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EDITED BY PROFESSOR YASSER METWALLY

Carotid bifurcation disease and risk for stroke

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

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

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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Case records

Vertebral hemangioma: a case study

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Axonal neuropathy: a case study

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Downloadable multiple choice questions software

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)

Downloadable single case study software

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)

Case of the week

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

Topic of the month

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)

Radiological quiz

What is this

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Topic of the month | Thesis section | Research section | Talking psychiatry | Differential diagnosis | Case of the week

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