Circle of Willis in Cerebral Vascular Disorders

Alpers, Bernard J.

doi:10.1001/archneur.1963.00460040068006

Cited by 158 publications

(69 citation statements)

References 2 publications

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“…A high incidence of anomalous CW has been reported in patients with saccular aneurysms of the intracranial arteries [3,4]. We found t 53 anomalous CW in the 404 brains examined, that is in 38 per cent, which is comparable to the figures reported from other countries.…”

Section: Anatomical Anomaliessupporting

confidence: 83%

Cerebrovascular Diseases in India — A Pathologists Viewpoint

1996

Medical Journal Armed Forces India

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Section: Anatomical Anomaliessupporting

confidence: 83%

Cerebrovascular Diseases in India — A Pathologists Viewpoint

1996

Medical Journal Armed Forces India

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“…The circle of Willis is considered an important collateral pathway in maintaining adequate cerebral blood flow in patients with ICA obstruction, 34 and a noncompetent circle of Willis has been regarded as a predisposing condition for border zone infarcts. 19 MRA has been used by others for the assessment of vessel patency in the circle of Willis.…”

Section: Discussionmentioning

confidence: 99%

Acute Stroke Patterns in Patients With Internal Carotid Artery Disease

Szabo

Kern

Gass

et al. 2001

Stroke

127

102

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Background and Purpose-Diffusion-weighted (DW) MRI is a sensitive method that facilitates early stroke pattern identification. There are limited data about the influence of stenosis grade on the development of particular stroke patterns in internal carotid artery (ICA) disease. We therefore investigated the lesion patterns on DW MRI in acute stroke patients with ICA disease. Methods-DW MRI was analyzed in 102 consecutive acute stroke patients with different degrees of ipsilateral ICA disease. Patients were assigned to 1 of 5 observed lesion patterns: (1) territorial ischemia, (2) subcortical ischemia without or (3) with embolus fragmentation, (4) disseminated lesions in distal cortical regions, and (5) multiple lesions in hemodynamic risk zones. In addition, perfusion-weighted (PW) MRI and MR angiography information was included in the assessment. Results-All patterns were observed in the different stages of ICA disease. Half of the patients with high-grade or subtotal stenosis had lesions in hemodynamic risk zones. Territorial stroke occurred in 47.6% of patients with ICA occlusion. Statistical analysis showed a significant relationship between the degree of stenosis and the observed stroke pattern (Pϭ0.001). In 77.8% of patients exhibiting high-grade ICA stenosis, subtotal stenosis, or occlusion, the perfusion lesion was larger than the diffusion lesion (PW/DW mismatch). Conclusions-Although in the individual patient any of the infarct patterns may occur, in statistical terms the incidence of a particular stroke pattern is clearly dependent on the degree of stenosis. Key Words: carotid artery diseases Ⅲ magnetic resonance imaging, diffusion-weighted Ⅲ stroke, acute A therosclerotic narrowing of the extracranial vessels is a well-recognized cause of cerebral ischemia. The annual stroke risk for patients with asymptomatic internal carotid artery (ICA) stenosis amounts to approximately 1% to 2%. 1,2 Both embolic and hemodynamic mechanisms are assumed to be the cause of stroke in ICA disease. 3 Neuroimaging studies have been performed in an attempt to improve the understanding of the underlying stroke mechanism as a basis for the identification of patients at high risk and for the best possible therapeutic rationale. Studies based on CT have suggested that hemodynamically significant stenoses or obstructions of the extracranial ICA may cause hemodynamic changes in the distal regions of the hemispheric blood supply, the so-called border zones between major vascular territories, while embolism from ICA stenosis is believed to disproportionately affect the middle cerebral artery (MCA) stem and distal branches producing territorial infarction, often including the deep lenticulostriate territory. 4 The coexistence of hypoperfusion and arterial embolism in patients with border zone stroke and ICA disease has recently been postulated. 5 Since the concept of border zone ischemia as a cause of stroke in patients with severe ICA stenosis has also been challenged, 6,7 uncertainty still remains regarding the occurrence and me...

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“…The concept of a congenital predisposition is supported by several lines of evidence including the presence of aneurysms in the infant 21 , their familial occurrence 22 , or their association with heritable connective tissue disorders 23 . Vascular anomalies have also been described to be associated with aneurysm SAH 12 , and their incidence in the circle of Willis is correlated with the occurrence of intracranial aneurysms 24,25 . The majority of the studies report vascular anomalies of the following arterial segments: the AcoA complex 26 , embryonic origin of the PCA 15,24 , PcoA infundibulum 15,27,28 , persistent trigeminal arteries 13,29 , and the vertebral artery (fenestration or anomalous termination) 14,15,30,31 .…”

Section: Discussionmentioning

confidence: 99%

Vascular Anomalies and the Risk of Multiple Aneurysms Development and Bleeding

et al. 2002

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The pathogenesis of aneurysmal subarachnoid hemorrhage is still debated and the prognosis remains severe, especially in multiple aneurysms, where the therapeutic management is complex. The aim of this study was to look for vascular anomalies and assess their relationship with aneurysm formation and bleeding in patients with multiple intracranial aneurysms. A prospective angiographical review was performed on 141 patients with multiple intracranial aneurysms seen from 1992 to 2000. Three hundred and fifty three aneurysms were studied. In 88% of the patients vascular anomalies were found. The most common were: asymmetric caudal basilar fusion (43.2%), variations of the anterior communicating artery (AcoA) complex (31.2%), symmetric caudal basilar fusion (26.2%), antero-inferior cerebellar artery-postero-inferior cerebellar artery (AICA-PICA) (15.6%), extradural origin of the PICA (10.6%), cavernous origin of the ophthalmic artery or dorsal ophthalmic artery (dOPH) (3.5%). Some aneurysm locations were associated with a high rate of vascular anomalies, e.g.: posterior cerebral aneurysm with asymmetric caudal fusion, AcoA aneurysm with AcoA complex variation, basilar tip aneurysm with extradural PICA or symmetric caudal fusion, PI CA aneurysm with AICA-PICA, para-ophthalmic aneurysm with dOPH. These aneurysm locations bled proportionally more frequently when associated with the related vascular anomaly. In conclusion, these results suggest that vascular anomalies are associated with aneurysm development and bleeding.

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Circle of Willis in Cerebral Vascular Disorders

Cited by 158 publications

References 2 publications

Cerebrovascular Diseases in India — A Pathologists Viewpoint

Cerebrovascular Diseases in India — A Pathologists Viewpoint

Acute Stroke Patterns in Patients With Internal Carotid Artery Disease

Vascular Anomalies and the Risk of Multiple Aneurysms Development and Bleeding

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