Symptomatic stenoses of the middle cerebral artery
Feldmeyer, J.J.; Merendaz, C.; Regli, F.
Revue Neurologique (Paris) 139(12): 725-736
1983
ISSN/ISBN: 0035-3787 PMID: 6665387 Document Number: 212722
The clinical angiographic and prognostic features of 13 patients with symptomatic stenosis of the middle cerebral artery (MCA) admitted between 1970-81 were reviewed. The etiology of the stenosis was probably atherosclerosis, except in 1 case which was due to fibromuscular dysplasia, 1 to postradiation angiopathy, and 2 related to oral contraceptives. 2 main clinical groups were delineated: 1) transitory and minor ischemic accidents arising in the same arterial area (usually in older patients with multiple atheromatous lesions along the carotid artery); and 2) progressive or stepwise strokes occurring in younger patients, mainly females, with isolated MCA stenosis. These cerebrovascular symptoms and signs, in the absence of carotid bruit, doppler ultrasonography abnormality, or evidence of cardiac embolism should suggest intracranial stenosis and require appropriate therapy to avoid complete occlusion. This study shows that early medical attention--1st with anticoagulation and then antiaggregation provides a suitable alternative to EC/IC bypsas. This is suggested by evidence for microembolization in addition to hemodynamic mechanisms. (author's modified)