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EDITED BY PROFESSOR YASSER METWALLY |
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Carotid bifurcation disease and risk for stroke |
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The importance of carotid artery
atherosclerosis in the pathogenesis of cerebral ischemia and
infarction has been recognized for many years. As early as 1856,
Savory pointed out this relationship, I and in 1904 Chiari suggested
the possibility of cerebral emboli originating from the cervical
portion of the carotid artery. 2 The concept was further popularized
by Fisher's clinicopathologic reports of symptomatic carotid artery
disease, 3,4 and in 1954 the first paper describing a feasible
technique for the surgical reconstruction of the carotid artery
appeared in the literature. 5 |
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The proximal aorta and risk for stroke |
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The potential for distal embolization from
atherosclerotic plaques in the descending aorta is well recognized,
particularly by vascular surgeons and by pathologists (Anderson,
1980). In addition, the ascending aorta may be a source of cerebral
embolism as a complication of cardiac surgery, due to the
dislodgement of atheromatous debris during intraoperative
manipulation of this area (Gardner et al, 1985; Mills and Prough,
1991). However, only in recent years have neurologists and
cardiologists turned their attention to the ascending aorta and
aortic arch as a potential site for spontaneous embolism in patients
presenting with cerebral ischaemic events. Both the anterior cerebral
circulation (via the carotid arteries) and the posterior circulation
(via the subclavian arteries, giving rise to the vertebral arteries)
are theoretically at risk from atheromatous material in the aorta
between the aortic valve and the origin of the left subclavian artery
(the proximal aorta). Cerebral ischaemia may be caused by cholesterol
embolism, by embolization of thrombus overlying atheromatous plaque,
or by obstruction of blood flow due to encroachment of plaque into
the origins of the arch vessels. |
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Aortogenic embolic stroke |
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In the present study 11 embolic
stroke patients with the echocardiographic diagnosis of atheroma of
the proximal aorta are included. The incidence of aortic atheroma, in
this study, was 5.5%. All patients were subjected to (1)
Full clinical neurological and cardiological examinations (2) CT
scan of the brain (3) Duplex study for evidence of carotid
bifurcation disease (4) Transthoracic and transoesophageal
echocardiography (5) ECG (6) Blood sugar, serum lipid, serum lipid
electrophoresis and serum fibrinogen. All aortic plaques, in this
study, were of the complex pattern from the sonographic point of view
( complex plaques are characterized by the presence of ulceration,
surface irregularities, absence of calcification, the presence of
mobile elements and the more heterogeneous echogenic pattern. Complex
plaques are also characteristically elevated above the surface). All
aortic plaques were associated with nonsignificant carotid
bifurcation disease and with silent myocardiac ischemia. The
emboligenic potential of complex aortic plaques and the significance
of the associated carotid bifurcation disease and myocardiac ischemia
will be presented and discussed. |
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Vertebral hemangioma: a case study |
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Axonal neuropathy: a case study |
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Downloadable multiple choice questions software |
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A downloadable software featuring 5 full radiological cases with
applied self- checking multiple choice questions on every case, you
can email the result to the author for evaluation and discussion. The
software is a freeware, a gift not to sold. You are free to use the
software for any educational purposes you want and to distribute it
on a non-profit basis. A new version of the software is available
every month and remains available for one month (The available
version now is version 4.3, January 2011), the software version is
changed with the monthly update of the bulletin. |
>>>Click
here to download the current version of the multiple choice
questions software>>> ....(Click
here to get a better idea about this publication)>>>...
(Click
for an online archive)
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Downloadable single case study software |
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A downloadable software featuring a full radiological study of a
single case with a radiological report and a review of literature.
You can email the author from within the software. The software is a
freeware, a gift not to sold. You are free to use the software for
any educational purposes you want and to distribute it on a
non-profit basis. A new version of the software is available every
month and remains available for one month (The available version now
is version 3.11, January 2010), the software version is changed with
the monthly update of the bulletin. |
>>>Click
here to download the current version of the single case study software>>> ....(Click
here to get a better idea about this publication)>>>...(Click
for an online archive)
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A downloadable, weekly updated, neurological case with full clinical,
radiological and pathological data. You can email the author from
within the downloaded software. The software is a freeware, a gift
not to sold. You are free to use the software for any educational
purposes you want and to distribute it on a non-profit basis. A new
version of the software is available every week and remains available
for one week, it is updated every Saturday. |
>>>Click
here to download the case of the week software>>>
....(Click
here to get a better idea about this publication)>>>
....(Click
for an online archive of the software version)
The
PDF version | The
Short case version | Archive
of long cases | Archive
of short case | Case
records
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A monthly updated PDF file fully addressing a single topic in the
field of neurology, psychiatry or neurosurgery. The PDF file is
changed with the monthly update of the bulletin. |
>>>Click
here to download the current issue of "topic of the month">>>.....(Click
for an archive of back issues of "topic of the month) ..(Topic
of the month)
>>>
Click
to view the radiological quiz>>> | >>>Click
to download the answer to the quiz>>>
Topic
of the month | Thesis
section | Research
section | Talking
psychiatry | Differential
diagnosis | Case
of the week
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Yasser Metwally, all rights reserved |
