Volume 4 Issue 1, January 2008

The question of whether carotid endarterectomy should be performed on patients with asymptomatic carotid stenosis is one of the big medical controversies of our time. Uncertainty over surgical benefits hasn't stopped people from operating, however, with surgery rates soaring in some countries. Vincent Thijs reminds clinicians of the open questions in the field and calls for a more selective and cautious approach to surgery.

Despite decades of debate, no consensus has been reached on the role of carotid endarterectomy in patients with asymptomatic carotid stenosis. Anne Abbott argues that the time for deliberation is over. In this Viewpoint, she makes a case for the suspension of surgery in favor of medical interventions.

It is becoming increasingly clear that the female population carries a larger stroke burden than the male population, partly because of increased life expectancy, and partly because most deaths from stroke occur in women. In this article, Cheryl Bushnell reviews our current knowledge regarding sex-related differences in stroke characteristics and risk factors, including the influence of endogenous and exogenous estrogens. She also describes a new initiative designed to advance the study of stroke in women.

Arterial dissections are one of the most common forms of vascular lesion to affect the cervical carotid and vertebral arteries, second only to atherosclerosis. Arterial dissections are often caused by sudden or unusual stretching of arteries in the neck or head, and can occur as a complication of chiropractic and other neck manipulations. In this article, Louis Caplan reviews the underlying causes and clinical features of dissections of brain-supplying arteries and outlines the current recommendations for treatment of these lesions.

The role of statins in primary stroke prevention is well established, but, until recently, their benefits with regard to secondary prevention of vascular events in patients who had already experienced a stroke or transient ischemic attack were less certain. In this article, Sanossian and Ovbiagele review the findings of the Stroke Prevention through Aggressive Cholesterol Levels (SPARCL) trial, which showed that an intensive statin regimen can protect against secondary stroke and other major vascular events. They also outline current guidelines for the use of statins in patients with stroke.

This Case Study describes a 80-year-old patient with lower-body parkinsonism who was diagnosed with vascular parkinsonism on the basis of clinical and neuroimaging findings, but whose gait and, to a lesser extent, cognitive impairments improved following external lumbar drainage. Postmortem neuropathology confirmed a diagnosis of normal pressure hydrocephalus.