Stroke & Ischaemia

Acute Stroke Intervention

Arteriovenous malformations (AVMs) happen when a group of blood vessels in your body forms incorrectly. In these malformations, arteries and veins are unusually tangled and form direct connections, bypassing normal tissues. (ref)

  • The most common symptoms are headaches and impaired vision. Other symptoms include nausea and vomiting, temporary episodes of blindness, double vision, and associated neck and shoulder pain.  The symptoms generally are persistent but can resolve spontaneously and recur later.

  • Diagnosis of IIH includes brain imaging with an MRI. This test excludes other causes of increased pressure and can demonstrate other associated conditions such as narrowing of the venous channels in the skull. A confirmed diagnosis of IIH also requires a lumbar puncture or spinal tap to confirm the diagnosis and assessment of the eyes and vision by an ophthalmologist to identify swelling of the optic nerve.

  • Treatment may be necessary in cases of worsening vision or debilitating headaches. Medical treatment is first line using diuretics such as acetazolamide that reduces the production of cerebrospinal fluid and may improve symptoms.  If the condition is severe or progressive surgical procedures to reduce the pressure may be required such as insertion of a shunt in the fluid spaces in the brain to divert excess fluid to the abdominal cavity or stenting of narrowed venous channels in the skull to facilitate blood flow out of the skull cavity. In cases of isolated deteriorating vision a procedure called an optic nerve sheath fenestration may be required where an ophthalmologist cuts an opening into the covering of the optic nerve to help drain excess cerebrospinal fluid.

Dr Andrew Gauden Melbourne neurosurgeon acute stroke intervention

Carotid Disease

Carotid stenosis is the narrowing of the carotid arteries, the main artery that supplies blood to the brain. This is caused by deposits of fatty tissue forming plaque.

Narrowing of the artery can increase the risk of stroke.

  • Some patients can have no symptoms (asymptomatic)

    Others may present with transient ischaemic attacks (TIAs) with symptoms such as:

    • Sudden weakness or numbness of face, arm or leg along one side

    • Difficulty speaking or understanding speech

    • Loss of vision

    • Headache

    • Difficulty walking, dizziness or loss of balance

  • Based on scans such as

    • CT or MR angiography

    • Ultrasound of the neck

    • In some cases, an angiogram may be needed

  • Medical management

    • Is used in patients with mild narrowing

    • Will require treatment with medications including cholesterol and blood pressure tablets and blood thinners

    • Lifestyle changes may be required

    Treatment with a procedure may be required to reduce the chance of a stroke

    Carotid stenting

    • A minimally invasive treatment

    • A small tube (catheter) is inserted into the artery from the groin or wrist

    • A metal tube (stent) is placed to keep the artery open

    • A balloon may be needed to inflate across the narrowed artery to widen it (angioplasty)

    • Stenting may need additional treatment with blood thinning medications

    Hospital stay is shorter – often only an overnight stay is required and a quick recovery

    Carotid endarterectomy

    • A surgical procedure of the neck

    • Usually performed with general anaesthetic

    • The neck is cut open to expose the artery

    • The artery is opened and the plaque narrowing the vessel is removed

    • The artery is then repaired with a patch and normal blood flow is restored

    • Hospital stay is longer – often up to 3 days with a longer recovery period of a few weeks

Dr Andrew Gauden Melbourne neurosurgeon carotid disease

Thrombectomy in Stroke/Acute Stroke Intervention

A thrombectomy is a procedure that removes blood clots from a large artery in the brain using special tubes (catheters) and devices. This procedure aims to restore normal brain blood flow and reduce damage to brain tissue.

  • Symptoms include:

    • Weakness or numbness (face, arm, or leg and usually confined to one side)

    • Difficulty speaking or understanding speech

    • Loss of vision

    • Headache

    • Difficulty walking, dizziness or loss of balance

    FAST is useful to describe stroke presentation and includes

    Face drooping,
    Arm weakness,
    Speech problems,
    Time to call 000 (in Australia)

  • Urgent testing is needed in an emergency department

    • CT and MRI are used to show the type and location of the stroke and the amount of brain tissue at risk

    • CT angiography or MR angiography – provides detailed blood vessel imaging of the brain and neck to look for the location of the blocked artery

    • Only certain patients are eligible for a thrombectomy and it depends on the time from onset of symptoms, type of stroke, degree of burden and the patient’s baseline condition

  • Treatment can only be performed in a specialised hospital with a team trained in neurointerventional radiology techniques

    A small tube (catheter) is inserted into an artery in the groin or wrist and guided to the site of blockage within the brain using x-rays

    A device (stent retriever or suction catheter) is used to engage and remove the blood clot

    Treatment may be combined with clot-busting medications in some cases.

Dr Andrew Gauden Melbourne neurosurgeon thrombectomy in stroke acute intervention

For Referring Doctors

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Doctors are encouraged to call the rooms for urgent questions about patients. For all other requests and referrals, please email directly via this form.