Medial Medullary Infarction This third syndrome is much less common. The anterior spinal artery supplying the medial medulla arises from the distal intracranial vertebral artery. The medial medullary syndrome is…
Lateral Medullary Syndrome Atherosclerosis of the intracranial vertebral arteries is most severe in the distal portion of the arteries, often at the vertebral-basilar artery junction, sometimes extending into the proximal…
VERTEBRAL ARTERIES IN THE NECK Atherosclerosis The origin of the vertebral arteries is the most common location for atherosclerotic disease in the vertebral system. Atheromas often begin in the subclavian…
The prospective randomized study SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) showed that aggressive medical management was superior to stenting, both because the risk…
Carotid endarterectomy (CEA) for prevention of ischemic stroke has been performed since the early 1950s (see Plate 9-16), but it was only in the 1990s that several large-scale trials were…
Stenting (see Plate 9-17) has been investigated as an alternative therapy for patients with carotid artery disease. Two multicenter studies, the International Carotid Stenting Study (ICSS) and the North American…
The presence of pacemaker devices and renal failure limit the imaging studies performed in patients with ICA disease. MRIs cannot be performed in patients with pacemakers, and renal failure is…
Neurologic findings vary by the location of the occlusion and the adequacy of collateral circulation. A large MCA territory stroke is usually seen in patients with MCA mainstem occlusion without…
DIAGNOSIS The diagnosis of anterior circulation ischemia is often made by noninvasive methods, including ultrasound techniques, computed tomography, and magnetic resonance imaging techniques (see Plates 9-14 and 9-15). Digital subtraction…
In addition to treating the acute stroke, attention must be directed toward prevention of future strokes. Identifying and modifying potential risk factors is essential. Pharmacologic treatment using antihypertensives, statins, and…
