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Conservative measures should be instituted before turning to surgical removal of the disc unless there are signs of a rapidly or subacutely progressing myelopathy (i.e., leg and arm weakness, hyperre exia in the legs, gait ataxia, sphincteric dysfunction). In the case of cervical disc with radicular pain, a close- tting foam collar is quite bene cial. The collar should be tted so that little exion and extension of the neck are permitted, but it must remain comfortable enough to encourage consistent use; we have found it helpful to have the patient bring the collar when visiting the doctor in order to assure a proper t. The patient is advised to wear the collar at all times during the day, especially while riding in a car, unless this becomes completely impractical. Analgesic medication, either NSAIDs or narcotics, may be required for a few days. While considered of little value in lumbar disc disease, traction with a halter around the occiput and chin may be of some bene t in cervical disc syndromes. Treatment can be administered with the patient recumbent, or it can be performed intermittently in the sitting position, using simple equipment that applies 2 to 10 lb of upward traction while the patient is seated and the weight attached to a rope over the top of the door. Many patients obtain a degree of relief in bed by the use of a cervical pillow, a foam or in atable neck rest shaped like a dog bone. A similar appliance is helpful during airplane ights.

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Rev Neurol 11:51, 1927 FORD CS, FRYE JL, TOOLE JF, LEFKOWITZ D: Asymptomatic carotid bruit and stenosis Arch Neurol 43:219, 1986 FRANK JI: Large hemispheric infarction, deterioration, and intracranial pressure Neurology 45:1286, 1995 FREIS ED, CALABRESI M, CASTLE CH, et al: Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension II: Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg JAMA 213:1143, 1970 GARRAWAY WM, WHISNANT JP, DRURY I: The changing pattern of survival following stroke Stroke 14:699, 1983 GARRAWAY WM, WHISNANT JP, DRURY I: The continuing decline in the incidence of stroke Mayo Clin Proc 58:520, 1983 GASECKI AP, ELIASZIW M, FERGUSON GG, et al: Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: Results from NASCET J Neurosurg 83:778, 1995.

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GILON D, BUONANO FS, JOFFE MM, et al: Lack of evidence of an association between mitral-valve prolapse and stroke in young patients N Engl J Med 3:41, 1999 GLADSTONE DJ, SILVER FL, WILLINSKY RA, et al: Deep cerebral venous thrombosis: An illustrative case with reversible diencephalic dysfunction Can J Neurol Sci 28:159, 2001 GREENBERG SM, REBECK GW, VONSATTEL JP, et al: Apolipoprotein E e4 and cerebral hemorrhage associated with amyloid angiopathy Ann Neurol 38:254, 1995 GREEENBERG SM, VONSATTEL JP, STAKES JW, et al: The clinical spectrum of cerebral amyloid angiopathy: presentations without lobar hemorrhage Neurology 43:2073, 1993 HACKE W, KASTE M, FIESCHI C, et al: Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: The European Cooperative Acute Stroke Trial (ECASS) JAMA 274: 1017, 1995 HACKE W, KASTE M, FIESCHI C, et al: Randomised double- blind placebocontrolled trial of thrombolytic therapy with intravenous aleptase in acute ischaemic stroke.

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