MODERN CONCEPTS CONCERNING ETIOLOGY AND TREATMENT OF CEREBROVASCULAR ACCIDENTS.

Concepts regarding the causes of strokes have undergone marked evolution during the past several years. Treatment has been revised accordingly. Development of safe cervical-cerebral angiography has been a potent factor in bringing about these changes, for it is through increasing use of angiography that accurate evaluation of the cerebrovascular system has been made possible, and a focal anatomical diagnosis the rule. Segmental arterial disease in the neck has emerged as an important cause of hemiplegia. Surgical restoration of blood flow through or around vertebral artery and carotid artery occlusions may, in certain cases, cure the patient with stroke or prevent further attacks, whereas anticoagulant medication has been shown to be beneficial for many of those with proved cerebral artery occlusions. Clinical neurologic evaluation of the patient with cerebrovascular disease may point with considerable accuracy to the zone or zones of cerebral dysfunction, but may often fail to indicate the precise location of the lesion responsible for such dysfunction. A variety of different distant lesions may, unfortunately, produce the same neurologic signs and symptoms. It is the thesis of this paper that the clinical syndrome known as stroke is a symptom complex representing cerebral dysfunction, the precise form of this dysfunction being dependent upon a number of complex variables in cervical-cerebral circulatory structure and function. These vascular unknowns are best investigated with the use of serial cervical-cerebral angiography. In many instances accurate diagnosis is possible only by use of this technique. [ABSTRACT FROM AUTHOR]