Clinical Syndromes Large Vessel Occlusion

OCCLUSION OF THE INTERNAL CAROTID ARTERY - may present in a 'stuttering' manner due to progressive narrowing of the lumen or recurrent emboli.

The degree of deficit varies - occlusion may be asymptomatic and identified only at autopsy, or a catastrophic infarction may result.

In the most extreme cases there may be: Deterioration of conscious level Homonymous hemianopia of the contralateral side Contralateral hemiplegia Contralateral hemisensory disturbance

Gaze palsy to the opposite side - eyes deviated to the side of the lesion

A partial Horner's syndrome may develop on the side of the occlusion (involvement of sympathetic fibres on the internal carotid wall).

Occlusion of the dominant hemisphere side will result in a global aphasia.

Examination of the neck will reveal:

Absent carotid pulsation at the angle of the jaw with poorly '' conducted heart sounds along the internal carotid artery.

External rc^ carotid

Common carotid

External rc^ carotid

Common carotid

Internal carotid

~ Bifurcation

Internal carotid

~ Bifurcation

Prodromal symptoms prior to occlusion may take the form of monocular blindness - AMAUROSIS FUGAX and transient hemisensory or hemimotor disturbance (see page 253).

The origins of the vessels from the aortic arch are such that an innominate artery occlusion will result not only in the clinical picture of carotid occlusion but will produce diminished blood flow and hence blood pressure in the right arm.

The outcome of carotid occlusion depends on the collateral blood supply primarily from the circle of Willis, but, in addition, the external carotid may provide flow to the anterior and middle cerebral arteries through meningeal branches and retrogradely through the ophthalmic artery to the internal carotid artery.

Right subclavian artery

Common carotid

Common carotid

Innominate artery

Ophthalmic artery

„-Internal carotid

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