To the Editor.
—Bogousslavsky and Regli1 noted that 12 patients with severe, bilateral, occlusive disease of the internal carotid artery often had, in addition to attacks of unilateral hemispheral ischemia, the following symptoms: (1) bilateral motor, sensory, or visual dysfunction; (2) dizziness or vertigo; (3) ataxia; (4) diplopia; (5) dysarthria or dysphagia; and (6) drop attacks. None of these patients had angiographically significant occlusive disease of the vertebral or basilar arteries, a finding which would have excluded them from the series. The authors interpreted these findings as demonstrating that bilateral carotid disease, often with "stealing" of blood from posterior circulation collaterals, led to a significant enough decrease in blood flow to the brain stem to cause "vertebrobasilar insufficiency".There is a simpler way of looking at the data, and one that I believe is more likely to be correct. I believe that we cannot reliably always separate symptoms of bilateral
Caplan LR. Vertebrobasilar Transient Ischemic Attacks. Arch Neurol. 1985;42(9):839–840. doi:10.1001/archneur.1985.04060080017006
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