Embolisation

Emboli consist of friable atheromatous material, platelet-fibrin clumps or well formed thrombus.

The diagnosis of embolic infarction depends on:

• The identification of an embolic source, e.g. cardiac disease.

• The clinical picture of sudden onset.

• Infarction in the territory of a major vessel or large branch.

Clinical picture - depends on the vessel involved. Emboli commonly produce transient ischaemic attacks (TIA) as well as infarction.

Symptoms are referable to the eye (retinal artery) and to the anterior and middle cerebral arteries, and take the form of:

Visual loss - transient, i.e. amaurosis fugax or permanent. Hemisensory and hemimotor disturbance. Disturbance of higher function, e.g. dysphasia.

Focal or generalised seizures - may persist for some time after the ischaemic episode. Depression of conscious level if major vessel occlusion occurs. Emboli less frequently affect the posterior circulation.

EMBOLI FROM THE INTERNAL CAROTID ARTERY AND AORTA

Emboli from these sources are commonest outwith the heart. The majority of all cerebral emboli arise from ulcerative plaques in the carotid arteries (see page 239). —4

Emboli arising from the aorta (atheromatous plaque or aortic aneurysm)

*m often involve both hemispheres and systemic embolisation (e.g. affecting limbs) may coexist. JP f > 253

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