Subarachnoid Hemorrhage (SAH)

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PATHOLOGY REPORT: CAROTID ARTERY DISEASE ~ ARIADNA BOGATSKY BIO 108 ~
OVERVIEW: Carotid Artery Disease (CAD) is the narrowing (stenosis) of the carotid arteries caused by the build-up of plaque in the lumen, (atherosclerosis). CAD is a major cause of ischemic strokes in the United States.
BACKGROUND
GROSS ANATOMY: The bilateral common carotid arteries provide O2-rich blood to the head.
The right common carotid arises directly from the aortic arch; the left common carotid arises as a branch off of the brachiocephalic trunk. After leaving the mediastinum, both ascend into the neck, where, at the level of C-3 to C-4, they bifurcate into the external and internal carotids. The external carotids supply blood to the face; the internal carotids supply blood to the brain. The common carotid bifurcation, at the origin of the internal carotid artery, is the most frequent site of atherosclerotic lesions.
HISTOLOGY: Carotid arteries exhibit the tunics present in large blood vessels. From the lumen out, tunics appear in the following order: tunica intima (endothelium + CTP), tunica media (smooth muscles providing vasoconstriction and vasodilation), tunica externa (CTP + vasa vasorum: blood vessels supplying O2 to vessel wall).
The build-up of plaque occurs at the site of the tunica intima.
RISK FACTORS
Although it is not clear why CAD occurs in some people and not in others, risk factors that contribute to plaque formation and therefore to stenosis include: smoking, hypertension, genetic familial hypercholesterolemia, diabetes, age, sleep apnea, lack of exercise.
SYMPTOMS
In the early stages of the disease, usually there are no symptoms. It’s a “silent killer”. Often, the first symptom is a TIA (transient ischemic attack), a “mini” stroke. Symptoms of a TIA may include: sudden numbness/weakness of one side of the body (contralateral projection via decussation of fibers in the medulla oblongata)), dizziness, severe headache, trouble seeing and speaking. Although TIAs may not cause lasting damage,1 in 3 patients who experience a TIA will have a major stroke, often within a year of the initial TIA.
DIAGNOSIS
Bruit (swishing sound heard with stethoscope); Ultrasound to determine blood flow, degree of stenosis; CT or MRI to look for evidence of stroke or other anomalies.
TREATMENT
Mild blockage (15-49 % luminal stenosis): lifestyle changes, including medication to lower cholesterol and hypertension.
Severe blockage (> 50% luminal stenosis): surgical procedures to remove blockage: carotid endarterectomy being the most common. This procedure involves incision into the affected carotid arteries and subsequent removal of plaque. Carotid angioplasty and stents may be used when blockage is difficult to access and/or patient has other conditions that make surgery risky.
PROGNOSIS
Medical treatment, combined with lifestyle changes, can mitigate the progression of atherosclerosis. The disease currently cannot be reversed or completely resolved.

AttachmentDonePATHOLOGY REPORT: CAROTID ARTERY DISEASE ~ ARIADNA BOGATSKY BIO 108 ~OVERVIEW: Carotid Artery Disease (CAD) is the narrowing (stenosis) of the carotid arteries caused by the build-up of plaque in the lumen, (atherosclerosis). CAD is a major cause of ischemic strokes in the United States.
BACKGROUND
GROSS ANATOMY: The bilateral common carotid arteries provide 02-rich blood to the head. The right common carotid arises directly from the aortic arch; the left common carotid arises as a branch off of the brachiocephalic trunk. After leaving the mediastinum, both ascend into the neck, where, at the level of C-3 to C-4, they bifurcate into the external and internal carotids. The external carotids supply blood to the face; the internal carotids supply blood to the brain. The common carotid bifurcation, at the origin of the internal carotid artery, is the most frequent site of atherosclerotic lesions.
HISTOLOGY: Carotid arteries exhibit the tunics present in large blood vessels. From the lumen out, tunics appear in the following order: tunica intima (endothelium + CTP), tunica media (smooth muscles providing vasoconstriction and vasodilation), tunica externa (CTP + vasa vasorum: blood vessels supplying 02 to vessel wall).
The build-up of plaque occurs at the site of the tunica intima.
RISK FACTORS
Although it is not clear why CAD occurs in some people and not in others, risk factors that contribute to plaque formation and therefore to stenosis include: smoking, hypertension, genetic familial hypercholesterolemia, diabetes, age, sleep apnea, lack of exercise.
SYMPTOMS
In the early stages of the disease, usually there are no symptoms. It’s a “silent killer”. Often, the first symptom is a TIA (transient ischemic attack), a “mini” stroke. Symptoms of a TIA may include: sudden numbness/weakness of one side of the body (contralateral projection via decussation of fibers in the medulla oblongata)), dizziness, severe headache, trouble seeing and speaking. Although TIAs may not cause lasting damage,1 in 3 patients who experience a TIA will have a major stroke, often within a year of the initial TIA.
DIAGNOSIS
Bruit (swishing sound heard with stethoscope); Ultrasound to determine blood flow, degree of stenosis; CT or MRI to look for evidence of stroke or other anomalies.
TREATMENT
Mild blockage (15-49 % luminal stenosis): lifestyle changes, including medication to lower cholesterol and hypertension.
Severe blockage (> 50% luminal stenosis): surgical procedures to remove blockage: carotid endarterectomy being the most common. This procedure involves incision into the affected carotid arteries and subsequent removal of plaque. Carotid angioplasty and stents may be used when blockage is difficult to access and/or patient has other conditions that make surgery risky.PROGNOSIS
Medical treatment, combined with lifestyle changes, can mitigate the progression of atherosclerosis. The disease currently cannot be reversed or completely resolved.