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Changing Ideas on the Pathogenesis of Stroke

Edinburgh, UK

EXTRACT

When I was a medical student in the 1950s we were taught about two main kinds of stroke – cerebral thrombosis, caused by blockage of one of the three main arteries supplying the brain, and cerebral haemorrhage (usually fatal) caused by rupture of an intracerebral artery. There was also a third and less common variety, cerebral embolism, which tended to affect younger patients and was caused by the sudden dislodgement of intracardiac thrombus. Minor strokes, which lasted a few minutes or hours and the patients recovered fully, were recognized and thought to be due to temporary spasm of a small artery within the brain. Textbooks of neuropathology described in detail the severity and distribution of ischaemic changes in neurones and glia but little was said about the cerebral blood vessels.

The carotid arteries (which we were told to palpate to determine the character of the pulse) were regarded as inert conduits ...

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