Cerebral angiography also called vertebral angiogram, carotid angiogram : Arteries are not normally seen in an X-ray, so contrast dye is utilized. The patient is given a local anesthetic, the artery is punctured, usually in the leg, and a needle is inserted into the artery. A catheter a long, narrow, flexible tube is inserted through the needle and into the artery.

It is then threaded through the main vessels of the abdomen and chest until it is properly placed in the arteries of the neck. This procedure is monitored by a fluoroscope a special X-ray that projects the images on a TV monitor.

The contrast dye is then injected into the neck area through the catheter and X-ray pictures are taken. Carotid duplex also called carotid ultrasound : In this procedure, ultrasound is used to help detect plaque, blood clots or other problems with blood flow in the carotid arteries.

A water-soluble gel is placed on the skin where the transducer a handheld device that directs the high-frequency sound waves to the arteries being tested is to be placed.

The gel helps transmit the sound to the skin surface. The ultrasound is turned on and images of the carotid arteries and pulse wave forms are obtained. There are no known risks and this test is noninvasive and painless. Computed tomography CT or CAT scan : A diagnostic image created after a computer reads x-rays.

In some cases, a medication will be injected through a vein to help highlight brain structures. Bone, blood and brain tissue have very different densities and can easily be distinguished on a CT scan.

A CT scan is a useful diagnostic test for hemorrhagic strokes because blood can easily be seen. However, damage from an ischemic stroke may not be revealed on a CT scan for several hours or days and the individual arteries in the brain cannot be seen. CTA CT angiography allows clinicians to see blood vessels of the head and neck and is increasingly being used instead of an invasive angiogram.

Doppler ultrasound : A water-soluble gel is placed on the transducer a handheld device that directs the high-frequency sound waves to the artery or vein being tested and the skin over the veins of the extremity being tested.

There is a "swishing" sound on the Doppler if the venous system is normal. Both the superficial and deep venous systems are evaluated.

Electroencephalogram EEG : A diagnostic test using small metal discs electrodes placed on a person's scalp to pick up electrical impulses. These electrical signals are printed out as brain waves. Lumbar puncture spinal tap : An invasive diagnostic test that uses a needle to remove a sample of cerebrospinal fluid from the space surrounding the spinal cord.

This test can be helpful in detecting bleeding caused by a cerebral hemorrhage. Magnetic Resonance Imaging MRI : A diagnostic test that produces three-dimensional images of body structures using magnetic fields and computer technology.

It can clearly show various types of nerve tissue and clear pictures of the brain stem and posterior brain. An MRI of the brain can help determine whether there are signs of prior mini-strokes. This test is noninvasive, although some patients may experience claustrophobia in the imager.

Magnetic Resonance Angiogram MRA : This is a noninvasive study which is conducted in a Magnetic Resonance Imager MRI. The magnetic images are assembled by a computer to provide an image of the arteries in the head and neck. The MRA shows the actual blood vessels in the neck and brain and can help detect blockage and aneurysms.

Stroke is an abrupt interruption of constant blood flow to the brain that causes loss of neurological function.

The interruption of blood flow can be caused by a blockage, leading to the more common ischemic stroke, or by bleeding in the brain, leading to the more deadly hemorrhagic stroke.

Ischemic stroke constitutes an estimated 80 percent of all stroke cases. Stroke may occur suddenly, sometimes with little or no warning, and the results can be devastating. Ischemic stroke is by far the most common type of stroke, accounting for a large majority of strokes.

There are two types of ischemic stroke: thrombotic and embolic. A thrombotic stroke occurs when a blood clot, called a thrombus, blocks an artery to the brain and stops blood flow.

An embolic stroke occurs when a piece of plaque or thrombus travels from its original site and blocks an artery downstream. The material that has moved is called an embolus. How much of the brain is damaged or affected depends on exactly how far downstream in the artery the blockage occurs.

In most cases, the carotid or vertebral arteries do not become completely blocked and a small stream of blood trickles to the brain.

The reduced blood flow to the brain starves the cells of nutrients and quickly leads to a malfunctioning of the cells. As a part of the brain stops functioning, symptoms of a stroke occur. During a stroke, there is a core area where blood is almost completely cut off and the cells die within five minutes.

However, there is a much larger area known as the ischemic penumbra that surrounds the core of dead cells. The ischemic penumbra consists of cells that are impaired and cannot function, but are still alive. These cells are called idling cells, and they can survive in this state for about three hours.

Ischemic stroke is treated by removing the obstruction and restoring blood flow to the brain. One treatment for ischemic stroke is the FDA-approved drug, tissue plasminogen activator tPA , which must be administered within a three-hour window from the onset of symptoms to work best. Unfortunately, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment.

This medication carries a risk for increased intracranial hemorrhage and is not used for hemorrhagic stroke. For patients beyond the three-hour time window, intrarterial thrombolysis with drugs or mechanical devices may be an option.

Carotid endarterctomy, and or stenting of the cervical and intracranial vessels, may help reduce recurrent stroke in some cases. The Merci Retriever, approved recently by the FDA, is a corkscrew-shaped device used to help remove blood clots from the arteries of stroke patients.

At the neck, a small catheter inside the larger catheter is guided through the arteries until it reaches the brain clot. The Merci Retriever, a straight wire inside the small catheter pokes out beyond the clot and automatically coils into a corkscrew shape.

It is pulled back into the clot, the corkscrew spinning and grabbing the clot. A balloon inflates in the neck artery, cutting off blood flow, so the device can pull the clot out of the brain safely. The clot is removed through the catheter with a syringe. A hemorrhagic stroke can be caused by hypertension, rupture of an aneurysm or vascular malformation or as a complication of anticoagulation medications.

An intracerebral hemorrhage occurs when there is bleeding directly into the brain tissue, which often forms a clot within the brain. A subarachnoid hemorrhage occurs when the bleeding fills the cerebrospinal fluid spaces around the brain.

Both conditions are very serious. Hemorrhagic stroke usually requires surgery to relieve intracranial within the skull pressure caused by bleeding. Surgical treatment for hemorrhagic stroke caused by an aneurysm or defective blood vessel can prevent additional strokes.

Surgery may be performed to seal off the defective blood vessel and redirect blood flow to other vessels that supply blood to the same region of the brain.

Endovascular treatment involves inserting a long, thin, flexible tube catheter into a major artery, usually in the thigh, guiding it to the aneurysm or the defective blood vessel and inserting tiny platinum coils called stents into the blood vessel through the catheter.

Stents support the blood vessel to prevent further damage and additional strokes. Recovery and rehabilitation are important aspects of stroke treatment. In some cases, undamaged areas of the brain may be able to perform functions that were lost when the stroke occurred.

Rehabilitation includes physical therapy, speech therapy and occupational therapy. Regardless of what type of stroke has been suffered, it is critical that victims receive emergency medical treatment as soon as possible for the best possible outcome to be realized.

By learning the signs and symptoms of stroke and treating risk factors preventively, it is possible to help avert the devastating results of this disease.

A TIA is a temporary cerebrovascular event that leaves no permanent damage. Most likely an artery to the brain is temporarily blocked, causing stroke-like symptoms, but the blockage dislodges before any permanent damage occurs.

Symptoms of a TIA may be similar to stroke, but they resolve quickly. In fact, symptoms may be so vague and fleeting that people just "brush" them off, especially when they last just a few minutes. TIA symptoms include:. While there is no treatment for the TIA itself, it is essential that the source of the TIA be identified and appropriately treated before another attack occurs.

If you experience TIA symptoms, seek emergency medical help and notify your primary care physician immediately. About 30 percent of all people who suffer a major stroke experience a prior TIA, and 10 percent of all TIA victims suffer a stroke within two weeks.

The quicker you seek medical attention, the sooner a diagnosis can be made and a course of treatment started. Early intervention is essential to effectively preventing a major stroke.

Treatment options for TIA patients focus on treating carotid artery disease or cardiac problems. Although they are more common in older adults, strokes can occur at any age.

Stroke prevention can help reduce disability and death caused by the disease. Controllable or treatable risk factors for stroke include:. The carotid arteries supply oxygen-rich blood to the brain. Plaque forms when the internal carotid arteries become blocked by fat and cholesterol buildup.

This process is called atherosclerosis. Severe blockage is called carotid stenosis. Carotid stenosis may cause a TIA. Carotid stenosis is frequently asymptomatic. A doctor may detect it through an abnormal sound called a bruit BROO'e when listening to the carotid arteries with a stethoscope.

Patients usually first undergo a thorough physical examination. This examination can reveal specific neurological, motor and sensory deficits that can provide clues about both the extent and location of the blockage.

If the physician suspects stenosis, diagnostic tests such as Doppler ultrasound, carotid duplex or cerebral angiography will be recommended. Treatment is determined by the extent of the narrowing and the condition of the patient.

For many people with arteries narrowed less than 50 percent, medication is prescribed to help reduce the risk of ischemic stroke. These include antihypertensives to control high blood pressure, medications to reduce cholesterol levels, and anticoagulants to thin blood and prevent it from clotting.

Carotid endarterectomy is a procedure in which the neurosurgeon makes an incision in the carotid artery and removes the plaque using a dissecting tool. Removing the plaque is accomplished by widening the passageway, which helps to restore normal blood flow.

The artery will be repaired with sutures or a graft. The entire procedure usually takes about two hours. The patient may experience pain near the incision in the neck and some difficulty swallowing during the first few days after surgery.

Most patients are able to go home after one or two days and return to work, usually within a month. Avoid driving and limit physical activities for a few weeks after surgery. An alternative, new form of treatment, carotid angioplasty and stenting, shows some promise in patients who may be at too high risk to undergo surgery.

Carotid stenting is a procedure in which a tiny, slender metal-mesh tube is fitted inside your carotid artery to increase the flow of blood blocked by plaques. The stent is inserted following a procedure called angioplasty, in which the doctor guides a balloon-tipped catheter into the blocked artery.

The balloon is inflated and pressed against the plaque, flattening it and re-opening the artery. The stent acts as scaffolding to prevent the artery from collapsing or from closing up again after the procedure is completed.

A cerebral or cranial aneurysm is an area where a blood vessel in the brain weakens, resulting in a bulging or ballooning out of part of the vessel wall.

Usually, aneurysms develop at the point where a blood vessel branches, because the "fork" is structurally more vulnerable. The disorder may result from congenital defects or from other conditions such as high blood pressure, atherosclerosis the buildup of fatty deposits in the arteries or head trauma.

Aneurysms occur in all age groups, but the incidence increases steadily for individuals age 25 and older, is most prevalent in people ages 50 to 60 and is about three times more prevalent in women.

The outcome for patients treated before a ruptured aneurysm is much better than for those treated after, so the need for adequate evaluation of patients suspected of having a cerebral aneurysm is very important. Unruptured cerebral aneurysms can be detected by noninvasive measures, including MRA and a carotid angiogram.

A rupture can be detected by a CT scan or lumbar puncture. If these tests suggest the presence of an aneurysm, formal cerebral angiography may be performed. People who suffer a ruptured brain aneurysm may have some or all of these warning signs: localized headache, nausea and vomiting, stiff neck, blurred or double vision, sensitivity to light photophobia , or loss of sensation.

Many people with unruptured brain aneurysms have no symptoms. Others might experience some or all of the following symptoms, which may be possible signs of an aneurysm: cranial nerve palsy, dilated pupils, double vision, pain above and behind eye and localized headache. When cerebral aneurysms rupture, they usually cause bleeding in the brain, resulting in a subarachnoid hemorrhage.

Blood can also leak into the cerebrospinal fluid CSF or areas surrounding the brain and cause an intracranial hematoma a blood clot. Blood can irritate, damage or destroy nearby brain cells. This may cause problems with bodily functions or mental skills. In more serious cases, the bleeding may cause brain damage, paralysis or coma.

The amount of blood that the cerebral circulation carries is known as cerebral blood flow CBF. Too much blood can raise intracranial pressure ICP , which can compress and damage delicate brain tissue. Too little blood flow ischemia results in tissue death. In brain tissue, a biochemical cascade known as the ischemic cascade is triggered when the tissue becomes ischemic, potentially resulting in damage to and death of brain cells.

Medical professionals must take steps to maintain proper CBF in patients who have conditions like shock, stroke, and traumatic brain injury. Brain Blood Flow : Schematic representation of the circle of Willis, arteries of the brain, and brain stem.

Search site Search Search. Go back to previous article. Sign in. Learning Objectives Evaluate the results of altered cerebral blood flow. Key Points The arteries deliver oxygenated blood, glucose and other nutrients to the brain and the veins carry deoxygenated blood back to the heart, removing carbon dioxide, lactic acid, and other metabolic products.