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Medicine

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Neurology

Question
21 out of 27
 

Investigation of choice for screening of proximal internal carotid artery stenosis is: (AIIMS May 2011)



A Doppler flow USG

B CT subtraction angiography

C MRI

D Angiography (DSA)

Ans. A

Doppler flow USG

INVESTIGATIONS –

1). CT Scans

a. Infarcts are detected after 24 – 48 hours. Q

b. Fail to detect small ischemic stroke in the posterior fossa. Also fail to show small cortical infarcts

c.Better than MRI in detecting early hemorrhage Q

CT Scan

a. Infarct upto 12 hrs. CT may be normal in cerebral infarct.

b. Then low attenuations occur in 24-36 hrs ischemic tissue swells producing a mass effect by 2nd to 3rd day Subsides by 7th day.

c. After 7 days infarcted tissue is invaded by phagocytic glial cell which increases attenuation. So plain CT looks near normal.

d. Same time infarcted area is also invaded by New Blood vessel which show an area of enhancement after iodinated contract media. Enhancement is maximum in 2nd week.

2). MRI

a. It can detect infarct in all locations of brain.

b. FLAIR (Fluid attenuated inversion recovery) Q

c. MRI with fat saturation – used to visualize extra & intracranial arterial dissection. Q

3). Cerebral Angiography – It is the ‘gold standard’ for identifying and quantifying atherosclerotic stenosis, aneurysm, Q

vasospasm, intraluminal thrombi, fibromuscular dysplasia, A – V fistula, vasculitis and collateral channels of blood flow.

4). Ultrasound techniques –

a. Doppler ultrasound assessment of flow velocity. (it is the best screening test for ICA stenosis).

b. Transcranial Doppler assessment of middle, anterior and posterior cerebral artery & vertebrobasilar flow.

5). PET (Positron emission tomography) - Can quantify cerebral blood flow.

6). SPECT (single photon emission tomography)

MANAGEMENT – (Ref. Hari-18th ed., pg- 3271)

Main goal is to prevent or reverse brain injury.

Neurology Flashcard List

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