Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Carotid stenosis ++ 433.1 Occlusion and stenosis of carotid artery ++ I65.29 Occlusion and stenosis of unspecified carotid artery ++ 5D Impaired motor function and sensory integrity associated with non-progressive disorders of the central nervous system—acquired in adolescence or adulthood1 +++ Description ++ Carotid arteries become blocked or receive limited blood flowCarotid stenosis: narrowing of the arteryPlaque builds up in the arteryPlaque can be stable and asymptomaticClots can lead to a strokeCan result in a sudden, specific neurological deficit +++ Essentials of Diagnosis ++ Stethoscope on carotid artery, bruit soundLipid profileTriglycerides testCVA symptoms +++ General Considerations ++ Ischemic (2 types)Thrombotic: Atherosclerotic plaques and hypertension (HTN) produce CVA due to plaques that form at the branching and curves of arteriesEmbolic: An embolus that causes a CVA can travel from the heart, internal carotid artery thrombosis, or atheromatous plaque of the carotid sinusBranches of the middle cerebral artery (MCA) are most commonly affected +++ Demographics ++ About 4 million Americans suffer physical impairments and disability from stroke2/3 of all CVAs occur in individuals older than 65 years of ageAfter age 55, risk of stroke doubles every 10 yearsIncidence is greater in men than in women and twice as high in blacks as in whitesCerebral infarction (thrombosis or embolism) is the most common form, accounting for 70% of all strokes, followed by hemorrhages at 20%, and 10% unspecified +++ Signs and Symptoms ++ Patients may not have any narrowing or blockage of arteriesPalpable pulse under the jaw lineHeadachesBlurred visionMemory lossSigns 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 hemorrhageWeakness in a region, motor planning deficitsSymptoms of cerebrovascular accident (CVA) includeSensory loss/dysfunctionAphasiaDysarthriaCommunication difficulties/DysphagiaVisual field defectsCognitive impairmentHemiplegia (most commonly) Motor lossAutonomic dysfunctionPerceptual changesPersonality, and behavioral changesChanges in consciousnessSpasticity or hypertonicity +++ Functional Implications ++ CVALoss of independence with all aspects of mobility, ADLs, self-careLoss of ability to interact with others effectivelyDifficulty with cognitive processing, particularly executive function +++ Possible Contributing Causes ++ HTNArteriovenous malformation (AVM)HyperlipidemiaCardiovascular disease, coronary artery disease, atrial fibrillationObesityAlcohol abuseSmokingSedentary lifestylePulmonary insufficiencyPeripheral vascular diseaseDiabetesFamily history of stroke or transient ischemic attackPatent foramen ovaleMarfan syndromeFibromuscular dysplasia +++ Differential Diagnosis ++ Transient ischemic attack (TIA)Hypertensive encephalopathyMeningitisHydrocephalus +++ Laboratory Tests ++ Vital signsStethoscope on carotid artery, ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.