Headache—A Common Symptom in Thrombosis of the Internal Carotid Artery

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INCREASING employment of anticoagulant therapy and direct surgical operation in the treatment of thrombosis of the internal carotid artery has stimulated interest in the clinical recognition of the condition. Visual disturbances (field defects, blurring of vision, scotomata and amblyopia of the eye on the affected side), aphasia, hemiparesis or monoplegia, sensory disturbances of the anus or legs, psychiatric symptoms, convulsions (often the jacksonian type) and headaches are the common manifestations.1–7 Three clinical types of onset occur: in one group the onset is sudden and the symptoms are severe (usually hemiparesis); episodic symptoms occur in a second group, symptoms often being absent between attacks; in a third group the symptoms are slowly progressive, resembling the manifestations of an intracranial neoplasm.

Our records of 56 cases of thrombosis involving the internal carotid arteries have been reviewed. All diagnoses were confirmed by arteriograms, and operative proof was secured in all 24 of the patients who underwent surgical procedures. In 35 patients, episodic symptoms occurred; in 14 patients the symptoms were sudden and severe; and in 7 patients the symptoms were slowly progressive. Table 1 shows the initial symptoms, the incidence of single symptoms, and the frequencies of various symptoms. Multiple symptoms occurred in most patients; some patients had several symptoms simultaneously at the onset of the disease; headache was the commonest initial single symptom. These observations correspond with those reported by others.

Headache occurred in 28 patients, being an initial symptom in 13 patients, in 11 of whom it was the single initial . . .



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