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This is a category of diseases that affect the arteries to the brain. The brain is supplied by a set of two arteries on either side of the neck. Each of these is responsible for supplying a certain part of the brain. When one of these arteries becomes significantly narrowed or blocked due to atherosclerosis or other causes, the corresponding part of the brain may be affected. Transient ischaemic attacks (TIAs) and embolic strokes are two common examples.
TIAs are self limiting attacks which last no longer than twenty four hours. During these attacks, a patient may experience a sudden loss of vision in one eye, weakness in one side of the body, slurred speech or facial weakness. These attacks occur when a small blood clot falls off an atherosclerotic plaque in one of the two arteries supplying the anterior part of the brain. These small clots (emboli) temporarily occlude some of the brain small arteries leading to these symptoms. If these emboli cause permanent occlusion, the above mentioned symptoms become permanent and the condition is then called a "stroke". Less commonly, the arteries supplying the posterior parts of the brain can become similarly affected. In this case, the patient experiences symptoms of impaired coordination, dizziness and bilateral visual impairment. It is very important that patients with one or more risk factors for arterial disease recognise the symptoms of TIAs and seek early medical advice as progression to stroke is preventable. The role of the surgeon in these situations is to determine the site and the extent of the arterial disease in order to formulate a management plan. Most patients will receive aspirin or other drugs that reduce the chances of clot formation and embolisation. In selected cases, surgery may be indicated to clear the affected artery and restore normal blood flow to the brain. |
A magnetic resonance image showing a significant carotid artery narrowing
A plaque that has been removed from a diseased carotid artery. Note the difference between the smooth lining at the right bottom corner and the rough ulcerated lining at the top left corner. |
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