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Non-Atherosclerotic Arterial disease-Cerebral . Hemorrhage: Underlying cause of 16% of all strokes. Hypertension is leading cause of cerebral hemorrhage. Aneurysm: can be congenital or result from atherosclerosis. . Hemorrhage cont. . Trauma can cause intracerebral or subarachnoid bleed.

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non atherosclerotic arterial disease cerebral
Non-Atherosclerotic Arterial disease-Cerebral
  • Hemorrhage: Underlying cause of 16% of all strokes.
    • Hypertension is leading cause of cerebral hemorrhage.
    • Aneurysm: can be congenital or result from atherosclerosis.
hemorrhage cont
Hemorrhage cont.
  • Trauma can cause intracerebral or subarachnoid bleed.
  • Thrombolytic Therapy: Lysis of thrombus (dissolution of or decomposition of thrombus)
  • Heparin Therapy: anticoagulant
non athero cerebral
Non-athero cerebral:
  • Emboli
    • Greatest number of cerebral emboli come from the heart.
    • Most go to the posterior circ
    • Numerous materials can embolize.
      • Air
      • Tumor
      • Thrombus
      • atherosclerosis
cerebral cont
Cerebral cont.
  • Aneurysm
    • Congenital: Berry (small, sacular), Arterio-venous malformation (avm) artery and vein connected causing shunting of flow.
    • Hypertension
    • Trauma (AVM)
non athero cerebral cont
Non-athero cerebral cont.
  • Inflammatory conditions:
    • Sickle Cell: young, African-American population
    • Periarteritis Nodosa/Polyarteritis:
      • A collegen / allergic disease
      • Necrosis of media and thickening of the intima
      • Segmental arteritis and possible small aneurysms occur
      • Can obstruct function of any arterial system involved
cerebral cont7
Cerebral cont.
  • Temporal Arteritis
    • Intimal proliferation and inflammation/cause unknown/ because patients also have polymyalgia rheumatica it is considered a rheumatic disease.
    • It affects medium size branches of carotid arteries, coronaries, aorta and it’s branches.
    • Complications: blindness, stroke, heart attack, and norrowing of major aortic branches.
    • 50 YO women. Women>Men.
non athero extracranial causes
Non-athero extracranial causes .
  • Takayasu’s: also a form of arteritis and is distinguished from Temporal Arteritis microscopically and clinically.
    • Predominantly affects young women,Asian.
    • Involves predominantly the aortic arch and it’s branches. Death is caused by CHF and CVA
    • Treated with corticosteroids
non athero extracranial causes cont
Non-athero extracranial causes cont.
  • Periarteritis nodosa/ polyarteritis
    • An inflammatory disease of small and medium sized arteries. Affects any organ or body system.
  • Temporal Arteritis
  • Reference: Cardiology Clinics PVD in the Elderly. 8-1991.
  • Reference: Diseases of the Heart and Circulation. 3rd ed. Wood, Paul page.727
non athero extracranial cont
Non-athero extracranial cont.
  • Carotid Body Tumor
    • Carotid body: 1X1 mm, in adventitia at carotid bifurcation, a component of the autonomic nervous system that helps control arterial PH, blood gas level, and blood pressure.
    • A paraganglioma, low incidence of malignance, highly vascular.
    • Located most often between ECA and ICA.
    • Causes palpable mass, neck pain, headache, laryngeal nerve palsy, and invasion of carotid arteries.
non athero causes extracranial
Non-athero causes extracranial
  • Dissection: Under forced pressure blood separates layers of the arterial wall.
    • Usually trauma
    • Can be spontaneous
    • Spontaneous dissection many times results with nonviolent trauma: exercise or rapid neck motion.
    • Contributing factors to spontaneous dissection: hypertension, fibromuscular hyperplasia, and conditions that weaken the arterial wall – Marfan’s syndrome, cystic medial necrosis, and Ehlers-Danlos syndrome.
dissection cont
Dissection cont.
  • Thrombosing is associated
    • Occlusion or hemdynamic stenosis
    • Embolic source
    • Either can cause TIA/CVA
    • Anitcoagulate or thrombectomy and repair wall
dissection cont13
Dissection cont.
  • A false lumen is created.
  • If separation is between media and adventia a pseudoaneurysm can occur.
non athero renal pathologies
Non-athero renal pathologies
  • Fibromuscular Dysplasia: Hyperplasia of the media or intimal layer of the renal artery. Forms concentric bands usually located in the mid to distal renal arteries.
    • Occurs more frequently in women
    • Onset can be at early age (teens) or before 50.
    • More than one band forms creating “tandem lesions). Known as “string of beads” on arteriogram.
non athero renal pathologies15
Non-athero renal pathologies
  • Rare causes of renovascular disease
    • Takayasu’s/ Polyarteritis
    • Renal artery thrombosis or embolism
    • Extrinsic renal artery compression by cyst or tumor
    • Abdominal aortic coarctation
    • Congenital vascular lesions
    • Reference: Bernstein, 4th ed, page 652
non atherosclerotic mesenteric lesions
Non-atherosclerotic mesenteric lesions
  • Compression syndrome
    • Median Arcuate ligament can compression the lumen of the celiac trunk or SMA
    • This is most often intermittant
    • Rarely a cause of bowel ischemia
non athero mesenteric lesions cont
Non-athero mesenteric lesions cont.
  • Emboli
    • Most often from heart
    • Thrombus
    • Tumor
references vas phy 2
References Vas Phy 2
  • Slide 1 Handout from Bowman Grey lecture on carotid duplex, 1984.
  • Slide 2 Cardiology Clinics, PVD in Elderly, August 1991, Saunders. Breslin, Ed. Pgs.508-509
  • Slides 5 & 7 Taber’s Cyclopedic Medical Dictionary, Davis, 1985.
  • Slide 6 Diseases of the Heart and Circulation 3rd ed. Wood’s, Paul. Lippincott, 1969.pg 727.
refer vas phy 2 cont
Refer Vas Phy 2 cont.
  • Slides 7,8,9 Cardiology Clinics, PVD in Elderly, August 1991. PGS 547-553
  • Slide 10 Introductin to Vascular Ultrasound, 4th Ed., Zwiebel, Saunders, 2000.pgs. 163-165 &160.
  • Slides 11,12,13 Cardiology Clinics, PVD in Elderly, August 1991. Pg.528. / Introduction to Vascular Ultrasound,4th Ed. Pages 156-161.
ref vas physi 2 cont
Ref Vas Physi 2 cont.
  • Slide 14 Cardiology Clinics, PVD in Elderly, August 1991. Pgs 528-530./ Ciba, Heart vol 5. 1981, Pg 229.
  • Slide 15 Vascular Diagnosis, 4th Ed., Bernstein, Mosby, 1993, Pg 652
  • Slide 16 Introduction to Vascular Ultrasonography, Zwiebel 4th, Ed. Saunders,2000 Pgs 421-422.