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  • Carotid stenosis

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  • 433.1 Occlusion and stenosis of carotid artery

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  • I65.29 Occlusion and stenosis of unspecified carotid artery

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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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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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Laboratory Tests

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  • Vital signs
  • Stethoscope on carotid artery, bruit sound
  • Neurovascular tests: neck flexion for meningeal irritation, ...

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