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To the Editor: The report by Katz et al. [1] of four additional cases of isolated neck extensor myopathy (INEM) adds significantly to the cumulative data regarding this clinical entity. The etiology of INEM, also known as the dropped head syndrome, [2] is unknown. Although muscle biopsies of the neck extensors have revealed nonspecific abnormalities …

To the Editor: We read with interest the Clinical/Scientific Note of Fisher [1] describing vomiting as the initial manifestation of ischemic brainstem stroke. Patient 1 suffered a cardiac arrest approximately 6 days after the onset of stroke symptoms. We do not know any of the details surrounding the cardiac arrest of Dr. Fisher's patient 1, but we speculate that his …

SUMMARY: Does the world need another ICA classification scheme? We believe so. The purpose of proposed angiography-driven classification is to optimize description of the carotid artery from the endovascular perspective. A review of existing, predominantly surgically-driven classifications is performed, and a new scheme, based on the study of NYU aneurysm angiographic and cross-sectional databases is proposed. Seven segments – cervical, petrous, cavernous, paraophthlamic, posterior communicating, choroidal, and terminus – are named. This nomenclature recognizes intrinsic uncertainty in precise angiographic and cross-sectional localization of aneurysms adjacent to the dural rings, regarding all lesions distal to the cavernous segment as potentially intradural. Rather than subdividing various transitional, ophthalmic, and hypophyseal aneurysm subtypes, as necessitated by their varied surgical approaches and risks, the proposed classification emphasizes their common endovascular treatment features, while recognizing that many complex, trans-segmental, and fusiform aneurysms not readily classifiable into presently available, saccular aneurysm-driven schemes, are being increasingly addressed by endovascular means. We believe this classification may find utility in standardizing nomenclature for outcome tracking, treatment trials and physician communication.