Bilateral Thrombosis of the Internal Carotid Artery

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SINCE the advent of intracranial angiography the remarkable compensatory capacity of the circle of Willis has been demonstrated in various vascular disorders of the internal carotid artery. That patients with bilateral occlusion of this artery could develop collateral circulation sufficient to prevent severe paralysis, blindness and a global aphasia has not been heretofore regarded as a possibility.

It is the purpose of this paper to present case reports of three patients with bilateral thrombosis of the internal carotid artery and to outline some of the clinical features of this condition.

Numerous cases of unilateral thrombosis of this vessel have been reported since arteriography established this circulatory defect as a clinical entity.1,2,3 The clinical diagnosis in the majority of these cases has been neoplasm, with subdural hematoma or multiple small vascular lesions as secondary considerations. The greatest incidence has been between the ages of 30 and 60 years. Etiologic factors such as thromboangiitis obliterans, syphilis, blood dyscrasias, acute infections and trauma to the neck have been suggested, but in a large autopsy series described by Fisher1 the cause was found almost without exception to be atherosclerosis.

Early recognition of thrombosis of the internal carotid artery is the exception rather than the rule. The characteristic syndrome of monocular optic atrophy, contralateral homonymous hemianopsia, hemisensory defects and complete hemiplegia is very rarely found. Aphasia, psychiatric disturbances, headaches, visual-field defects and a slowly progressive course are signs that may be associated with the lesion but hardly are considered pathognomonic of either unilateral or bilateral. . .



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