1. 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.

2. Hemorrhage cont. Trauma can cause intracerebral or subarachnoid bleed. Thrombolytic Therapy: Lysis of thrombus (dissolution of or decomposition of thrombus) Heparin Therapy: anticoagulant

3. Hemorrhage cont.

4. 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

5. Cerebral cont. Aneurysm –Congenital: Berry (small, sacular), Arterio- venous malformation (avm) artery and vein connected causing shunting of flow. –Hypertension –Trauma (AVM)

6. 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

7. 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.

8. 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

9. 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. 3 rd ed. Wood, Paul page.727

10. 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.

11. 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.

12. Dissection cont. Thrombosing is associated – Occlusion or hemdynamic stenosis –Embolic source –Either can cause TIA/CVA –Anitcoagulate or thrombectomy and repair wall

13. Dissection cont. A false lumen is created. If separation is between media and adventia a pseudoaneurysm can occur.

14. 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.

15. 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, 4 th ed, page 652

16. 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

17. Non-athero mesenteric lesions cont. Emboli –Most often from heart –Thrombus –Tumor

18. 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 3 rd ed. Wood’s, Paul. Lippincott, 1969.pg 727.

19. 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, 4 th 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,4 th Ed. Pages 156-161.

20. 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, 4 th Ed., Bernstein, Mosby, 1993, Pg 652 Slide 16 Introduction to Vascular Ultrasonography, Zwiebel 4 th, Ed. Saunders,2000 Pgs 421-422.