The Cerebrovascular Disease and Stroke Program at the Marcus Neuroscience
Institute includes the Divisions of Stroke Neurology, Cerebrovascular
Surgery and Endovascular Surgery. Within these divisions, we treat the
Ischemic and Hemorrhagic Strokes
Ischemic strokes account for more than 80 percent of stroke cases. They
are caused by blood clots, the result of fatty deposits that build up
on vessel walls and block the flow of blood to the brain. The deposits
can lead to two kinds of obstructions, cerebral thrombosis and cerebral
embolism. Cerebral thrombosis develops on the clogged part of a vessel.
Cerebral embolism forms elsewhere in the circulatory system, such as the
heart or large arteries within the upper chest and neck. In this case,
part of the clot breaks free and travels through the bloodstream until
blocked by vessels. Atrial fibrillation, or an irregular heartbeat, can
also cause a clot to form in the heart, eventually break off and reach
Hemorrhagic strokes are the result of bleeding in the brain, caused by
either intracerebral or subarachnoid hemorrhages. A cerebral hemorrhage
occurs when a weak vessel ruptures, releasing blood that accumulates and
compresses brain tissue. A head injury or aneurysm (see below) may cause
a cerebral hemorrhage. A subarachnoid hemorrhage refers to when there
is bleeding between the brain and skull, though the blood does not reach
the brain. Both types of hemorrhages cause an unnatural flow of blood
to the brain, thus hindering its function.
Transient Ischemic Attacks (TIAs)
Also known as "mini-strokes," Transient Ischemic Attacks (TIAs) carry
stroke-like symptoms, but are usually fleeting and typically do not cause
permanent damage. However, a TIA should be considered a serious warning,
since about one in three people who have a TIA will later suffer a stroke
- sometimes within a year of the initial TIA.
Carotid Artery Disease
Carotid artery disease refers to a disease caused by plaque buildup in
the carotid arteries, located on the sides of the neck. The carotid arteries
divide into internal and external carotid arteries, with the internal
supplying oxygen-rich blood to the brain and the external to the face,
scalp and neck. Too much plaque buildup prevents blood flow to the brain,
which can cause a stroke.
Also known as an intracranial or intracerebral aneurysm, a cerebral aneurysm
refers to a weakened spot on a blood vessel within the brain that balloons
and fills with blood. The aneurysm can create pressure on a nearby nerve
or tissue or possibly rupture (a hemorrhage). Not all cerebral aneurysms
bleed, and they can occur anywhere within the brain, though most occur
on arteries between the brain and the skull. They are more common to occur
in people with specific genetic diseases, such as connective tissue disorders
and polycystic kidney disease, or circulatory disorders such as arteriovenous
malformations (see below).
Abnormal blood vessels, cavernous malformations resemble small mulberries
in the spinal cord or brain. They can be hereditary, but that is not always
the case. If the malformations bleed, it can cause a hemorrhage and lead
to neurological symptoms. These include numbness or weakness in the face,
arms or legs, double vision or loss of vision, unsteadiness and trouble
with speaking or swallowing. Cavernous malformations can also cause seizures
or additional hemorrhages.
Arteriovenous Malformations (AVMs)
Arteriovenous malformations (AVMs) refer to abnormal blood flow between
arteries and veins. AVMs often occur in the central nervous system, but
can occur in any location. They can lead to acute pain, bleeding or additional
medical issues. AVMs are rare and their cause is unknown. Although AVMs
usually are not hereditary, patients with AVMs are often born with them.
What is Moyamoya Disease?
A rare, progressive disorder, Moyamoya disease is caused by blocked arteries
at the brain’s base. Its name is Japanese for “puff of smoke”
and refers to the look of tiny vessels that form as a result of the blockage.
The disease is primarily found in children, but it can affect adults.
Initial symptoms include a stroke or multiple “mini-strokes”
(transient ischemic attacks), often with seizures, paralysis on half of
the body or weakness in muscles. Moyamoya is thought to be an inherited
disease and symptoms include speech deficits, involuntary movements, and
vision, sensory or cognitive impairments.