Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Cerebral Embolism: Review and Current Perspectives

Cerebral Embolism: Review and Current Perspectives Abstract In a discussion of old and new concepts of cerebral embolism, two cases are used to illustrate the phathophysiology of atheroembolism in producing intermittent and lasting neurologic deficits. Emboli are due to both cardiogenic and noncardiogenic sources. The onset is characteristically abrupt, but premonitory warnings may occur. The risk of recurrent embolism must be weighed against the risk of anticoagulant therapy, which may cause lethal hemorrhage into the infarcted area. Definitive therapy may require surgical intervention. It seems likely that embolism occurs more frequently than has been previously stated, and these patients should be identified to permit appropriate medical and surgical therapy. References 1. Adams RD, Vander Eecken HM: Vascular diseases of the brain. Ann Rev Med 4:213-252, 1953.Crossref 2. Marshall J, Meadows S: The natural history of amaurosis fugax. Brain 91:419-434, 1968.Crossref 3. Russell RR: The source of retinal emboli. Lancet 2:789-792, 1968.Crossref 4. Naiman JL, Donohue WL, Prichard JS: Fatal nucleus pulposus embolism of spinal cord after trauma. Neurology 11:83-87, 1961.Crossref 5. Groch SN, McDevitt E, Wright IS: A long term study of cerebral vascular disease. Ann Intern Med 55:358-367, 1961.Crossref 6. Carter AB: Strokes: Natural history and prognosis. Proc Roy Soc Med 56:483-486, 1963. 7. Aring CD, Merritt HH: The differential diagnosis between cerebral hemorrhage and cerebral thrombosis. Arch Intern Med 56:435-456, 1935.Crossref 8. Kane WC, Aronson SM: Cerebrovascular disease in an autopsy population: 2. Embolic lesions. Trans Amer Neurol Assoc 94:29-33, 1969. 9. Browne TR, Poskanzer DC: Treatment of strokes. New Eng J Med 281:594-692, 650-657, 1969.Crossref 10. Castaigne P, Lehrmitte F, Gautier JC, et al: Internal carotid artery occlusion. A study of 61 instances in 50 patients with postmortem data. Brain 93:231-258, 1970.Crossref 11. Sartwell PE: Thromboembolism and oral contraceptives: Epidemiological case control study. Amer J Epidem 90:365-380, 1969. 12. Fisher CM, Pearlman A: Nonsudden onset of cerebral embolism. Neurology 17:1025-1032, 1967.Crossref 13. Wells CE: Cerebral embolism: The natural history, prognostic signs, and effects of anticoagulation. Arch Neurol Psychiat 81:667-677, 1959.Crossref 14. Fisher CM: Occlusion of the carotid arteries. Arch Neurol Psychiat 72:187-204, 1954.Crossref 15. Fisher CM: Observations of the fundus oculi in transient monocular blindness. Neurology 9:333-347, 1959.Crossref 16. Gunning AJ, Pickering GW, Robb-Smith AHT, et al: Mural thrombosis of the internal carotid artery and subsequent embolism. Quart J Med 33:155-195, 1964. 17. Millikan CH, Siekert RG, Schick RM: Studies in cerebrovascular disease: V. The use of anticoagulant drugs in the treatment of intermittent insufficiency of the internal carotid arterial system. Mayo Clin Proc 30:578-586, 1955. 18. Ehrenfeld WK, Hoyt WF, Wylie EJ: Embolization and transient blindness from carotid atheroma. Arch Surg 93:784-794, 1966.Crossref 19. Russell RR: Observations on the retinal blood vessels in monocular blindness. Lancet 2:1422-1428, 1961.Crossref 20. Hollenhorst RW: Significance of bright plaques in the retinal arterioles. JAMA 178:23-29, 1961.Crossref 21. Skovborg F, Lauritzen E: Symptomless retinal embolism. Lancet 2:361-362, 1965.Crossref 22. Swash M, Earl CJ: Transient visual obscurations in chronic rheumatic heart disease. Lancet 2:323-326, 1970.Crossref 23. Sturgill BC, Netsky MG: Cerebral infarction by atheromatous emboli. Arch Path 76:189-196, 1963. 24. McDonald I: Recurrent cholesterol embolism as cause of fluctuating cerebral symptoms. J Neurol Neurosurg Psychiat 30:489-496, 1967.Crossref 25. Millikan CH: The pathogenesis of transient focal cerebral ischemia. Circulation 32:438-450, 1965.Crossref 26. Moore WS, Hall AD: Importance of emboli from carotid bifurcation in pathogenesis of cerebral ischemic attacks. Arch Surg 101:698-716, 1970.Crossref 27. Wood EH, Correll JW: Atheromatous ulceration in major neck vessels as a cause of cerebral embolism. Acta Radial (Diagn) 9:520-536, 1969. 28. Gore I, Collins DP: Spontaneous atheromatous embolization. Amer J Clin Path 33:416-426, 1960. 29. Friedman GD, Loveland DB, Ehrlich SP: Relationship of stroke to other cardiovascular disease. Circulation 38:533-541, 1968.Crossref 30. Keen G, Leveaux VM: Prognosis of cerebral embolism in rheumatic heart disease. Brit Med J 2:91-92, 1958.Crossref 31. Weiss S, Davis D: Rheumatic heart disease: III. Embolic manifestations. Amer Heart J 9:45-52, 1933.Crossref 32. Case Records of the Massachusetts General Hospital: Case 30-1970. New Eng J Med 283:143-148, 1970.Crossref 33. Cooper ES, West JW: Cardiac arrhythmias, cerebral function and stroke. Curr Cone Cerebrovasc Dis 5:53-58, 1970. 34. Jones HR, Siekert RG, Geraci JE: Neurologic manifestations of bacterial endocarditis. Ann Intern Med 71:21-28, 1969.Crossref 35. Newman HA, Cordell AR, Prichard RW: Intracardiac myxomas: Literature review and report of six cases, one successfully treated. Amer Surg 32:219-230, 1966. 36. Cronqvist S, Efsing HO, Palacios E: Embolic complications in cerebral angiography with catheter technique. Acta Radiol (Diagn) 10:97-107, 1970.Crossref 37. Shillito J, Rockett FX: Retinal artery embolism: A complication of carotid endarterectomy. J Neurosurg 20:718-720, 1963.Crossref 38. Fischer-Williams M, Gottschalk PG, Brownell JN: Transient cortical blindness: An unusual complication of coronary angiography. Neurology 20:353-355, 1970.Crossref 39. Clyne DH, Epstein J, Sloman G, et al: Retrograde cerebral emboli during procedure to clear arterial thrombi from hemodialysis shunts. Med J Aust 1:359-361, 1970. 40. Tropea F Jr, Entine J: Peripheral embolization following mitral commissurotomy. Arch Surg 67:43-46, 1953.Crossref 41. Akbarian M, Austen WG, Yurchak PM, et al: Thromboembolic complications of prosthetic cardiac valves. Circulation 37:826-831, 1968.Crossref 42. Hawe A, Rastelli GC, Brandenburg RO, et al: Embolic complications following repair of atrial septal defects. Circulation 39,40( (suppl 1) ):185-191, 1969.Crossref 43. Brierly JB: Neuropathologic findings in patients dying after open heart surgery. Thorax 18:291-304,1963.Crossref 44. Javid H, Tufo HM, Najafi H, et al: Neurological abnormalities following open heart surgery. J Thorac Cardiovasc Surg 58:502-507, 1969. 45. Tufo HM, Ostfeld AM, Shekelle R: Central nervous system dysfunction following open heart surgery. JAMA 212:1333-1340, 1970.Crossref 46. Harris LS, Kennedy JH: Atheromatous cerebral embolism: A complication of surgery of the thoracic aorta. Ann Thorac Surg 4:319-326, 1967.Crossref 47. Price DC, Harris J: Cholesterol emboli in cerebral arteries as a complication of retrograde aortic perfusion. Neurology 20:1209-1214, 1970.Crossref 48. MacGregor BA, Cullen RA: The syndrome of fever, anemia, and high sedimentation rate with an atrial myxoma. Brit Med J 2:991-993, 1959.Crossref 49. Carter AB: Prognosis of cerebral embolism. Lancet 2:514-519, 1965.Crossref 50. Deykin D: Warfarin therapy. New Eng J Med 283:691-694, 801-803, 1970.Crossref 51. Sigell LT, Flessa HC: Drug interactions with anticoagulants. JAMA 214:2035-2038, 1970.Crossref 52. McHenry LC Jr, Jaffe ME, Kawamura J, et al: Effect of papaverine on regional blood flow in focal vascular disease of the brain. New Eng J Med 282:1167-1170, 1970.Crossref 53. Gilroy J. Barnhart MI, Meyer JS: Treatment of acute stroke with dextran 40. JAMA 210:293-298, 1969.Crossref 54. Michaels L: Incidence of thromboembolism after stopping anticoagulant therapy. JAMA 215:595-599, 1971.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cerebral Embolism: Review and Current Perspectives

Archives of Internal Medicine , Volume 130 (3) – Sep 1, 1972

Loading next page...
 
/lp/american-medical-association/cerebral-embolism-review-and-current-perspectives-pryNhWe5Sx
Publisher
American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.03650030102023
Publisher site
See Article on Publisher Site

Abstract

Abstract In a discussion of old and new concepts of cerebral embolism, two cases are used to illustrate the phathophysiology of atheroembolism in producing intermittent and lasting neurologic deficits. Emboli are due to both cardiogenic and noncardiogenic sources. The onset is characteristically abrupt, but premonitory warnings may occur. The risk of recurrent embolism must be weighed against the risk of anticoagulant therapy, which may cause lethal hemorrhage into the infarcted area. Definitive therapy may require surgical intervention. It seems likely that embolism occurs more frequently than has been previously stated, and these patients should be identified to permit appropriate medical and surgical therapy. References 1. Adams RD, Vander Eecken HM: Vascular diseases of the brain. Ann Rev Med 4:213-252, 1953.Crossref 2. Marshall J, Meadows S: The natural history of amaurosis fugax. Brain 91:419-434, 1968.Crossref 3. Russell RR: The source of retinal emboli. Lancet 2:789-792, 1968.Crossref 4. Naiman JL, Donohue WL, Prichard JS: Fatal nucleus pulposus embolism of spinal cord after trauma. Neurology 11:83-87, 1961.Crossref 5. Groch SN, McDevitt E, Wright IS: A long term study of cerebral vascular disease. Ann Intern Med 55:358-367, 1961.Crossref 6. Carter AB: Strokes: Natural history and prognosis. Proc Roy Soc Med 56:483-486, 1963. 7. Aring CD, Merritt HH: The differential diagnosis between cerebral hemorrhage and cerebral thrombosis. Arch Intern Med 56:435-456, 1935.Crossref 8. Kane WC, Aronson SM: Cerebrovascular disease in an autopsy population: 2. Embolic lesions. Trans Amer Neurol Assoc 94:29-33, 1969. 9. Browne TR, Poskanzer DC: Treatment of strokes. New Eng J Med 281:594-692, 650-657, 1969.Crossref 10. Castaigne P, Lehrmitte F, Gautier JC, et al: Internal carotid artery occlusion. A study of 61 instances in 50 patients with postmortem data. Brain 93:231-258, 1970.Crossref 11. Sartwell PE: Thromboembolism and oral contraceptives: Epidemiological case control study. Amer J Epidem 90:365-380, 1969. 12. Fisher CM, Pearlman A: Nonsudden onset of cerebral embolism. Neurology 17:1025-1032, 1967.Crossref 13. Wells CE: Cerebral embolism: The natural history, prognostic signs, and effects of anticoagulation. Arch Neurol Psychiat 81:667-677, 1959.Crossref 14. Fisher CM: Occlusion of the carotid arteries. Arch Neurol Psychiat 72:187-204, 1954.Crossref 15. Fisher CM: Observations of the fundus oculi in transient monocular blindness. Neurology 9:333-347, 1959.Crossref 16. Gunning AJ, Pickering GW, Robb-Smith AHT, et al: Mural thrombosis of the internal carotid artery and subsequent embolism. Quart J Med 33:155-195, 1964. 17. Millikan CH, Siekert RG, Schick RM: Studies in cerebrovascular disease: V. The use of anticoagulant drugs in the treatment of intermittent insufficiency of the internal carotid arterial system. Mayo Clin Proc 30:578-586, 1955. 18. Ehrenfeld WK, Hoyt WF, Wylie EJ: Embolization and transient blindness from carotid atheroma. Arch Surg 93:784-794, 1966.Crossref 19. Russell RR: Observations on the retinal blood vessels in monocular blindness. Lancet 2:1422-1428, 1961.Crossref 20. Hollenhorst RW: Significance of bright plaques in the retinal arterioles. JAMA 178:23-29, 1961.Crossref 21. Skovborg F, Lauritzen E: Symptomless retinal embolism. Lancet 2:361-362, 1965.Crossref 22. Swash M, Earl CJ: Transient visual obscurations in chronic rheumatic heart disease. Lancet 2:323-326, 1970.Crossref 23. Sturgill BC, Netsky MG: Cerebral infarction by atheromatous emboli. Arch Path 76:189-196, 1963. 24. McDonald I: Recurrent cholesterol embolism as cause of fluctuating cerebral symptoms. J Neurol Neurosurg Psychiat 30:489-496, 1967.Crossref 25. Millikan CH: The pathogenesis of transient focal cerebral ischemia. Circulation 32:438-450, 1965.Crossref 26. Moore WS, Hall AD: Importance of emboli from carotid bifurcation in pathogenesis of cerebral ischemic attacks. Arch Surg 101:698-716, 1970.Crossref 27. Wood EH, Correll JW: Atheromatous ulceration in major neck vessels as a cause of cerebral embolism. Acta Radial (Diagn) 9:520-536, 1969. 28. Gore I, Collins DP: Spontaneous atheromatous embolization. Amer J Clin Path 33:416-426, 1960. 29. Friedman GD, Loveland DB, Ehrlich SP: Relationship of stroke to other cardiovascular disease. Circulation 38:533-541, 1968.Crossref 30. Keen G, Leveaux VM: Prognosis of cerebral embolism in rheumatic heart disease. Brit Med J 2:91-92, 1958.Crossref 31. Weiss S, Davis D: Rheumatic heart disease: III. Embolic manifestations. Amer Heart J 9:45-52, 1933.Crossref 32. Case Records of the Massachusetts General Hospital: Case 30-1970. New Eng J Med 283:143-148, 1970.Crossref 33. Cooper ES, West JW: Cardiac arrhythmias, cerebral function and stroke. Curr Cone Cerebrovasc Dis 5:53-58, 1970. 34. Jones HR, Siekert RG, Geraci JE: Neurologic manifestations of bacterial endocarditis. Ann Intern Med 71:21-28, 1969.Crossref 35. Newman HA, Cordell AR, Prichard RW: Intracardiac myxomas: Literature review and report of six cases, one successfully treated. Amer Surg 32:219-230, 1966. 36. Cronqvist S, Efsing HO, Palacios E: Embolic complications in cerebral angiography with catheter technique. Acta Radiol (Diagn) 10:97-107, 1970.Crossref 37. Shillito J, Rockett FX: Retinal artery embolism: A complication of carotid endarterectomy. J Neurosurg 20:718-720, 1963.Crossref 38. Fischer-Williams M, Gottschalk PG, Brownell JN: Transient cortical blindness: An unusual complication of coronary angiography. Neurology 20:353-355, 1970.Crossref 39. Clyne DH, Epstein J, Sloman G, et al: Retrograde cerebral emboli during procedure to clear arterial thrombi from hemodialysis shunts. Med J Aust 1:359-361, 1970. 40. Tropea F Jr, Entine J: Peripheral embolization following mitral commissurotomy. Arch Surg 67:43-46, 1953.Crossref 41. Akbarian M, Austen WG, Yurchak PM, et al: Thromboembolic complications of prosthetic cardiac valves. Circulation 37:826-831, 1968.Crossref 42. Hawe A, Rastelli GC, Brandenburg RO, et al: Embolic complications following repair of atrial septal defects. Circulation 39,40( (suppl 1) ):185-191, 1969.Crossref 43. Brierly JB: Neuropathologic findings in patients dying after open heart surgery. Thorax 18:291-304,1963.Crossref 44. Javid H, Tufo HM, Najafi H, et al: Neurological abnormalities following open heart surgery. J Thorac Cardiovasc Surg 58:502-507, 1969. 45. Tufo HM, Ostfeld AM, Shekelle R: Central nervous system dysfunction following open heart surgery. JAMA 212:1333-1340, 1970.Crossref 46. Harris LS, Kennedy JH: Atheromatous cerebral embolism: A complication of surgery of the thoracic aorta. Ann Thorac Surg 4:319-326, 1967.Crossref 47. Price DC, Harris J: Cholesterol emboli in cerebral arteries as a complication of retrograde aortic perfusion. Neurology 20:1209-1214, 1970.Crossref 48. MacGregor BA, Cullen RA: The syndrome of fever, anemia, and high sedimentation rate with an atrial myxoma. Brit Med J 2:991-993, 1959.Crossref 49. Carter AB: Prognosis of cerebral embolism. Lancet 2:514-519, 1965.Crossref 50. Deykin D: Warfarin therapy. New Eng J Med 283:691-694, 801-803, 1970.Crossref 51. Sigell LT, Flessa HC: Drug interactions with anticoagulants. JAMA 214:2035-2038, 1970.Crossref 52. McHenry LC Jr, Jaffe ME, Kawamura J, et al: Effect of papaverine on regional blood flow in focal vascular disease of the brain. New Eng J Med 282:1167-1170, 1970.Crossref 53. Gilroy J. Barnhart MI, Meyer JS: Treatment of acute stroke with dextran 40. JAMA 210:293-298, 1969.Crossref 54. Michaels L: Incidence of thromboembolism after stopping anticoagulant therapy. JAMA 215:595-599, 1971.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1972

References