Cerebrovascular disease is the most frequent cause of new rapid-onset, nontraumatic neurologic deficit. It is a far more common etiology than seizures or tumors. Vascular structures are subject to a variety of chronic pathologic processes which compromise vessel wall integrity. Diabetes, high cholesterol, high blood pressure, and smoking are risk factors for vascular disease. These conditions can lead to vascular damage by such mechanisms as atheroma deposition causing luminal stenosis, endothelial damage promoting thrombogenesis, and weakening of the vessel wall resulting in aneurysm formation or dissection. These processes may coexist. For instance, a vessel may contain an atheromatous plaque that significantly decreases lumen diameter, and also have compromised endothelium over the plaque, providing the opportunity for thrombus formation, which can lead to acute total occlusion of the remaining lumen. Aneurysms and dissection often occur in atheromatous vessels. Specific patterns of disease relevant to the cerebrovascular system are atheromatous and thrombotic carotid occlusion, brain ischemia due to embolus from a proximal source, vessel wall breakage leading to hemorrhage, and rupture of abnormal, thin-walled structures, specifically aneurysms and arteriovenous malformations.
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