Differential. The major important condition to separate from these “micropathologies” is occlusion of parent arteries blocking flow in penetrating artery branches. In patients of Asian origin, especially Japan, Korea, and…
THE RECIPIENT ARTERIES The recipient artery is the main determinant of the clinical symptoms and signs. When a recipient neck or intracranial artery is blocked, blood flow to the area…
4. Coma. When the reticular formation is affected bilaterally in the medial pontine tegmentum, coma results. Sensory and cerebellar abnormalities are absent or slight because the infarct usually affects the…
The posterior choroidal arteries originate from the posterior cerebral arteries and course forward from caudal to rostral in the thalamus. The lateral posterior choroidal arteries supply mostly the pulvinar, a…
3. Decreased alertness. Hypersomnolence or frank coma can result from bilateral paramedian rostral brainstem dysfunction. After the acute phase, the patient may remain relatively inert and apathetic. Some patients sleep…
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…
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…
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…
