Uncommon causes of ischaemic stroke: how to approach the diagnosis.

Stroke is a common neurological emergency and although most cases are associated with traditional vascular risk factors leading to cerebral ischaemia by well-recognised pathophysiological mechanisms, around 4% of ischaemic strokes are due to rare conditions. These are important to recognise due to their different management, which is often specific and effective, and due to their different prognosis from otherwise cryptogenic ischaemic strokes. We outline a practical approach to identifying uncommon causes of ischaemic stroke by highlighting diagnostic 'red flags' and propose a structured approach to investigating them.

Lyme disease: diagnosis and management.

Lyme disease (borreliosis) is a tick-borne bacterial infection caused by the spirochaete , transmitted by hard-backed ticks. Actual numbers of cases are increasing and it appears that the distribution across the UK is widening; however, it occurs most frequently in area of woodland, with temperate climate. It typically presents in mid to late summer.

Critical cap thickness and rupture in symptomatic carotid plaques: the oxford plaque study.

Background And Purpose: Advances in carotid plaque imaging could allow quantification of fibrous cap thickness in vivo. While a cap thickness <65 microm is the accepted definition of rupture-prone plaque in the coronary circulation, the threshold value for carotid plaques is unknown.

Methods: We made detailed histological assessments of 526 carotid plaques from consecutive patients undergoing endarterectomy for symptomatic carotid stenosis.

Cerebral venous sinus thrombosis.

Cerebral (or dural) venous sinus thrombosis (CVST) is a condition distinct from other cerebrovascular disease, which presents its own particular diagnostic difficulties and treatment controversies. The clinical presentation is variable and may mimic a wide range of other neurological disorders that include subarachnoid haemorrhage, encephalitis, eclampsia, idiopathic intracranial hypertension and arterial stroke.

Site of carotid plaque ulceration in relation to direction of blood flow: an angiographic and pathological study.

Background: Rupture of atherosclerotic plaque is the main cause of acute coronary syndromes and carotid territory ischaemic stroke. Haemodynamic stress is important in early plaque formation and may affect the stability of mature plaques. There is some evidence that macrophage infiltration and plaque rupture tend to localise to the proximal (upstream) part of the plaque where shear stress is highest.

Pulse pressure is independently associated with carotid plaque ulceration.

Background: Plaque rupture is the principal cause of acute coronary ischaemia, and unstable carotid plaques are associated with a high risk of ischaemic stroke. Carotid plaque ulceration also predicts acute coronary events, suggesting that systemic factors may determine plaque instability. One potentially important factor is pulse pressure.