The Diagnosis of the Major and Minor Syndromes of Basilar Insufficiency

Williams, Denis; Wilson, T. G.

doi:10.1093/brain/85.4.741

Cited by 192 publications

(68 citation statements)

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“…4,[8][9][10][11][12][13][14][15][16] In addition, we found that patients who developed headaches after tPA administration were younger, which is consistent with a previous observation. 17 One previous study reported a higher incidence of headache in cardioembolic infarcts than in TIAs, lacunar infarcts, or thrombotic infarcts.…”

Section: Discussionsupporting

confidence: 92%

Post-IV thrombolytic headache and hemorrhagic transformation risk in acute ischemic stroke

et al. 2016

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Section: Discussionsupporting

confidence: 92%

Post-IV thrombolytic headache and hemorrhagic transformation risk in acute ischemic stroke

et al. 2016

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“…74 Siekert later served during 1976 -1981 as the first program chair of the International Stroke meeting of the American Heart Association. 75 Other clinicians, including Fang and Palmer in California 76 and Denis Williams in the United Kingdom, 77,78 wrote about symptoms and signs in patients with VBI, and the term became popular on both sides of the Atlantic Ocean.…”

Section: Caplanmentioning

confidence: 99%

Posterior Circulation Ischemia: Then, Now, and Tomorrow

Caplan

2000

Stroke

173

103

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know and appreciate where we are now and where we are going in the future, it is essential to know where we have been. We cannot afford to relive and repeat the history of stroke every several decades. Posterior circulation stroke represents a microcosm of stroke in general. In this presentation I first review the development of ideas regarding brain and posterior circulation ischemia and its recognition and treatment. I then share some recent data from a large prospective registry of patients with posterior circulation ischemia. Finally, I look ahead to reflect on what I believe should be the future directions for research and for the care of patients with posterior circulation disease.Patients who present to physicians and hospitals with symptoms that suggest posterior circulation ischemia are handled differently from patients who have symptoms that suggest anterior circulation disease in the great majority of medical facilities in the United States and in the world. A patient who has an attack of dizziness with diplopia and ataxic gait usually has a brain image but seldom has vascular or cardiac investigations. A diagnosis of "vertebrobasilar insufficiency" (VBI) is often made, and physicians then debate whether or not to treat with warfarin-type anticoagulants, and, if so, for how long and at what intensity. In contrast, a patient who has right-hand weakness and aphasia is usually evaluated and treated quite differently at the very same facilities. Brain imaging, cardiac investigations, noninvasive vascular tests of the carotid and intracranial anterior circulation with the use of extracranial and transcranial ultrasound and/or MR angiography (MRA) and CT angiography, and catheter angiography are often pursued, depending on the local technological capabilities and experience of the treating physicians. An effort is made to identify the etiology and mechanism of the ischemia. Treatment is then chosen among a variety of possibilities (including carotid artery surgery, angioplasty, anticoagulants, and antiplatelet aggregants) depending on the nature, location, and severity of the occlusive disease and the mechanism of ischemia.Why should anterior and posterior circulation ischemia be handled so differently? Does this schizophrenic approach make sense? After all, the internal carotid artery and its branches and the vertebral (VA) and basilar arteries (BA) and their branches are just a few inches apart; they are made of the same coats and look the same under the microscope except for size. These vessels carry the same blood under the same blood pressure. The diseases that affect the blood vessels in the 2 circulations are the same. Do stroke mechanisms really differ between the 2 circulations? How did this differing approach originate, and does it continue to make sense today? These are some questions that I will attempt to answer as I review the development of ideas about posterior circulation ischemia and as I report recent data. Development of IdeasHerein I review how knowledge about the posterior circulation ...

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“…3 Similar observations have been made with regard to vertebrobasilar insufficiency. 4 Despite these reports, the occurrence of headache in association with other symptoms of transient cerebral ischemia has received little attention.The objectives of this communication are: (1) to study the frequency, location, and temporal relationships of headaches which occurred in association with other symptoms of transient cerebral ischemia, and (2) to compare such patients in terms of population characteristics, angiographical findings, and prognosis with the larger TIA population from which these cases were drawn. …”

mentioning

confidence: 99%

Headache and Transient Ischemic Attacks

Grindal

Toole

1974

Stroke

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Abstract:Headache and Transient Ischemic A Hacks• Headache occurring in association with episodes of transient cerebral ischemia has not been emphasized as part of the symptom complex.In an effort to ascertain the frequency and characteristics of these headaches and to determine whether there is any localizing, diagnostic, or prognostic significance to them, the records of 240 TIA patients were reviewed.We concluded that headache is a prominent symptom in 25% of patients with TIA and that there were no distinguishing population characteristics, arteriographical findings or prognostic features among patients whose TIAs were accompanied by headache. The locations and temporal relationships of headache occurring in cases of carotid and vertebrobasilar TIA also were compared. Additional Key Words amaurosis fugaxcarotid ischemia vertebrobasilar insufficiency subclavian steal• Headache is a frequent premonitory symptom of cerebral ischemia. 1" Andrell 1 reported headache as an early symptom in three of nine cases of internal carotid thrombosis. This association was later confirmed by Fisher 2 and Wells. 3 Similar observations have been made with regard to vertebrobasilar insufficiency. 4 Despite these reports, the occurrence of headache in association with other symptoms of transient cerebral ischemia has received little attention.The objectives of this communication are: (1) to study the frequency, location, and temporal relationships of headaches which occurred in association with other symptoms of transient cerebral ischemia, and (2) to compare such patients in terms of population characteristics, angiographical findings, and prognosis with the larger TIA population from which these cases were drawn. MethodsThe records of 240 Caucasian patients with TIA admitted to this hospital between 1964 and 1973 were reviewed. All patients had at least one TIA within one month of hospitalization, and all received aortic arch and four-vessel selective arteriography. Those cases with a history of headache, cranial, facial, or neck pain temporarily related to other symptoms of transient cerebral ischemia were selected for study. Patients with light-headedness or cranial or facial numbness, as well as those in whom the relationship between headache and TIA was unclear, were not included. Also noted were those cases in which a definite negative history of headache was obtained.From the entire population of 240 cases, 58 patients were selected. Based on clinical and angiographical findings, 56 patients were divided into two groups depending upon whether their symptoms were felt to arise from the carotid or vertebrobasilar circulation. In the remaining two cases the distribution of the TIA could not be determined.One hundred and sixty of these 240 patients were the subject of a previous study in which age, sex, incidence of hypertension, distribution of angiographical lesions and prognosis were determined.5 This population of 160 was compared with the headache patients within this group (40) to determine if any significant difference...

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The Diagnosis of the Major and Minor Syndromes of Basilar Insufficiency

Cited by 192 publications

References 0 publications

Post-IV thrombolytic headache and hemorrhagic transformation risk in acute ischemic stroke

Post-IV thrombolytic headache and hemorrhagic transformation risk in acute ischemic stroke

Posterior Circulation Ischemia: Then, Now, and Tomorrow

Headache and Transient Ischemic Attacks

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