Carotid Endarterectomy
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…
Diagnosis of Internal Carotid Disease
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…
Occlusion of Middle and Anterior Cerebral Arteries
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…
Clinical Manifestations of Carotid Artery Disease
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…
Common Sites of Cerebrovascular Occlusive Disease
Atherosclerosis causes stenosis or occlusion of extracranial and intracranial arteries and is directly responsible for a significant percentage of cerebral ischemic events. Atheroma formation involves the progressive deposition of circulating…
Other Etiologies of Carotid Artery Disease
Giant cell arteritis is a common form of systemic vasculopathy affecting patients older than 50 years. Although it typically involves the temporal, maxillary, and ophthalmic arteries, it can rarely affect…
Uncommon Etiologic Mechanisms in Stroke
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…
Clinical Evaluation and Therapeutic Options in Stroke (Continued)
CT is readily available in most hospitals and reliably demonstrates the presence or absence of intracerebral hemorrhage. Immediately after the onset of bleeding, intracerebral hematomas (ICHs) are seen on CT…
Clinical Evaluation and Therapeutic Options in Stroke
Timing and Evolution In intracerebral hemorrhage patients, symptoms and signs gradually develop over minutes or hours. Improvements and fluctuations do not occur during this time. In aneurysmal subarachnoid hemorrhage, symptoms…
Temporal Profile of Transient Ischemic Attack (TIA) and Completed Infarction (CI)
Subarachnoid hemorrhages are usually caused by rupture of an aneurysm that breaks, spilling blood instantly into the spinal fluid. The sudden release of blood under arterial pressure increases intracranial pressure,…
