular coordination usually described as the inability to control gait or to touch an object with the hand is defined as?
Ataxia
A Drop Attack is?
Falling to the ground without other symptoms or loss of consciousness.
Non-localizing symptoms are those whose origins are not readily discernable. Name 3.
Dizziness
Syncope
Difficulty w/speech
headache
Confusion
The affects of a TIA are long lasting, true or false?
False, they last few min.-few hours never >24hours.
The most common sources of TIA are?
Emboli from the Carotid(s) or heart.
Define R.I.N.D.
Reversable Ischemic Neurologic Deficit
The affects of RIND usually resolve completely with time, True or False?
True, brain tissue is damaged but recovers comletely with time.
Does Vertebrobasilar Insufficiency (VBI) usually cause Unilateral or Bilateral symptoms of visual blurring or parasthesia and complaints of vertigo, ataxia, and drop attacks.
Bilateral
Does a Cerebrovascular Accident (CVA) usually cause temporary or permanent neurological deficit?
Permanent
Acute symptoms of CVA are associated with _____onset and considered unstable.
sudden
In a Stroke in Evolution symptoms come and go and are considered _______?
Unstable
A Completed Stroke's symptoms are considered stable because why?
There is no progression or resolution of symptoms.
The Two main causes of Cerebrovascular Insuff. are?
Ischemia and Hemorrhage
The leading causes of Ischemia are?
Atherothrombotic
Cardiogenic
Lacunar Infarction
Lacunar Infarction is characterized by?
Small circumscribed area lost brain tissue caused by occlusion of one or the small penetrating arteries into the brain.
Cerebrovascular Insuff. caused by hemorrhage may be the result of what?
Hypertension
Ruptured Anneurysm
Trauma-ie. subarachnoid hemorrhage
Atherosclerosis is a form of arteriosclerosis that is characterized by:
Localized accum. of lipid containing material, smooth muscle cells, collagen, fibrin, and platelets that form beneath or within the intimal surface of the blood vessel.
What is Takayasu's Arteritis?
Chronic Inflammation of arteries that result in occlusion or near occlusion.
Temporal Arteritis is?
Inflammation of Distal Superficial Temporal artery that may cause severe headache &/or sudden unilateral blindness.
Arterial Dissection is most commonly caused by what?
Trauma
A thin membrane divides a true and false lumen in the case of this arterial lesion?
Dissection.
Dissection is?
A sudden tear in the intimal wall
Fibromuscular Dysplasia usually occurs in what patient population?
Younger Women
FMD is commonly caused by what?
Dysplasia of the media along with collagen overgrowth in the mid-distal portions of a vessel.
Intimal thickening due to vascular injury is?
Neointimal Hyperplasia.
Neointimal Hyperplasia may produce a hemodynamically significant stenosis 6-24 months following this procedure?
Endarterectomy
Doppler of the Frontal artery behind the eyelid should demonstrate what kind of flow?
Antegrade
Compression of facial, superficial temporal, and infraorbital arteries during the Doppler evaluation of the Frontal artery should produce?
No diminshed flow, or retrograde flow.
Ipsilateral compression of the carotid artery during Frontal artery Doppler should demonstrate?
Diminshed or retrograde flow.
Retrograde Flow of the Frontal artery means there is an occlusion of?
Ipsilateral Carotid
Reversed flow of the Frontal artery during vessel compressions means what?
The vessel being compressed (ie. facial, superficial temporal, or infraorbital) is supplying collateral flow to the area and there is an occlusion of the ipsilateral carotid.
The use of a sunction cup applied to the eye is during what procedure?
Oculopneumoplethsymography (OPG-Gee)
Contraindications for OPG are? Name 4.
Allergies to local anesthetics
Eye surgery w/last 6 mo.
Past Spontaneous Retinal Detachment
Acute or Unstable Glaucoma
What is a limitation to Continuous Wave Doppler.
There is a fixed sample size, no range resolution or ability to place the sample volume at a specific depth.
The optimum angle of Insonation during a Carotid Duplex Study is?
45-60 degrees
In spectral analysis, Time is displayed by what?
The horizontal
In spectral analysis Frequency shift is diplayed where?
The Vertical
Amplitude is characterized by what in a spectral analysis?
Brightness of the signal or wave.
During carotid scanning, the sample volume should be?
The smallest possible 1-1.5mm
Intimal thickness is people over 60 should be?
< or = .9mm
Distal to a stenosis, there may be increased or decreased flow through diastole?
Increased.
Distal to a stenosis- acceleration time is usually seen to?
Increase
Tardus Parvus is characterized by what?
A systolic peak that is slow to rise and increased flow through diastole due to the pressure drop distal to a stenosis.
During ICA occlusion the ipsilateral Carotid wave form will show?
Increased Resistance(sharper upstroke) and loss of Diastolic component- "knocking on the door"
Increased flow of ECA, Contralateral ICA, or either Vertebral indicates the presence of what?
ICA occlusion.
Aortic Regurg. or Insuff. may be seen on spectral annalysis of the Carotid artery how?
Antegrade flow of the CCA in systole w/sustained reversal of flow through diastole.
PSV > or = to 290cm/sec and EDV of > or = 80cm/sec is characteristic of?
> or = 60% Diameter reduction of the ICA
ICA PSV/CCA PSV ratio of > or = 4.0 is indicative of?
> or = 70% diameter reduction of ICA.
Aliasing is a Doppler artifact created by what?
Flow information exceeding the Nyquist limit( 1/2 the PRF) that cannont be displayed.
To Increase the Nyquist limit you can?
Change to a lower Frequency probe or alter the angle to decrease the depth of the vessel.
Define Crosstalk.
Spectral Mirror image artifact due to the presence of strong reflectors or overly high gain setting.
[1-(d/D)] x 100
where d=diameter of residual lumen
where D=diameter of true lumen
is the equation for?
The calculation of % stenosis based on vessel diameter.
[1-(d2/D2)] x 100 where d=diameter of residual lumenwhere D=diameter of true lumenis the equation for?
The calculation for %stenosis based on Area reduction.
A 50% Reduction in Diameter is = to?
75% reduction in cross sectional area.
The angle of Insonation for Transcranial Doppler is?
