Stenoticocclusive Disease Investigations

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Carotid stenosis and ulceration

Carotid stenosis and ulceration

Indication for angiography

1. With suspected extracranial vascular disease

- a recovered stroke patient 1 if ultrasound at further risk J positive.

- following TIAs

2. With suspected intracranial vascular disease. Angiography identifies the site and nature of the disease in intra- and extracranial vessels, and indicates the degree of collateral circulation. Suspected carotid disease: demonstrate both carotids, intracranial vessels, the aortic arch and origins of the vertebráis. Approximately two-thirds of patients with carotid territory attacks will have angiographic abnormality.

Suspected vertebrobasilar disease: note the intracranial vessels and the course of the vertebral artery through the cervical foramina where osteophytic encroachment may occur. Note that proximal subclavian occlusion may result in retrograde flow down the vertebral arteries into the subclavian arteries, and cause TIAs aggravated by arm exercise - subclavian steal (page 246).

3. IDENTIFY FACTORS WHICH MAY INFLUENCE TREATMENT AND OUTCOME

General investigations identify conditions which may predispose towards premature cerebrovascular disease. These are essential in all patients. Chest X-ray - cardiac enlargement - hypertension/valvular heart disease ECG- - ventricular enlargement and/or arrhythmias - hypertension/embolic disease recent myocardial infarct - embolic disease sinoatrial conduction defect - embolic disease/output failure Blood glucose - diabetes mellitus Serum lipids and cholesterol - hyperlipidaemia ESR - Vvasculitis/collagen vascular disease

Auto-antibodies - f

Urine analysis - polyarteritis, thrombocytopenia Full blood count - polycythaemia, thrombocytopenia VDRL-TPHA - neurosyphilis Prothrombin time - circulating auto-anticoagulants Note drug history - oral contraceptives, amphetamines, opiates Cervical spine X-ray - atlanto-axial subluxation

Following the interpretation of these preliminary investigations, more detailed studies may be required, e.g.

- cardiac ultrasound — cardiac embolic source

- blood cultures-subacute bacterial endocarditis

- HIV screen- AIDS

- sickle cell screen

- plasma electrophoresis > haematological disorder

- viscosity studies

- anticardiolipin antibodies - antiphospholipid syndrome

- muscle biopsy - mitochrondrial disease

See inflammatory vasculitis and blood diseases (pages 261, 264)

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