تدريب Shadowing: Anatomy - Carotid Artery (Carotid artery disease, aneurysm, dissection, amourosis fugax) - تعلم التحدث بالإنجليزية مع YouTube
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The carotid arteries are major blood vessels in the neck that supply blood to the brain,
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The carotid arteries are major blood vessels in the neck that supply blood to the brain,
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neck and face.
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We have two carotid arteries,
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one on the right side of the body and the other on the left.
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The right common carotid artery arises from a split or bifurcation of the brachiocephalic trunk.
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The right subclavian is the other branch,
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which is a branch of the aortic arch.
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This bifurcation occurs roughly at the level of the right sternoclavicular joint,
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level of T2 vertebrae.
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The left common carotid artery branches directly from the arch of the aorta.
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Both the left and right common carotid arteries travel up the neck.
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At roughly the level of the thyroid cartilage and cervical vertebrae 4,
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the carotid artery splits into the external and internal branches.
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This bifurcation happens in an anatomical area called the carotid triangle.
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Just above the bifurcation of the common carotid artery,
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there is an area called the carotid sinus.
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In this area, the common carotid and internal carotid are slightly dilated.
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This is an important area as it contains baroreceptors which are sensors that help the body to detect and regulate blood pressure.
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At the bifurcation of the common carotid artery there is also the carotid body,
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a chemoreceptor important in maintaining oxygen levels in the blood.
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First off, let's take a look at the external carotid artery,
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which supplies blood to the areas of the head and neck external to the cranium.
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After arising from the common carotid artery,
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it travels up the neck,
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passes behind the mandibular neck and in front of the lobule of the ear.
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The external carotid artery has a number of branches.
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In ascending order these are superior thyroid artery,
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ascending pharyngeal artery, lingual artery,
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facial artery, occipital artery, posterior auricular artery,
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maxillary artery, superficial temporal artery.
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The internal carotid arteries, as their name suggests,
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take a different path, carrying blood internally into the cranial cavity.
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They do this via the carotid canal in the petrous part of the temporal bone.
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Unlike the external carotid artery,
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the internal carotid artery do not supply any structures in the neck.
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Instead they supply the brain by joining and forming the circle of willis,
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the eyes through the ophthalmic artery and the forehead.
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Now that we've given an overview of the anatomy of the carotid arteries,
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let's take a look at how these structures are clinically relevant.
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Clinical anatomy, carotid pulse.
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The carotid arteries are a commonly used site for assessment of a patient's pulse.
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As the heart pushes blood through the arteries,
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the arteries expand and contract with the flow of blood.
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Palpation of the carotid arteries in the neck can be used to assess the pulse rate,
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the heart rhythm or character and the strength of the pulse.
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The carotid arterial pulses are best examined with the patient supine
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and the trunk of the patient body slightly elevated
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and is measured by placing the fingers behind the larynx and the anterior border of the sternocleid mastoid muscle.
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It is very important to not palpate both carotid arteries at the same time as this reduces blood flow to the brain.
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Clinical anatomy, carotid artery hypersensitivity.
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We previously talked about the carotid baroreceptors which are sensors and regulators of blood pressure.
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Baroreceptors are stretch and pressure receptors.
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So you can imagine if external pressure was placed on the carotid sinus,
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the baroreceptors within the carotid sinus would think there is an increase in blood pressure.
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They would then communicate this with your brain to reduce your heart rate in order to reduce and restore blood pressure levels.
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Normally, this is only a small amount.
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However, in some people, the carotid sinus overreacts to the external pressure,
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making their heart slow down or their blood pressure drop a significant amount.
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And this is called carotid sinus hypersensitivity.
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This overreaction can be triggered by wearing tight clothing around the neck or even turning the head.
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The response is manifested clinically as syncope or presyncope and can lead to falls and injury.
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Carotid sinus hypersensitivity is only treated if people are symptomatic.
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If the condition causes the patient's heart rate or heart rate and blood pressure to fall substantially,
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they are offered a pacemaker.
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Clinical anatomy, carotid plaque, atherosclerosis and ischemic stroke.
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The next condition we are going to talk about is atherosclerosis.
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Now, atherosclerosis is deposition of plaques or fatty material on the inner wall of the arteries.
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When this occurs, blood flow is reduced.
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Atherosclerosis usually occurs at bifurcations,
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branching regions and regions where there is high curvature of vessels.
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The example in the bifurcation of the common carotid artery into the internal and external carotid arteries.
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The internal carotid artery is the most susceptible to atherosclerosis and can result in reduced blood flow to the brain.
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This can result in presyncope or even syncope.
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Concerningly, if a piece of the plaque ruptures,
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breaks off and migrates up,
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it can occlude the cerebral arteries causing an ischemic stroke.
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To assess the severity of the vessel wall thickening in the corded arteries,
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a Doppler study can be used to enable estimation of the blood flow through the vessel.
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If the condition is severe,
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if the plaque is severe enough,
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the artery can be surgically cut open and the athromatous tunica intima,
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that plaque, can be removed to restore the blood flow.
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This procedure is referred to as a carotid endarterectomy.
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If this is not possible,
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there is also carotid angioplasty and stenting, which can be done.
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Clinical Anatomy, Carotid Artery Aneurysm Atherosclerosis is a risk factor for a condition called a carotid artery aneurysm,
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which is a balloon-like bulge or dilation of the carotid artery.
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As the artery expands, the wall becomes progressively thinner,
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increasing the chance that the aneurysm will burst.
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Any segment of the carotid artery can be affected,
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however the internal carotid artery is the most commonly involved.
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Carotid artery aneurysms can be associated with certain diseases including Marfan syndrome,
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fibromuscular dysplasia and giant cell arthritis.
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Diagnosis of a carotid artery aneurysm may be made incidentally in patients who are asymptomatic or suspected due to clinical manifestations.
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These clinical manifestations include presence of a pulsatile mass in the neck.
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It can be from a mass effect,
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so the aneurysm may push against nearby nerves.
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For example, in the cavernous sinus it can push against nerves here causing ophthalmoplegia.
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It can also push against the vagus nerve causing hoarse voice.
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It can also push against the internal jugular vein,
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not a nerve, and when it pushes against the internal jugular vein,
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it causes compression and facial swelling from backflow.
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Finally, another clinical manifestation is that the aneurysm can rupture and bleed.
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diagnostic tests include a carotid angiography which will reveal the aneurysm here is an example
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clinical anatomy carotid artery dissections a young person's stroke This next condition we will be discussing is a carotid artery dissection.
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This is a serious condition involving injury to the innermost wall of the carotid artery.
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This tear creates two channels of blood flow.
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The first is the normal lumen of the carotid artery and the other is in the wall where blood remains stationary.
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The blood that remains in the wall results in narrowing
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or stenosis or complete occlusion of the artery resulting in reduction or elimination of the blood flow.
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In the dissection, bloods can clot and form and they can also break off from the site of the dissection.
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They can form an emboli.
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These can travel through the arteries of the brain and block blood supply in the brain,
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causing an ischemic stroke.
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Carotid artery dissection is a common cause of stroke in young patients.
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Classic presentation of a carotid artery dissection include local pain to that area,
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an ipsilateral headache to one side or to the neck,
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an ipsilateral Horner syndrome, ischemic stroke, and retinal ischemia.
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The current gold standard first-line investigation is digital subtraction angiography,
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and this is a fluoroscopic technique which enables visualization of the blood vessels.
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The last clinical anatomy we're going to talk about is amaurosis fugax and I'm probably pronouncing that last part wrong.
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Amaurosis fugax from the Greek amaurosis meaning dark
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and Latin fugax meaning fleeting is a temporary loss of vision in one or both eyes caused by a blocked blood vessel.
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The most common cause of the blocked blood vessel is a cholesterol plaque
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or blood clot and most cases are due to stenosis of the ipsilateral carotid artery,
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the carotid artery on the same side of the eye symptoms.
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The symptoms of amaurosis fugax are partial or complete loss of vision in one or both eyes that is sudden,
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painless and temporary.
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The vision loss is often referred to as curtain visual loss
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as it appears like a vertical curtain coming down over the eye before resolving over several minutes.
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Even though this vision loss is temporary,
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patients experiencing amaurosis fujax are at risk of strokes.
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So in summary, in this video we talked about the carotid arteries,
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which are major blood vessels that supply blood to the brain, neck and face.
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We discussed that there are two crotid arteries,
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one on each side of the body,
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and the fact that in the neck,
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each common crotid artery branches into two divisions.
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The external crotid artery that supplies blood to the head and neck,
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external to the cranium, and then the internal crotid artery that supplies blood to the brain,
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eyes, and forehead.
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We also discussed why the carotid arteries are clinically important and relevant,
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such as in the conditions of carotid artery hypersensitivity,
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carotid plaques, carotid artery aneurysm,
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carotid artery dissections, and amorosis fugax.
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Thank you.
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