Stroke secondary to carotid s... Health Article

Definition

Stroke secondary to carotid stenosis is a group of brain disorders involving loss of brain function.

Causes, incidence, and risk factors

Stroke secondary to carotid stenosis occurs when blood flow to the brain is blocked. This is usually related to hardening of the arteries (atherosclerosis), particularly those arteries in the neck. Carotid stenosis means hardening of the neck arteries.

Atherosclerosis occurs when a sticky substance called plaque builds up in the inner lining of the arteries. The plaque may block or narrow an artery. A blood clot may occur at the site of the plaque. If a piece of plaque breaks off and travels to an artery in the brain, it can cause a blockage or even a stroke. The risks for stroke secondary to carotid stenosis are the same as atherosclerosis.

Stroke secondary to carotid stenosis is most common in older people. Often times, patients with stroke secondary to carotid stenosis have atherosclerotic heart disease or diabetes.

Radiation therapy to the area may also cause carotid stenosis.

Symptoms

• Weakness or total inability to move a body part
• Numbness, loss of sensation
• Tingling or other abnormal sensations
• Decreased or lost vision (may be partial or temporary)
• Language difficulties (aphasia)
• Inability to recognize or identify sensory stimuli (agnosia)
• Loss of memory
• Loss of coordination
• Swallowing difficulties
• Personality changes
• Mood and emotion changes
• Urinary incontinence (lack of control over bladder)
• Lack of control over the bowels
• Consciousness changes:
  • Sleepiness
  • Stupor, lethargy
  • Coma, unconsciousness

Signs and tests

An exam may show:

• Blood clots in the retina  
• Reflex problems
• Muscle weakness
• Decreased sensation
• A bruit (an abnormal sound heard with the stethoscope) over the carotid arteries of the neck

The following tests may be done:

• Serum lipids blood test (may show high levels of  triglycerides and cholesterol)
• Carotid or cerebral angiography
• Carotid duplex or Doppler ultrasound
• MRI of the head
• MRA (magnetic resonance angiography) of the brain vessels and neck vessels

Treatment

For specific treatment, see stroke.

Medicine may be prescribed for:

• High blood pressure  
• Cholesterol problem

Surgery to remove the plaque from the carotid (neck) arteries may be needed, especially if more than 70% of the carotid artery is blocked. The procedure is called carotid endarterectomy.

Expectations (prognosis)

Stroke is a leading cause of death in the United States. About 25% of people who have a stroke die from the stroke itself or complications. About half have long-term problems.

However, 25% of people who have a stroke recover most or all of their function.

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms occur.

Prevention

High blood pressure, diabetes, heart disease, and other risk factors should be treated.

If you smoke, you should stop.

Treatment of TIA (transient ischemic attack, "warning strokes") may prevent future strokes.

Aspirin therapy (81mg a day or 100mg every other day) is now recommended for stroke prevention in women under 65 as long as the benefits outweigh the risks. It should be considered for women over age 65 only if their blood pressure is controlled and the benefit is greater than the risk of gastrointestinal bleeding and brain hemorrhage.

References

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.