  
Home | Carotid Surgery | Aneurysm Surgery | Sympathectomy | Vascular Reconstructions | General Surgery | Venous Surgery DISORDERS OF STROKE, TIAs and AMAUROSIS FUGAX  The brain controls all the functions of the body including thought, language, movement and feeling. The commonest cause of a stroke is when an artery that supplies blood to a part of the brain becomes blocked. That part of the brain is starved of blood and oxygen and unless the blood supply returns quickly, that part of the brain dies. Once a part of the brain dies it can never be repaired and the effects are permanent. The commonest area of the brain affected by stroke is that concerned with controlling the movements of the arms and legs. The right side of the brain controls the left arm and leg and vice versa. So if the artery supplying the right side of the brain becomes blocked the person would lose the use of the left arm and leg. This is known as hemiplegia - the paralysis of one side of the body. If the area of the brain controlling speech is affected the person cannot speak or the speech is slurred. The face and movements of the tongue can also be affected. If a large artery supplying a large amount of brain becomes blocked the effects are very serious, the person may be unconscious and paralysed for a long time and may even die.
Alternatively, arteries may only be blocked temporarily and the brain tissue recovers quickly. This results in strokes which last less than 24 hours - also known as a transient ischaemic attacks - or TIAs. If the arteries to the eye are affected a person may lose sight in part of their eye. Again, if this resolves quickly it is known as amaurosis fugax or fleeting blindness. Both of these symptoms are important because they are warning signs that a permanent stroke may be about to occur and urgent investigation is indicated. If these symptoms are due to disease in the carotid arteries an operation can be performed called carotid endarterectomy which removes the disease from the carotid arteries and prevents stroke. THE CAROTID ARTERIES  There are four main arteries in the neck that supply blood to the brain, the two smaller arteries at the back of the neck - the vertebral arteries and two larger arteries at the front - the carotid arteries. Hardening of the arteries tends to affect the wall of the carotid arteries at the point where they split into external and internal carotid arteries - about the level of the Adam's apple. The inside of the arteries becomes narrowed and roughened. Blood clot and thrombus can build up on the roughed surface of the internal carotid artery. Fragments of clot and thrombus can break off and be carried in the blood stream and block the smaller arteries in the brain to cause mini-strokes (TIAs), fleeting blindness or major strokes.
Any one who has a ministroke or fleeting blindness should be assessed to exclude disease in the carotid arteries. This is because an effective operation exists to remove the disease from the carotid arteries and prevent stroke - the operation is known as CAROTID ENDARTERECTOMY. ASSESSMENT OF MINI-STROKES AND FLEETING BLINDNESS Assessment begins with a detailed medical interview and a full physical examination performed by a specialist in stroke surgery or medicine.  The arteries in the neck are assessed by performing a special ultrasound scan known as a colour Duplex scan. This investigation is completely painless and takes about 10-15 minutes to complete. The ultrasound probe is placed on the skin of the neck and produces an ultrasound picture of the underlying carotid arteries. Measurements can be made of the blood flow through different parts of the artery and any disease is easily identified.
 If severe disease is identified a further investigation may be required known as a carotid angiogram. This requires admission to hospital and is performed in the x-ray department. Under local anaesthetic a needle is used to puncture the femoral artery in the groin. A catheter is passed from the groin through the main artery in the abdomen and chest to the carotid arteries. Dye is injected into the carotid arteries and x-rays are taken as the dye is carried in the blood flow to the brain. These x-rays pictures give us detailed information regarding the severity and extent of disease in the carotid arteries which is valuable when planning surgery.
Depending on the results of the medical interview and examination further investigations may be needed e.g. blood tests or an assessment of the heart. If these assessments indicate that a severe narrowing of the carotid artery is the most likely cause of your symptoms, then the doctor will discuss the operation of carotid endarterectomy with you. The practice of medicine and surgery is not an exact science and reputable practitioners cannot properly guarantee results either expressed or implied. These procedures are highly advanced and discussion about them (including risks and benefits) should be with your specialist. |
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