History of occlusive cerebrovascular disease. II. After Moniz, with special reference to surgical treatment

Angiography and related procedures are discussed. Ophthalmodynamometry, recording of bruits and temporal pulse, and thermography have been mentioned. Transient ischemic attacks (TIAs) and some causes are described: embolic obstruction, followed by absorption of the clot or its removal in the blood, with symtomatic recovery; hemodynamic crisis resulting from lowering of systemic blood pressure by hemorrhage due to trauma, gastrointestinal bleeding, and other causes with recovery following blood replacement. Special types of occlusive disease include fibromuscular hyperplasia of the carotid, dissecting aneurysm of the aortic arch and branches, causing carotid and vertebral occlusions, moyamoya disease, and low profusion syndrome, generalized or unilateral. Surgical management includes reconstructive surgery and endarterectomy of extracranial vessels supplying the brain and extracranial-intracranial vascular anastomosis.