• Nineteen patients experienced progressive or episodic weakness of one lower extremity caused by severe stenosis or occlusion of the internal carotid artery. The majority of patients (84.2%) had occlusion or severe stenosis at the origin. Based on clinical profiles, angiographic findings, and cerebral blood flow patterns, we concluded that the pathophysiologic mechanism was hypoperfusion in the border zone between the anterior cerebral artery and the middle cerebral artery and that patients with progressive weakness had more extensive compromise in cerebral circulation. Following surgical treatment in 17 patients, progressive and episodic weakness disappeared and the majority of them (76.4%) became asymptomatic. However, the patients with stenosis at the siphon and those with progressive weakness from occlusion at the origin appeared to be at increased risk for cardiac death.
Yanagihara T, Sundt TM, Piepgras DG. Weakness of the Lower Extremity in Carotid Occlusive Disease. Arch Neurol. 1988;45(3):297–301. doi:10.1001/archneur.1988.00520270075023