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May 1965

Internal Carotid vs Middle Cerebral Artery Occlusions: Clinical Differences

Author Affiliations

From the departments of neurology and neurosurgery, the Mount Sinai Hospital.

Arch Neurol. 1965;12(5):468-471. doi:10.1001/archneur.1965.00460290024004

THE DISTRIBUTION of pathologic changes in the brains of patients dying with occlusion of the internal carotid artery and with occlusion of the middle cerebral artery has been shown to be similar.1-3 It is not surprising, therefore, that the neurological syndromes resulting from occlusion of these arteries may at times be identical, and that the clinical differentiation between them may be quite difficult.4-8

Internal carotid artery occlusion may be suspected if evidence of impaired flow through its first branch, the ophthalmic artery, can be elicited. Thus, transient monocular blindness, ipsilateral reduction of retinal artery pressure, delay in ipsilateral retinal fluorescein circulation time, and, rarely, unilateral optic atrophy, are all generally accepted features of diagnostic importance. More controversial diagnostic signs of carotid occlusion include ipsilateral, local, or contralateral eyeball bruit, diminished pharyngeal pulsations, Horner's syndrome without anhydrosis, dilatation of the superficial vessels of the face, and the response to