From Managing strokes and TIAs in practice By Ronald S. MacWalter, Colin P. ShirleyPage 33Other types of strokesStuttering StrokeA stuttering stroke may occur with occlusion of the internal carotid artery. The actual impact of occlusion of the internal carotid artery depends upon the effectiveness of compensatory mechanisms, principally the circle of Willis. (The circle of Willis is a vascular structure located on the floor of the cranial cavity and represents the termination of the basilar and internal carotid arteries, The circle of Willis loops around the brain stem above the pons and the brain’s major blood vessels [the anterior, middle, and posterior cerebral arteries] branch from it. Because the circke of Willis is supplied by three vessels, damage to one may compromise the blood supply to the brain as the arrangement allows collateral flow. In addition, even if there is an occlusion of part of the circle itself, blood can flow in either direction around it.) It also depends on the external carotid, which may provide flow to the anterior and the middle cerebral arteries through menigeal branches, and retrogradely through the ophthalmic artery to the internal carotid, Total occlusion may be silent or catastrophic. Characterisctically, the picture is one of a stuttering stroke. If the innominate artery is occluded after branching from the aortic arch, a similar picture may be seen. Additionally, there will be reduced blood pressure in the right arm.Stuttering stroke occurs when the internal carotid artery is occluded, but the stroke impact depends on compensatory mechanisms, eg the circle of Willis, and alternative route of blood flow
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