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Condition/Disorder Synonym

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  • Carotid stenosis

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ICD-9-CM Code

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  • 433.1 Occlusion and stenosis of carotid artery

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ICD-10-CM Code

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  • I65.29 Occlusion and stenosis of unspecified carotid artery

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Preferred Practice Pattern

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Key Features

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Description

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  • Carotid arteries become blocked or receive limited blood flow

  • Carotid stenosis: narrowing of the artery

  • Plaque builds up in the artery

  • Plaque can be stable and asymptomatic

  • Clots can lead to a stroke

  • Can result in a sudden, specific neurological deficit

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Essentials of Diagnosis

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  • Stethoscope on carotid artery, bruit sound

  • Lipid profile

  • Triglycerides test

  • CVA symptoms

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General Considerations

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  • Ischemic (2 types)

    • Thrombotic: Atherosclerotic plaques and hypertension (HTN) produce CVA due to plaques that form at the branching and curves of arteries

    • Embolic: An embolus that causes a CVA can travel from the heart, internal carotid artery thrombosis, or atheromatous plaque of the carotid sinus

      • Branches of the middle cerebral artery (MCA) are most commonly affected

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Demographics

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  • About 4 million Americans suffer physical impairments and disability from stroke

  • 2/3 of all CVAs occur in individuals older than 65 years of age

    • After age 55, risk of stroke doubles every 10 years

  • Incidence is greater in men than in women and twice as high in blacks as in whites

  • Cerebral infarction (thrombosis or embolism) is the most common form, accounting for 70% of all strokes, followed by hemorrhages at 20%, and 10% unspecified

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Clinical Findings

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Signs and Symptoms

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  • Patients may not have any narrowing or blockage of arteries

  • Palpable pulse under the jaw line

  • Headaches

  • Blurred vision

  • Memory loss

  • Signs and symptoms are dependent on the part(s) of the brain affected by the CVA as well as the amount of damage to the tissues from obstruction or hemorrhage

  • Weakness in a region, motor planning deficits

  • Symptoms of cerebrovascular accident (CVA) include

    • Sensory loss/dysfunction

    • Aphasia

    • Dysarthria

    • Communication difficulties/Dysphagia

    • Visual field defects

    • Cognitive impairment

    • Hemiplegia (most commonly) Motor loss

    • Autonomic dysfunction

    • Perceptual changes

    • Personality, and behavioral changes

    • Changes in consciousness

    • Spasticity or hypertonicity

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Functional Implications

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  • CVA

    • Loss of independence with all aspects of mobility, ADLs, self-care

    • Loss of ability to interact with others effectively

    • Difficulty with cognitive processing, particularly executive function

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Possible Contributing Causes

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  • HTN

  • Arteriovenous malformation (AVM)

  • Hyperlipidemia

  • Cardiovascular disease, coronary artery disease, atrial fibrillation

  • Obesity

  • Alcohol abuse

  • Smoking

  • Sedentary lifestyle

  • Pulmonary insufficiency

  • Peripheral vascular disease

  • Diabetes

  • Family history of stroke or transient ischemic attack

  • Patent foramen ovale

  • Marfan syndrome

  • Fibromuscular dysplasia

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Differential Diagnosis

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