Showing papers on "Cerebral infarction published in 1979"
TL;DR: Following ligation of the right middle cerebral artery, rats were hyperactive for 2 to 3 weeks and did not show any significant change in catecholamines in any of the brain areas studied, suggesting lateralization of behavioral and biochemical response to cerebral infarction may be the consequence of anatomical or physiological asymmetries in the brain.
Abstract: Following ligation of the right middle cerebral artery, rats were hyperactive for 2 to 3 weeks whether activity was measured by running wheel revolutions or open field observations. Assays of brain catecholamines revealed 30 percent reductions of norepinephrine in the injured and uninjured cortex and locus coeruleus and a 20 percent reduction of dopamine in the substantia nigra. In contrast, rats with left middle cerebral artery ligations did not become hyperactive and did not show any significant change in catecholamines in any of the brain areas studied. Right and left hemispheric infarctions were comparable in their locations and extent of tissue damage. This lateralization of behavioral and biochemical response to cerebral infarction may be the consequence of anatomical or physiological asymmetries in the brain.
389 citations
TL;DR: Results show that the BBB becomes permeable immediately following hypoxia-ischemia, and shows that BBB permeability to HRP during cerebral ischemia occurs through two mechanisms: an active, energy-requiring permeability through enhanced pinocytosis within endothelial cells and a passive leakage of protein tracers through necrotic vessel walls.
Abstract: Cerebral infarction was produced in rats by a combination of transient unilateral common carotid artery occlusion and systemic hypoxia. Horseradish peroxidase (HRP) and Evans blue were given 5 minutes prior to sacrifice to assess the integrity of the blood-brain barrier (BBB) at 1 minute, 30 minutes, and 2 hours following the ischemic insult. There was immediate permeability to HRP in the early (1 minute and 30 minutes) post-ischemic period, whereas, Evans blue was not seen until the late (1.5 to 2 hours) post-ischemic period. Ultrastructural examination showed two routes of barrier permeability to HRP. In the early post-ischemic period, HRP was transported by pinocytosis through endothelial cells in areas of brain containing ischemic neurons. In the late post-ischemic period, HRP diffusely leaked into the brain through the necrotic walls of vessels in areas of infarction. In contrast to previous reports, these results show that the BBB becomes permeable immediately following hypoxia-ischemia. In addition, this study shows that BBB permeability to HRP during cerebral ischemia occurs through two mechanisms: an active, energy-requiring permeability through enhanced pinocytosis within endothelial cells and a passive leakage of protein tracers through necrotic vessel walls.
145 citations
TL;DR: The present findings suggest that moderate dietary supplements of fish oil may be beneficial in the prophylactic treatment of ischemic cerebral vascular disease.
134 citations
TL;DR: Platelet counts and coagulation factors returned toward normal after control of intestinal inflammation in each of the 4 surviving patients after the course of inflammatory bowel disease in 5 patients.
Abstract: Recurrent retinal branch artery occlusions, carotid thromboembolism, cerebral venous thrombosis, transient brainstem ischemia, and massive brainstem and cerebral infarction complicated the course of inflammatory bowel disease in 5 patients. Three patients had ulcerative colitis and 2 had regional enteritis. The usual risk factors for stroke were absent. Neuropathological examination in 1 patient showed in situ thrombosis of small cerebral and brainstem arteries and veins. Coagulation studies showed thrombocytosis, short partial thromboplastin times, and elevation of fibrinogen and Factor VIII levels. Platelet counts and coagulation factors returned toward normal after control of intestinal inflammation in each of the 4 surviving patients. Inflammatory bowel disease can be accompanied by a hypercoagulable state that predisposes to stroke.
116 citations
TL;DR: CT without contrast medium may lead to misinterpretation during the second and third weeks after the onset of cerebral infarction, so knowledge of the fogging effect is important for correct interpretation of the CT image and the indication for contrast medium CT.
Abstract: Systematic CT studies on ten patients with persistent ischemic cerebral infarct revealed a constant phenomenon, the fogging effect. The hypodense infarct at the beginning will be isodense, or close to isodense, on the plain CT during the seond of third weeks and at a later stage will be hypodense again. The fogging infarcted area shows homogeneous intensive contrast enhancement. Knowledge of the fogging effect is important for correct interpretation of the CT image and the indication for contrast medium CT. CT without contrast medium may lead to misinterpretation during the second and third weeks after the onset of cerebral infarction.
114 citations
TL;DR: The clinical course of 16 consecutive patients with stenosis of the middle cerebral artery angiographically diagonosed between 1970 and 1977 was reviewed and supports the need for a randomized study of bypass efficacy in these patients.
Abstract: The clinical course of 16 consecutive patients with stenosis of the middle cerebral artery angiographically diagonosed between 1970 and 1977 was reviewed. All were managed nonsurgically with medical treatment including anticoagulation. Prior to therapy, transient ischemic attacks had occurred in 15 and cerebral infarction in 11. Initially, none exhibited more than a minor neurological deficit. Follow-up from one month to six years showed a benign course in 14 patients: 13 experienced no subsequent transient attacks or new stroke; 1 had repeated transient attacks for two years but not in the following four years. Two of the 16 developed a severe stroke early in the course, before medical therapy was started. No distinctive clinical or radiographic features were identified that permitted prediction of the outcome. This small series supports the need for a randomized study of bypass efficacy in these patients.
105 citations
TL;DR: In twelve patients who developed delayed recurrent cerebral or retinal ischemia ipsilateral to their internal carotid artery occlusion, there were found obstructive and/ or ulcerative plaques involving the common and/or external carotids.
Abstract: Twenty-three instances of internal carotid artery occlusion occurring with minimal neurological deficit in 22 patients are described. Although each of these patients was referred to the neurosurgical service for evaluation for an extracranial-intracranial microvascular bypass procedure, complete arteriographic evaluations of their cerebrovasculature suggested that alternative methods should be the treatment of choice. For each patient reported the ipsilateral external carotid artery was demonstrated by angiography to be an important source of collateral blood supply to the cerebral hemispheres or retinae distal to the occluded internal carotid arteries. Ten patients with no significant atherosclerotic narrowing or ulceration of the external carotid artery have remained free of symptoms of cerebral ischemia for 6 to 40 months. In twelve patients who developed delayed recurrent cerebral or retinal ischemia ipsilateral to their internal carotid artery occlusion, there were found obstructive and/or ulcerative plaques involving the common and/or external carotid arteries. Thromboendarterectomy in 11 of these patients gave complete relief of ischemic symptoms during the 4 to 36 months of postoperative follow up. One of these 12 patients refused operation and went on to develop a major cerebral infarction. Angiographic identification of a functionally important external carotid artery ipsilateral to an internal carotid artery occlusion carries considerable prognostic and therapeutic significance.
86 citations
TL;DR: Cerebral infarction was documented by arteriography and serial computed cranial tomography in four young adulte (ages 16 to 32 years) with migraine and may be more prevalent in “complicated” migraine than is generally appreciated.
Abstract: Cerebral infarction was documented by arteriography and serial computed cranial tomography (CT) in four young adults (ages 16 to 32 years) with migraine. In one case, posterior cerebral artery occlusion produced a deep parietotemporal infarct. The other three cases all had frontotemporal infarcts (one hemorrhagic) in the territory of the middle cerebral artery, without major arterial occlusion. Two infarcts produced lasting neurologic deficits; one was associated with mild, transitory symptoms, and one was asymtomatic. Laboratory investigations in two cases revealed no hematologic or cardiovascular predisposition to cerebrovascular disease. Cerebral infarction, as revealed by CT, may be more prevalent in "complicated" migraine than is generally appreciated. Such lesions may or may not develop in chronologic and anatomic relationship to the headache, and may involve either large or small arteries. The prognosis for functional recovery, based on this limited sample, seems favorable.
76 citations
TL;DR: In cases with good clinical course some improvement in the immunological parameters was observed, but full recovery did not occur until 3 weeks after the onset of disease, it is suppose that the depression in the Immunological function was caused by severe stress during the course of disease.
72 citations
TL;DR: Computerized tomography scans of 54 patients with an arteriovenous malformation of the brain were reviewed and a correlation of the CT scan with clinical, angiographic, and histological findings is presented.
Abstract: Computerized tomography (CT) scans of 54 patients with an arteriovenous malformation (AVM) of the brain were reviewed. The 31 males and 23 females (mean age: 33 years) were classified according to clinical presentation: 1) intracranial hemorrhage (30 patients); 2) seizure disorder (19 patients); and 3) other neurological disturbance (five patients). A brain hematoma was identified in all of the patients in the hemorrhage group have a CT scan within 1 week of the bleed. Extension of hemorrhage into the ventricular system as seen in eight cases was invariably accompanied by severe neurological dysfunction. A high-density lesion without associated mass effect was found in 48% of patients presenting with a seizure disorder. Dilatation of the ipsilateral lateral ventricle, a common finding in this group of patients, was thought to indicate an atrophic process. Evidence of discrete brain infarction was unusual. Intravenous infusion with Hypaque provided additional information in 31 of the 35 patients so studied. Demonstration of prominent or enlarged feeding arteries and/or draining veins occurred in 20% of patients with large malformations. Six cases of angiographically occult AVM's were found. A correlation of the CT scan with clinical, angiographic, and histological findings is presented.
67 citations
TL;DR: Measurements of regional cerebral hemodynamics and metabolism in patients undergoing a superficial temporal artery-middle cerebral artery anastomosis to bypass cerebrovascular lesions not amenable to extracranial operative procedures suggest that measurements of this type could provide objective criteria for surgery as well as assess the effect of surgery.
Abstract: ✓ Regional cerebral blood flow (rCBF) and regional cerebral oxygen utilization (rCMRO2) were measured before and after surgery in nine patients undergoing a superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to bypass cerebrovascular lesions not amenable to extracranial operative procedures. The objective of these studies was to determine whether measurements of this type could provide objective criteria for surgery as well as assess the effect of surgery. The preliminary data, although limited, suggest that measurements of regional cerebral hemodynamics and metabolism in these patients before and after surgery provide valuable data upon which to develop criteria and assess results. For example, 1) a significant depression of rCBF and rCMRO2 in patients in whom a major cerebral infarction has not occurred, or 2) relative preservation of rCMRO2 despite depressed rCBF seem to be favorable indications for establishing a functioning STA-MCA anastomosis. In such patients, STA-MCA anastomo...
TL;DR: Evidence of increased community surveillance and treatment of hypertension among persons before the onset of cerebral infarction is presented, with a relatively greater reduction occurring in women and in the more elderly age groups.
Abstract: This study has identified all persons in the population of Rochester, Minnesota, who had a diagnosis of cerebral infarction during the period Jan. 1, 1970, through Dec. 31, 1974, and has confirmed the continuing decline in the incidence rate previously reported. The decline in the rate has been accelerating, with a relatively greater reduction occurring in women and in the more elderly age groups. There has been a decline in the prevalence rate in women which was not seen in men. The over-all impact of cerebral infarction was to reduce the proportion of those persons who were completely independent from 57% before cerebral infarction to 16% after infarction. Comparison of survival among patients with cerebral infarction occurring in the two quinquennia 1945--49 and 1970--74 showed only a 2% increased probability of survival at 30 days; the difference in survival increased progressively to 16% at 5 years. The reason for the declining incidence and increased survival in cerebral infarction in this population has not been established, but evidence of increased community surveillance and treatment of hypertension among persons before the onset of cerebral infarction is presented.
TL;DR: The animals with left hemispheric lesion showed no postoperative change in either mean spontaneous 24 hour activity or mean catecholamine concentrations in several areas of the brain, demonstrating a remarkable asymmetry in the behavioral and biochemical response to cerebral cortical infarction.
TL;DR: Cerebrovascular disease is more frequent in Japanese men in Hiroshima than Honolulu, and men of Japanese ancestry in Honolulu are spared an appreciable risk of cerebral infarction through decreased frequency of intraparenchymal arterial sclerosis despite higher levels of atherosclerosis of large intracranial arteries.
Abstract: Evidence of cerebrovascular disease at autopsy was compared in 2 groups of men: 186 long-time residents of Hiroshima, Japan, and 253 men of Japanese ancestry long resident in Honolulu, Hawaii. They were 45 to 71 years-of-age at death. Atherosclerosis of the circle of Willis and its major branches, sclerosis of the intraparenchymal arteries and the frequency of cerebral hemorrhage and cerebral infarct were compared in the 2 populations. The Honolulu subjects had significantly more atherosclerosis of the circle of Willis, but less intraparenchymal artery sclerosis and less cerebral infarction. Cerebral hemorrhage was equally frequent in the 2 cities. It was concluded that cerebral infarction is more frequent in Japanese men in Hiroshima than Honolulu, and that men of Japanese ancestry in Honolulu are spared an appreciable risk of cerebral infarction through decreased frequency of intraparenchymal arterial sclerosis despite higher levels of atherosclerosis of large intracranial arteries.
TL;DR: It is argued that, in many cases, ischemic optic neuropathy represents a direct and early complication of hypertension arterial disease affecting small arterioles supplying the anterior part of the optic nerve, and may be similar or identical to lacunar infarction of the brain.
TL;DR: The results, obtained in respect of electrocardiographic findings after the isoproterenol stress test, suggest that the HDL-cholesterol levels and HDL/LDL-ch cholesterol ratios may be related not only to the established myocardial infarction, but also to the presence of coronary atherosclerosis and stenosis.
Journal Article•
TL;DR: Two cases of cardiac myxoma with secondary involvement of the brain and death are reported, and the second case represents the only instance of cardiacMyxoma behaving as a true malignant neoplasm with actual invasion of the neural tissues recorded in the literature.
TL;DR: The computed tomographic findings of three patients with cerebral syphilis, including cerebral gumma, which regressed completely under penicillin therapy, syphilitic angiitis with cerebral infarction, and syPHilitic cerebral atrophy, are reported.
Abstract: The computed tomographic findings of three patients with cerebral syphilis, including cerebral gumma, which regressed completely under penicillin therapy, syphilitic angiitis with cerebral infarction, and syphilitic cerebral atrophy, are reported. CT is unable to provide specific diagnostic data for these conditions. The etiology can be clarified only by taking into consideration the clinical findings and course, the serological results, and the result of therapy.
TL;DR: Brainstem-cerebellar flow values were increased following acute cerebral infarction if patients were alert but reduced if consciousness was impaired, and later, rCBF values returned toward normal in the contralateral hemisphere of patients withinfarction and in both hemispheres with carotid TIAs.
Abstract: Regional CBF was measured by 133Xe inhalation in unilateral cerebral infarction, carotid TIAs, and normal volunteers. Regional CBF values were bilaterally and symmetrically reduced in patients measured within 3 weeks after stroke. Later, rCBF values returned toward normal in the contralateral hemisphere of patients with infarction and in both hemispheres with carotid TIAs. In cases with carotid occlusive disease, flow reduction was seen in the contralateral posterior cerebral artery distribution, with hyperemia in ipsilateral occipital lobe caused by interhemispheric steal. Brainstem-cerebellar flow values were increased following acute cerebral infarction if patients were alert but reduced if consciousness was impaired.
TL;DR: The clinical outcome of the first 40 patients treated with a superficial temporal artery-middle cerebral artery anastomosis with no operative mortality and Neurological deficits were either unchanged or improved, showed patency in 97% of the anASTomoses.
Abstract: • The clinical outcome of our first 40 patients (six with transient ischemic attacks, 22 with mild ischemic infarctions, and 12 with moderate ischemic infarctions) treated with a superficial temporal artery-middle cerebral artery anastomosis was analyzed. All cerebral ischemias or infarctions occurred in the internal carotid artery distribution. An independent neurologist observer recorded the patient's preoperative and postoperative medical and neurological histories and objective neurological findings. There was no operative mortality. During the period of observation (up to 36 months), four patients died of probable myocardial infarction. No patient suffered from recurrent cerebral infarction. Three patients experienced a single ischemic event postoperatively. Neurological deficits were either unchanged (21 patients) or improved (19 patients). Postoperative angiograms showed patency in 97% of the anastomoses.
TL;DR: Evidence obtained indicated that fundamentally different destructive and/or degenerative processes in the brain may be involved in intracerebral hemorrhage, subarachnoid hemorrhage and cerebral infarction and that determination of CSF astroprotein may have clinical significance in stroke patients.
Abstract: Astroprotein (an astrocyte-specific cerebroprotein) levels in cerebrospinal fluid (CSF) were determined by radioimmunoassay in 47 stroke patients. (Astroprotein is immunologically identical to glial fibrillary acidic protein.) Astroprotein levels in CSF increased markedly in acute cases of intracerebral hemorrhage and slightly to moderately in some acute cases of subarachnoid hemorrhage and cerebral infarction. In intracerebral hemorrhage, CSF astroprotein levels in the acute stage of the ictus reflected the size of the lesion and were used to estimate the clinical outcome. In subarachnoid hemorrhage and cerebral infarction, CSF astroprotein levels were related to the general neurological state. Evidence obtained indicated that fundamentally different destructive and/or degenerative processes in the brain may be involved in intracerebral hemorrhage, subarachnoid hemorrhage and cerebral infarction and that determination of CSF astroprotein may have clinical significance in stroke patients.
Journal Article•
TL;DR: Results of CT scanning appear to be associated with degree of functional recovery in patients with cerebral infarction.
TL;DR: A representation of cerebral perfusion is obtained using cranial computed tomography following the rapid bolus injection of iodinated intravenous contrast medium, and this classification is affirmed in an experimental model of cerebral infarction in the baboon.
Abstract: A representation of cerebral perfusion is obtained using cranial computed tomography following the rapid bolus injection of iodinated intravenous contrast medium. This technique permits the definition of four gross patterns of perfusion (normal, circulatory arrest, hypoperfusion, and hyperperfusion). This classification is affirmed in an experimental model of cerebral infarction in the baboon. The limitations of dynamic imaging using computed tomography are reviewed.
TL;DR: Findings showed that platelet thrombi form in association with cerebral infarcts and suggested that they are induced by tissue necrosis rather than by neuronal ischemic cell change alone.
Abstract: Cerebral infarction was produced in paralyzed, ventilated rats by a 30 min period of right common carotid artery occlusion combined with systemic hypoxia (Pao2 21-25 mm Hg). After 30 min the arterial clamp was removed and the animals were reoxygenated and allowed to survive for 1 min (6 animals), 30 min (12 animals), or 1 1/2 to 2 h (6 animals). The animals were reanesthetized and sacrificed by perfusion-fixation with paraformaldehyde-glutaraldehyde. Light and electron microscopy revealed ischemic cell change in neurons in the ipsilateral cerebral cortex, striatum and hippocampus. These changes were mild to moderate in the early post-ischemic period and severe in the post-ischemic period. Cerebral infarction was present in one of the 30 min survivors and in all of the 1 1/2 to 2 h survivors. Electron microscopy showed platelet thrombi in the infarcted brain in 3 of the 7 animals with infarcts, and in an area of very severe ischemic cell change in a fourth animal. They were not present in areas of brain showing only mild to moderate ischemic cell change. These findings showed that platelet thrombi form in association with cerebral infarcts and suggested that they are induced by tissue necrosis rather than by neuronal ischemic cell change alone.
TL;DR: A British born white man, age 51 years, presented with cerebrovascular insuffciency, and was found radiologically to have moya-moya disease as mentioned in this paper.
Abstract: A British born white man, age 51 years, presented with cerebrovascular insuffciency, and was found radiologically to have moya-moya disease. He also suffered from a let onset type of progressive myopathy. Five months after the first signs of cerebrovascular disease he died of massive cerebellar infarction. At necropsy the brain showed multiple old and recent infarctions. The anterior cerebral, middle cerebral, and posterior communicating arteries showed segments of narrowing and occlusion by delicate connective tissue, with marked thickening and folding of the elastic lamina. Many dilated thin-walled vessels without a muscle layer and with a poorly formed elastic lamina were present in the subarachnoid space, these probably being newly formed collateral vessels. The cause of the occlusive lesions affecting the cerebral arteries is not known but the morphological appearances do not fall within any known aetiology. It seems that moya-moya disease could be regarded as a distinct entity.
TL;DR: Various cerebrovascular diseases involving larger areas of the brain tissue resulted in clear adenylate kinase activities in CSF either alone as in 11 of the patients with cerebral infarction or in combination with the appearance of also glutathione.
Abstract: Adenylate kinase activity and glutathione concentration were measured in cerebrospinal fluid (CSF) of 64 consecutive patients admitted for various neurological disorders. These two analyses were performed in addition to conventional examination of the CSF. Neurological symptoms most probably connected in some cases with no and in others with only subtle changes in the central nervous system were linked to no or only moderate activities of adenylate kinase together with no glutathione. 1 patient with meningioma had no adenylate kinase activity at all while 3 patients with malignant brain tumours showed clear activities similar to 3 patients with well established diagnoses of multiple sclerosis. On the contrary, glutathione was absent in CSF of the patients with brain tumours and multiple sclerosis. Various cerebrovascular diseases involving larger areas of the brain tissue resulted in clear adenylate kinase activities in CSF either alone as in 11 of the patients with cerebral infarction or in combination with the appearance of also glutathione as in the remaining 7 patients with cerebral infarction as well as in the 14 patients studied with hemorrhages of the brain.
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TL;DR: This chapter discusses cerebral infarction and primary intracerebral hemorrhage in patients under the age of 40 and indicates that young patients may need particular advice concerning return to work and sexual activity.
Abstract: Publisher Summary Stroke in young adults is uncommon. In 1976 in England and Wales, 509 deaths under the age of 40 were attributed to cerebrovascular disease and of these 335 (66%) were because of subarachnoid hemorrhage. The frequency of cerebrovascular disease, reflected in the mortality statistics, is very much greater in the elderly than in the young and over the age of 30, the contribution of subarachnoid hemorrhage declines. This chapter discusses cerebral infarction and primary intracerebral hemorrhage in patients under the age of 40. A a stroke patient of any age requires careful nursing, physiotherapy, occupational therapy, and planned rehabilitation to as near normality as possible. In younger patients, there is often an identifiable and treatable cause and the appropriate treatment may not only prevent recurrence but also improve the prospects for recovery. Young patients may need particular advice concerning return to work and sexual activity. Clearly, risk factors for vascular disease, such as hypertension, smoking, and diabetes, should be minimized if possible.
TL;DR: It is proposed that cerebral revascularization at 4 and 24 hours following a regional MCA infarct in the dog is followed by an exacerbation of the microcirculatory obstruction, cerebral edema, and infarction.
Abstract: The efficacy of cerebral revascularization by anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA), performed 4 and 24 hours after a regional MCA infarction had been produced by combined occlusion of the MCA and internal carotid artery, was tested in 12 dogs. To control possible intercurrent variables, seven other dogs remained untreated and five had a sham operation. Clinical and pathological changes were recorded and analyzed. An incidence of 85% infarction was obtained in the untreated control group. The severity of the clinical deficits and pathological changes for the anastomosed groups were greater than those seen in the untreated control group. The extent of the infarction was significantly greater (p less than 0.05) in the anastomosed groups than in the sham-operated and control groups. Hemorrhagic infarcts occurred in most of the dogs in the anastomosed groups, but were not present in either control group (p less than 0.05). Two dogs in the 4-hour and one in the 24-hour group improved more than any control dog, but the difference was not statistically significant (p greater than 0.05). In two dogs with occluded anastomosis the clinical deficits and the pathological changes were less than those seen in animals with patent anastomosis. The severity of the pathological and clinical changes correlated well with the reestablishment of flow in the MCA territory. It is proposed that cerebral revascularization at 4 and 24 hours following a regional MCA infarct in the dog is followed by an exacerbation of the microcirculatory obstruction, cerebral edema, and infarction. From improvement noted in three animals the authors suggest that under special conditions the revascularization could benefit some cases following acute cerebral infarction.
TL;DR: A 77-year-old man with autopsy-proven bilateral cerebral infarction had a periodic alternating conjugate horizontal ocular deviation for 2 days, which ceased shortly before death, which suggests acute bilateral cerebral disease with a relatively intact brainstem.
Abstract: A 77-year-old man with autopsy-proven bilateral cerebral infarction had a periodic alternating conjugate horizontal ocular deviation for 2 days, which ceased shortly before death. There have been four previously reported patients with this disorder. The phenomenon suggests acute bilateral cerebral disease with a relatively intact brainstem.
TL;DR: Long-term, anticoagulant treatment can be recommended in carefully selected patients with TIA, and also with infarction in the carotid territory.
Abstract: One hundred seventeen patients, 31 with TIA and 86 with cerebral infarction, had angiographically verified atherosclerosis within the relevant carotid artery territory and normal CSF. They were treated with anticoagulants for a mean of 11.1 months. No TIA but 1 cerebral infarction, appearing during inadequate anticoagulant therapy, was registered. Seventy-six of the patients, 20 with TIA and 56 with infarction, were followed for a mean of 4.4 months after cessation of anticoagulants or during inadequate antinecessitating re-institution of anticoagulant therapy. Long-term, anticoagulant treatment can be recommended in carefully selected patients with TIA, and also with infarction in the carotid territory.