Artéria trigeminal e aneurisma segmentar da artéria carótida associadas a hemorragia subaracnóide / Trigeminal artery and segmental aneurysm of the carotid artery associated with subarachnoid hemorrhage

A persistência e a falha da involução das comunicações embrionárias entre a circulação cerebral anterior e posterior contribuem para anomalias vasculares em adultos. Esta variação é comumente detectada de forma incidental, causando sintomas muito raramente. Sua proximidade com os nervos oculomotor, troclear e abducente podem levar a paresia muscular ocular. Em alguns casos pode causar tinnitus pulsátil e ao espasmo de hemiface. Muitos casos de artéria trigeminal foram relatados como associados a aneurismas intracranianos.

The persistence and failure of the involution of embryonic communications between the anterior and posterior cerebral circulation contribute to vascular anomalies in adults. This variation is commonly detected incidentally, rarely causing symptoms. Its proximity to the oculomotor, trochlear, and abducent nerves can lead to ocular muscle paresis. Sometimes it can cause pulsatile tinnitus and hemiface spasm. Many cases of trigeminal artery have been reported to be associated with intracranial aneurysms.

Assessment of carotid artery wall in patients with OSA syndrome and the effect of CPAP on its thickness

In patients with Obstructive sleep apnea [OSA], the risks of fatal and nonfatal cardiovascular diseases and coronary artery disease are increased and measuring carotid intima-media thickness [CIMT] can assess these complications. Studying the effect of OSA syndrome in the carotid artery wall thickness as an indicator to cardiovascular complications, and the effect of CPAP on these changes. Polysomnography [PSG] was done for 45 patients; 29 patients of them proved to have OSA, and 10 obese subjects with normal PSG were included as a control group. All of them had ultrasonographic assessment of CIMT. 17 patients with OSA used CPAP overnight for 6 months and the CIMT was remeasured. 29 were diagnosed with OSA [12 severe, 9 moderate and 8 mild OSA]. There was a highly significant difference [p < 0.01] in CIMT between patient and control groups, and also between severe and mild OSA patients with non-significant difference [p > 0.05] between severe and moderate OSA. Regarding the different risk factors predispose to atherosclerosis, only factors related to OSA syndrome were correlated with CIMT. There was a highly significant reduction [p < 0.01] in CIMT after six months of CPAP usage. CIMT as a marker of atherosclerosis is significantly increased in patients with OSA and the use of CPAP in those patients is very important not only for improving sleep efficiency but also for reducing cardiovascular complications associated with OSAS

Bilateral Carotid and Vertebral Rete Mirabile Presenting with a Prominent Anterior Spinal Artery Mimicking a Spinal Dural AV Fistula at MRI

Bilateral carotid and vertebral rete mirabile (CVRM) is a very rare condition. We report a new case of CVRM initially detected by magnetic resonance imaging (MRI) of the cervical spine. MRI demonstrated tortuous vascular signal voids limited to the anterior cerebrospinal fluid space mimicking spinal dural arteriovenous fistula. A diagnosis of CVRM was confirmed on the basis of angiographic findings of rete formation associated with bilateral aplasia of the cavernous internal carotid and vertebral arteries without abnormal arteriovenous connection.

Hyperuricemia and its association with carotid intima-media thickness in hypertensive and non hypertensive patients

Carotid intima-media thickness [C-IMT] measured noninvasively by ultrasonography is widely used as a marker for increased risk of cardiovascular disease. Also hyperuricemia [HU] is a well recognized risk factor for cardiovascular diseases. The study was designed to assess the relation between hyperuricemia and carotid intima-media thickness C-IMT in patients with and without hypertension [HTN]. This study included 126 patients divided into four groups: [1] Group A, included 59 hypertensive patients with hyperuricemia. [2] Group B, included 29 hypertensive patients without hyperuricemia. [3] Group C, included 17 patients with hyperuricemia and normal blood pressure without history of hypertension. [4] Group D, included 21 control subjects. We measured carotid intima-media thickness by B-mode ultrasound in the common carotid and internal carotid artery. Routine echocardiography and uric acid level was assessed for all patients. We found that C-IMT was significantly higher in group A, B and C than group D; and it was significantly higher in group A than B. This means that C-IMT is significantly higher in all hypertensive groups than control group but it was significantly higher in hypertensive hyperuricemia [group A] than those hypertensives without hyperuricemia. We also observed a higher C-IMT in hyperuricemic non hypertensive patients than control group this means that hyperuricemia per se could be a risk factor for atherosclerosis. Uric acid levels among the whole number of patients included in the study and among the groups with hyperuricemia [group A and group C] were positively correlated with the intimal-media thickness [IMT] while there were no correlations in the other two groups without hyperuricemia. We found that left ventricular hypertrophy [LVH] was significantly higher in hypertensive patients [group A and B] than normotensives [group C and D] either with or without hyperuricemia and this was evident in the hypertensive hyperuricemic patients [group A]; but unexpectedly we observed the presence of LVH in the hyperuricemic non hypertensive patients [group C] which was significantly higher than the control group [group D]. This means that hyperuricemia is a risk factor for development of LVH hypertrophy independently of hypertension. Therefore, higher serum uric acid levels are associated with increased C-IMT and left ventricular hypertrophy in hypertensive and even non hypertensive patients. So, early screening for hyperuricemia and lowering serum uric acid levels might be beneficial in slowing progression of atherogenesis

Caso clínico radiológico: carótida interna aberrante / Radiologic clinic case: deviant internal carotid

La carótida interna aberrante es una rara malformación congénita. Se presenta el caso de una paciente pediátrica con esta alteración como hallazgo durante la evaluación por imágenes, complementaria de una patología otorrinolaringológica frecuente.

The deviant internal carotid is a unusual congenital malformation. The case of a pediatric patient with this alteration is presented. The finding was made during a rutine image assesment of an ENT disease.

Idade e tempo em diálise são associações maiores com placas de carótida em pacientes não diabéticos em HD / Age and time on dialysis are major associations with carotid plaques in non-diabetic HD patients

Introdução: Aterosclerose acelerada é uma característica bem reconhecida da doença renal avançada, sendo um dos fatores predominantes associados com a alta morbidade e mortalidade nesta população de pacientes. Vários estudos correlacionaram a presença de placas ateroscleróticas com o estado nutricional e a inflamação nestes pacientes. Entretanto, fatores de risco tradicionais como hipertensão, tabagismo e dislipidemia devem sempre ser considerados no contexto de aspectos étnicos, geográficos e culturais de uma dada população de pacientes renais. Objetivo: Este estudo teve por objetivo a descrição da prevalência da aterosclerose avançada, segundo avaliação através da presença de placas carotídeas, e sua correlação com dados epidemiológicos, fatores de risco tradicionais e não-tradicionais em pacientes não diabéticos em hemodiálise (HD). Métodos: Trinta e nove pacientes em um programa regular de HD foram avaliados (idade média: 47,0 ± 12,8 anos, 20 homens, tempo médio em diálise: 5,2 ± 2,9 anos). A presença de aterosclerose foi investigada por Doppler de carótida e a inflamação pela proteína C-reativa (PCR). Dados acerca do estado nutricional, pressão arterial e parâmetros bioquímicos foram igualmente analisados. Resultados: A presença de placa em carótida foi um achado prevalente, observada em 64,1% dos pacientes. A idade (50,8 ± 10,6 anos) e o tempo em diálise (6 [1-15] anos) foram significativamente maiores no grupo de pacientes com placas, comparado ao grupo de pacientes sem placas (41,3 ± 14,5 e 4 [1-11], respectivamente, p < 0,05). Não houve diferença estatística entre os grupos no que diz respeito à PCR, estado nutricional e parâmetros bioquímicos. Placas de carótida foram associadas com a idade acima de 38 anos (O.R.: 28.29; C.I.: 2.68-712.8; p < 0,001), e tempo em diálise acima de 4 anos (O.R.: 5.5; C.I.: 1.02-33.37; p < 0.05).Além disso, 70% dos pacientes com pressão diastólica pós HD menor do que 90 mmHg apresentaram placas de carótida.

Introduction: Accelerated atherosclerosis is a well-recognized characteristic of end stage renal disease (ESRD), as one of the leading factors associated with the high cardiovascular morbidity and mortality in this patient population. Several studies have been done correlating the presence of atherosclerotic carotid plaques with nutritional status and inflammation in this setting. Nevertheless, traditional risk factors like hypertension, smoking and dyslipidemia must always be taken into account in the context of the specific ethnic, geographic and cultural aspects of a given renal population. Aim: The present study was designed to describe the prevalence of advanced atherosclerosis, as detected by the presence of carotid plaques, and its correlation with epidemiological data, traditional and non-traditional risk factors in non-diabetic hemodialysis (HD) patients. Methods: Thirty-nine patients on a regular HD program were evaluated (mean age: 47.0±12.8 years, 20 men, mean time on dialysis: 5.2±2.9 years). Atherosclerosis was assessed by carotid Doppler and inflammation by serum C reactive protein (CRP). Data on nutritional status, biochemical parameters, and arterial pressure (AP) were also analyzed. Results: Carotid plaque was a prevalent finding, observed in 64.1% of the patients. The age (50.8±10.6 years) and time on dialysis (6 [1-15] years) were significantly higher in the group of patients with plaques, compared to the group of patients without plaques (41.3±14.5 and 4 [1-11], respectively, P<0.05). There was no statistical difference between the groups regarding CRP, nutritional status, biochemistry parameters, and mean pre and post HD arterial, diastolic and systolic pressure. Carotid plaques were associated with age higher than 38 (OR.: 28.29; 95% CI.: 2.68-712.8; p<0.001), and time on dialysis higher than 4 years (OR.: 5.5; 95% CI.: 1.02-33.37; p<0.05). In addition, 70% of patients with post HD diastolic AP lower than 90 mmHg presented carotid plaques.

Anatomical variation of the brachiocephalic trunk and common carotid artery in neck dissection / Variación anatómica del tronco braquicefálico y arteria carótida común en disecciones de cuello

Variations in the trajectory of the brachiocephalic trunk and the common carotid artery predispose to disorders which might be critical in a tracheotomy and/or surgeries. Dissection of 110 formol fixed adult cadavers, both sexes, were performed to increase the anatomic knowledge of the neck vessels and its variations. Cadavers were from the Laboratory of Descriptive and Topographic Anatomy of the Federal University of São Paulo- Paulista Medical School- UNIFESP-EPM. In 109 of these cadavers no variations were found while in one (0.9%) it was possible to observe a variation in the trajectory of the brachiocephalic trunk and in the right common carotid artery.

Las variaciones en el trayecto del tronco braquiocefálico y de la arteria carótida común predisponen a complicaciones que pueden ser fatales durante una traqueotomía y/o cirugías. Con el objetivo de ampliar el conocimiento anatómico de estos vasos del cuello y de sus variaciones, decidimos diseccionar 110 cadáveres, formalizados, adultos, de ambos los sexos, provenientes del Laboratorio de Anatomía Descriptiva y Topográfica de la Universidad Federal de São Paulo-Escuela Paulista de Medicina ¡ UNIFESP-EPM. En 109 (99,1%) de los cadáveres no encontramos variaciones En un caso (0,9%) observamos variación en el trayecto del tronco braquiocefálico y de la arteria carótida común derecha.

Hemihydranencephaly; a case report

Hemihydranencephaly is a rare disorder of the brain characterized by complete or almost complete unilateral absence of cerebral cortex with preservation of meninges, basal ganglia, pons, medulla, cerebellum, and falx. Thirteen year-old male child presented with left sided upper and lower limb weakness with facial asymmetry since the age of six months. His magnetic resonance imaging [MRI] scans demonstrated a nearly complete absence of the right cerebral hemisphere including basal ganglion, which was replaced by cerebrospinal fluid with a small residual rim of the occipital cortex. The imaging features were suggestive of right-sided hemihydranencephaly. Patients with hemihydranencephaly provide an experiment of nature with potential implications for normal cognitive development and illustrate how much there is still to be learned about human development

Proteína C reativa e instabilidade clínica na doença obstrutiva de artérias carótidas / C-reactive protein and clinical instability in carotid artery obstructive disease

CONTEXTO: A atividade inflamatória na aterosclerose vem sendo exaustivamente estudada; entretanto, a relevância da Proteína C Reativa como marcador de instabilidade clínica, na doença obstrutiva de artérias carótidas ainda não encontra-se bem estabelecido OBJETIVO: Identificar se os níveis séricos de proteína C reativa ultra-sensível se associam com a apresentação clínica (estável versus instável) da doença obstrutiva grave das artérias carótidas. MÉTODO: Foram estudados 70 pacientes consecutivos com indicação de endarterectomia de carótida pelos critérios dos ensaios NASCET ou ACST, com diferentes tipos de apresentação clínica: grupo 1- assintomáticos ou com sintomas hemisféricos com mais de 90 dias; grupo 2 - com sintomas hemisféricos com menos de 90 dias. Amostras de sangue de cada paciente foram obtidas por punção venosa periférica; a proteína C reativa ultra-sensível foi dosada por nefelometria e a comparação entre os grupos foi realizada através do teste de t de Student, considerando-se significativo o valor de p < 0,05. RESULTADOS: o quadro clínico neurológico foi considerado estável em 28 (40 por cento) pacientes, enquanto que 42 (60 por cento) dos casos foram considerados instáveis. Os valores de proteína C reativa ultra-sensível foram significativamente maiores nos pacientes clinicamente instáveis, quando comparados aos casos estáveis neurologicamente (1,54±1,7 versus 0,67±0,8 mg/dL, respectivamente; p = 0,006). Não houve diferença nos níveis de proteína C reativa ultra-sensível quando comparados os percentuais de estenose angiográfica. CONCLUSÕES: A constatação de que níveis elevados de proteína C reativa ultra-sensível correlacionam-se com instabilidade da placa de carótidas, possivelmente antevendo eventos clínicos, poderá contribuir para uma redefinição dos critérios de tratamento cirúrgico da doença cerebrovascular.

BACKGROUND: Inflammatory activity in atherosclerosis has been exhaustively studied; however, the relevance of C-reactive protein as a marker of clinical instability in carotid artery obstructive disease has not been well established yet. OBJECTIVE: To identify whether high-sensitivity C-reactive protein serum levels are associated with clinical presentation (stable vs. unstable) of carotid artery severe obstructive disease. METHODS: Seventy consecutive patients underwent carotid endarterectomy based on NASCET or ACST criteria, and were classified according to clinical presentation: group 1 - asymptomatic or with hemispheric symptoms for more than 90 days; group 2 - with hemispheric symptoms for less than 90 days. Blood samples were collected by peripheral vein puncture; high-sensitivity C-reactive protein was dosed by nephelometry and comparison between groups was performed using Student's t test; p < 0.05 was considered significant. RESULTS: Neurological clinical status was considered stable in 28 (40 percent) patients, whereas 42 (60 percent) cases were considered unstable. High-sensitivity C-reactive protein levels were significantly higher in clinically unstable patients, when compared with neurologically stable cases (1.54±1.7 vs. 0.67±0.8 mg/dL, respectively; p = 0.006). There was no difference in high-sensitivity C-reactive protein levels, when compared with percentages of angiographic stenosis. CONCLUSIONS: The fact that high levels of high-sensitivity C-reactive protein are associated with unstable carotid plaque, possibly anticipating clinical events, could contribute to redefining indications for cerebrovascular interventions.

Síndrome de Eagle: revisión de la literatura / Eagle´s syndrome: a review of the literature

El síndrome de Eagle, también conocido como el síndrome estiloide, síndrome de la arteria carótida o síndrome del proceso estiloide alargado y huesificado, consiste en el alargamiento del proceso estiloide o en la hosificación del ligamento estilóideo, produciendo dolores estimulados por los nervios cranianos y sensoriales. El objetivo del presente estudio es realizar una revisión de literatura, enfatizando peculiaridades sobre la anatomía, embriología, etiología, diagnóstico diferencial, sintomatología y tratamiento de este síndrome.

The Eagle Syndrome, also known as Styloid Syndrome, Arteria Carotus Syndrome and Syndrome of the elongated and ossified styloid process, consists in an elongated styloid process or a calcified stylohyoid ligament, causing pain due to stimulation of cranial and sensorial nerves. The objective of this study is to realize a literature review of this syndrome, emphasizing peculiarities of its anatomy, embryology, etiology, differential diagnosis, symptomatology and treatment.

A Síndrome de Eagle, também conhecida como a síndrome estilóide, síndrome da artéria carótida ou síndrome do processo estilóide alongado e ossificado, consiste no alongamento do processo estilóide ou na ossificação do ligamento estiloióideo, produzindo dores estimuladas pelos nervos cranianos e sensoriais. O objetivo do presente estudo é realizar uma revisão de literatura, enfatizando peculiaridades sobre a anatomia, embriologia, etiologia, diagnóstico diferencial, sintomatologia e tratamento desta síndrome.

Existencia bilateral del tronco maxilofacial en el hombre: una variación anatómica rara / Bilateral ocurrence of the maxillofacial trunk in man: a strange anatomical variation

La formación de un tronco arterial raro, el tronco maxilofacial, fue observado bilateralmente durante la disección anatómica de un individuo blanco, adulto, de sexo masculino. El tronco arterial estaba cubierto por el músculo estilohioideo y por el vientre posterior del músculo digástrico y después de un corto trayecto anterior, se bifurcaba originando las arterias facial y maxilar. Durante su trayecto, la arteria maxilar presentaba características y relaciones diferentes a las encontradas en la mayoría de las disecciones anatómicas. Por otro lado, sus ramas eran semejantes a las descritas en la literatura especializada

Aneurismas carotídeos extracraneales. presentación de siete casos y revisión de la literatura / Aneurysms of the extracranial carotid artery. Seven cases are presented: Review of the literature

Los aneurismas de las arterias carótideas son raros. Presentamos siete casos, cuatro verdaderos, tres aneurismas falsos. Fueron tratados quirúrgicamente sin complicaciones. Se revisan los aspectos fisopatológicos, diagnóstico diferencial, y tratamiento quirúrgico encontrados en la literatura mundial

Neonatal stridor: a life-threatening condition

Stridor, when present since birth, should alert the physician of the possibility of a major cause of airway obstruction. In some cases, it can be life-threatening if timely and adequate intervention is not performed. In this report we discuss an infant who presented with stridor since birth. It's clinical picture, diagnostic approach and management are reviewed. The use of fiberoptic bronchoscopy as the most important diagnostic tool in the evaluation of stridor is emphasized and prompt referral for proper evaluation is recommended

Isquemia cerebral transitória associada a artéria trigeminal persistente: relato de caso / Transient cerebral ischemia associated to persistent trigeminal artery: report of case

Uma paciente com artéria trigeminal persistente apresentou vários episódios de isquemia cerebral transitória, associada a ateroesclerose difusa, na circulaçäo anterior. O autor enfatiza a investigaçäo desta anomalia arterial em pacientes jovens com quadros isquêmicos, fazendo uma revisäo da embriologia e quadros clínicos apresentados