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1.
ABC., imagem cardiovasc ; 34(2)2021. ilus
Article in Portuguese | LILACS | ID: biblio-1291096

ABSTRACT

Adulto jovem de 18 anos que evoluiu após traumatismo craniencefálico leve com fístula carotídea direta. Apresentou zumbido e exoftalmia, ambos de característica pulsátil e à esquerda. Foi submetido a estudo com Doppler das carótidas, que mostrou elevadas velocidades do fluxo sanguíneo e índices de resistência reduzidos nas artérias carótidas comum e interna esquerdas, compatíveis com fístula carotídea direta. A angiotomografia computadorizada cerebral confirmou a fístula carotídea. Foi encaminhado para tratamento endovascular por embolização, com sucesso. O Doppler de carótidas pode ter papel importante no diagnóstico das fístulas carotídeas diretas e acompanhamento de pacientes submetidos à terapêutica endovascular.(AU)


Subject(s)
Humans , Adolescent , Carotid Artery Diseases/physiopathology , Carotid Artery, Internal/pathology , Carotid-Cavernous Sinus Fistula/therapy , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Brain Injuries, Traumatic/diagnostic imaging , Echocardiography, Doppler, Color/methods , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Computed Tomography Angiography/methods
2.
Rev. Assoc. Med. Bras. (1992) ; 66(1): 31-35, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1091903

ABSTRACT

SUMMARY Homozygous familial hypercholesterolemia is a rarely agentic disorder of the lipoprotein metabolism intimately related to premature atherosclerotic cardiovascular disease that can lead to high disability and mortality. Homozygous familial hypercholesterolemia typically affects not only the aortic root, compromising the coronary ostia, but also affects other territories such as the carotid, descending aorta, and renal arteries. Multi-contrast high-resolution magnetic resonance imaging (MRI) provides a validated and useful method to characterize carotid artery atherosclerotic plaques quantitatively. However, very few studies have been done on assessing plaque composition in patients with Homozygous familial hypercholesterolemia using high-resolution MRI. This report is to evaluate the value of MRI in accessing carotid artery disease in patients with Homozygous familial hypercholesterolemia. We describe a 28-year-old patient from Beijing, China, who presented to the Neurology Clinic with intermittent blurred vision of the right eye, headache, nausea, and vomiting for eight years without obvious causes. Familial hypercholesterolemia was suspected based on medical history and laboratory examination. Carotid Doppler ultrasound showed bilateral common carotid artery, internal carotid artery, and external carotid artery wall thickening with hyperechoic signals. Subsequently, high-resolution multi-contrast MRI of the carotid showed calcification with hypo-intense areas located at the middle layer of the plaque, with moderate stenosis. The plaque located at the right bifurcation of the common carotid artery extended to the internal carotid artery, causing lumen stenosis close to occlusion. The patient was treated with right carotid artery endarterectomy. At a 6-month follow-up, there had been no recurrence of the patient's symptoms.


RESUMO A hipercolesterolemia familiar homozigótica, uma doença patogênica rara do metabolismo da lipoproteína intimamente relacionada com a doença cardiovascular aterosclerótica prematura, pode conduzir a uma elevada deficiência e mortalidade. A hipercolesterolemia familiar homozigótica afeta tipicamente não só a raiz aórtica, comprometendo os óstios coronários, mas também outros territórios, como a carótida, a aorta descendente e as artérias renais. Imagens de ressonância magnética multicontraste de alta resolução (RM) fornecem um método validado e útil para caracterizar quantitativamente as placas de aterosclerose da artéria carótida. No entanto, muito poucos estudos foram feitos sobre a avaliação da composição da placa em doentes com hipercolesterolemia familiar homozigótica utilizando ressonância magnética de alta resolução. Este trabalho deve avaliar o valor da ressonância magnética no acesso à doença da artéria carótida em doentes com hipercolesterolemia familiar homozigótica. Descrevemos um paciente de 28 anos de Pequim, China, que se apresentou à clínica neurológica com visão turva intermitente do olho direito, dor de cabeça, náuseas e vômitos por oito anos sem causas aparentes. Suspeitava-se de hipercolesterolemia familiar com base no histórico médico e no exame laboratorial. O ultrassom Doppler carotídeo mostrou uma artéria carótida bilateral comum, artéria carótida interna e parede da carótida externa espessando-se com sinais hiperecoicos. Posteriormente, a ressonância multicontraste de alta resolução da carótida mostrou calcificação com áreas hipointensas localizadas na camada média da placa, com estenose moderada. A placa localizada na bifurcação direita da artéria carótida comum estendia-se até a artéria carótida interna, causando estenose do lúmen próxima à oclusão. O paciente foi tratado com endarterectomia da artéria carótida direita. Em seis meses de acompanhamento, não houve recorrência dos sintomas do paciente.


Subject(s)
Humans , Female , Adult , Thrombosis/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Magnetic Resonance Imaging/methods , Carotid Stenosis/diagnostic imaging , Plaque, Atherosclerotic/diagnostic imaging , Hyperlipoproteinemia Type II/diagnostic imaging , Carotid Artery, External/pathology , Carotid Artery, External/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Artery, Internal/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Plaque, Atherosclerotic/pathology , Carotid Intima-Media Thickness , Computed Tomography Angiography/methods
3.
Arq. bras. oftalmol ; 81(2): 148-152, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-950435

ABSTRACT

ABSTRACT Differentiating glaucomatous from nonglaucomatous optic disc cupping remains challenging. We present a case of a 48-year-old woman with an internal carotid aneurysm of approximately 3.5 mm × 6.5 mm that mimicked normal-tension glaucoma. The patient had a 2-year history of low vision acuity in her left eye and frontal oppressive headache. Owing to the carotid aneurysm, she developed an asymmetric vertical cup-to-disc ratio above 0.2, and marked inferotemporal neuronal rim loss and pallor of the residual rim were noted in the left disc. She also developed a visual field defect with an arcuate scotoma in the left eye. The patient was referred to a neurosurgeon and underwent endovascular aneurysm occlusion. This case highlights the diagnostic importance of recognizing that many neurological defects remain underdiagnosed.


RESUMO diferenciação de escavações glaucomatosas e não glaucomatosas ainda permanece um desafio ainda nos dias de hoje. Nos descrevemos um caso de aneurisma de carótida interna medindo 3.5mm x 6.5mm que simulava um glaucoma de pressão normal. O caso é sobre uma paciente feminino de 48 anos com história de 2 anos de baixa acuidade visual no olho esquerdo e cefaléia frontal. Devido ao aneurisma de carótida a paciente desenvolveu uma assimetria de escavação vertical maior que 0.2 no olho esquerdo em relação ao direito com defeito localizado da camada de fibras nervosas temporal inferior. Ela também apresentava um defeito arqueado temporal superior a esquerda, cruzando a linha média vertical consistente. Após o diagnostico confirmado pela ressonância magnética funcional, a paciente foi enviada para o neurocirurgião para realização de uma oclusão endovascular do aneurisma. Esse caso nos alerta da importância de se lembrar que não apenas o glaucoma gera escavações suspeitas no disco óptico e que ainda muitos defeitos por causas neurológicas são subdiagnosticados.


Subject(s)
Humans , Female , Middle Aged , Carotid Artery Diseases/diagnostic imaging , Carotid Artery, Internal/diagnostic imaging , Low Tension Glaucoma/diagnostic imaging , Aneurysm/diagnosis , Retina/diagnostic imaging , Magnetic Resonance Imaging/methods , Carotid Artery Diseases/physiopathology , Carotid Artery Diseases/pathology , Carotid Artery, Internal/physiopathology , Carotid Artery, Internal/pathology , Diagnosis, Differential , Low Tension Glaucoma/physiopathology , Low Tension Glaucoma/pathology , Visual Field Tests , Intraocular Pressure
4.
Arq. neuropsiquiatr ; 74(5): 396-404, May 2016. tab, graf
Article in English | LILACS | ID: lil-782025

ABSTRACT

ABSTRACT Objective To evaluate the intercarotid distance (ICD) of patients with pituitary macroadenoma and compare to heatlhy controls. Method We retrospectively reviewed contrast-enhanced MRI images from twenty consecutive patients diagnosed with non-functioning pituitary macroadenoma, measured the ICD at two different levels (petrous segment – ICD1 and horizontal cavernous segment – ICD2) and compared to twenty paired controls. Results There was no statistically significant difference of the mean ICD1 between the groups and subgroups. For the ICD2 there was statistically significant difference between the case and controls. However, there was no significant difference between the patients with smaller adenomas and the controls. In contrast, the patients with giant adenomas showed statistically significantly higher ICD2 than the controls. Conclusion The ICD at the horizontal segment of the cavernous carotid tends to be wider in patients with giant pituitary adenomas than in healthy individuals or patients with smaller adenomas.


RESUMO Objetivo Avaliar a distância intercarotídea (DIC) de pacientes com macroadenoma de hipófise e comparar com controles saudáveis. Método Foram analisados retrospectivamente imagens de ressonância magnética com contraste de vinte pacientes consecutivos com diagnóstico de macroadenoma hipofisário não-funcionante, medidas as DIC em dois níveis diferentes (segmento petroso – DIC1 e segmento cavernoso horizontal – DIC2) e comparados com vinte controles pareados. Resultados Não houve diferença estatisticamente significativa da DIC1 média entre os grupos e subgrupos. Para a DIC2 houve diferença estatisticamente significativa entre os casos e controles. No entanto, não houve diferença significativa entre os doentes com adenomas menores e os controles. Entretanto, os pacientes com adenomas gigantes tiveram estatisticamente significativamente DIC2 que os controlos. Conclusão A DIC no segmento horizontal da carótida cavernoso, tende a ser mais larga em doentes com adenomas hipofisários gigantes do que em indivíduos saudáveis ou de pacientes com adenomas menores.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Pituitary Neoplasms/diagnostic imaging , Carotid Artery, Internal/diagnostic imaging , Adenoma/diagnostic imaging , Pituitary Neoplasms/pathology , Sphenoid Sinus/pathology , Sphenoid Sinus/diagnostic imaging , Magnetic Resonance Imaging/methods , Carotid Artery, Internal/pathology , Adenoma/pathology , Case-Control Studies , Cavernous Sinus/pathology , Cavernous Sinus/diagnostic imaging , Retrospective Studies
6.
São Paulo; s.n; 2013. 64 p. ilus, tab. (BR).
Thesis in Portuguese | LILACS, BBO | ID: biblio-866690

ABSTRACT

A identificação de ateroma de carótida em radiografia panorâmica de pacientes com alterações sistêmicas que predispõem a aterosclerose é mais frequente do que em amostras da população em geral. O uso da terapia antirretroviral combinada (TARVc), que prolongou a sobrevida dos pacientes portadores do HIV (HIV+), também contribuiu para o aumento da incidência de alterações metabólicas e provavelmente de complicações cardiovasculares. Este estudo teve o objetivo de investigar a prevalência de imagens suspeitas de ateromas de carótida (ISAC) em radiografias panorâmicas de pacientes HIV+ em tratamento no Centro de Atendimento de Pacientes Especiais (CAPE) da Faculdade de Odontologia da Universidade de São Paulo, bem como tentar identificar variáveis associadas à ocorrência destas imagens. Foram avaliadas 300 radiografias de pacientes de ambos os gêneros e com média de idade de 40 anos (18-73 anos). A prevalência de radiografias com ISAC foi de 8,2% (25/300). Estes pacientes apresentaram a média de idade significativamente maior do que a dos pacientes sem ISAC (p= 0,008) e a mediana do nadir de CD4 significativamente menor (p=0,019). O uso do medicamento lopinavir/r (LPV/r) estava associado a chance 2,8 vezes maior para presença de ISAC (OD=2,79 1,12-6,95 IC=95%, p=0,045). Conclui-se que quanto maior a idade maior a probabilidade de ocorrência de ISAC e que as variáveis significativas encontradas (nadir de CD4 e LPV/r) são compatíveis com os fatores de risco cardiovascular observados em pacientes portadores do HIV, relacionados tanto à gravidade da infecção como ao uso de medicamentos.


The identification of calcified carotid artery atheroma (CCAA) in panoramic radiography of patients with systemic diseases that predispose the atherosclerosis is more frequent than in the general population samples. The use of high active antiretroviral therapy (HAART), which prolonged the life of patients with HIV (HIV+), also increase the incidence of cardiovascular complications, probably by the use of protease inhibitors (PI). This study aimed to investigate the prevalence of suspected images of CCAA in panoramic radiographs of HIV+ patients in treatment in the Special Care Dentistry Center of the University of São Paulo, São Paulo, Brazil, as well as trying to identify variables associated with these images. Three hundred radiographs of patients of both genders, with a mean age of 40 years (18-73 years) were evaluated. The prevalence of CCAA suspected images was 8.2% (25/300). This patients showed the mean age significantly higher than that of the patients without CCAA images (p = 0.008) and the CD4 nadir median significantly lower (p = 0.019). The use of HAART with lopinavir/r (LPV/r) was associated with a greater chance for CCAA images (OD 2.79, CI 95% 1.12-6.95; p = 0.045). In conclusion, patients with higher age are more susceptible to CCAA suspected image and the significant variables found (CD4 nadir and LPV/r) are compatible with the cardiovascular risk factors in patients HIV+, related both to the severity of the infection and the use of antiretroviral.


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Carotid Artery, Internal/pathology , Cardiovascular Diseases , HIV , Radiography, Panoramic
7.
Arq. neuropsiquiatr ; 70(12): 917-921, Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-660313

ABSTRACT

This study evaluated anatomical variants in the carotid siphon and of the circle of Willis in patients with aneurysms. We performed a retrospective analysis of cerebral angiographies. The Control Group was composed of patients without aneurysms. Posterior communicating artery (PcomA) aneurysms were more common in women (p<0.05), and the anterior communicating artery (AcomA) aneurysms in men (p<0.1). The incidence of fetal-type PcomA was higher in cases with co-occurring PcomA aneurysm (24 versus 8%, p<0.05). Patients with AcomA aneurysm had higher incidence of A1 hypoplasia (p<0.0001, OR=32.13, 95%CI 12.95-79.71) and lower frequency of fetal-type PcomA compared to their control counterparts (p=0.0125). The angle of carotid siphon was narrower in patients with PcomA aneurysm (27.3±19.1 versus 34.8±22.6, p=0.028). In conclusion, a narrower carotid siphon or the presence of fetal-type PcomA or A1 hypoplasia may cause hemodynamic stress, thereby promoting the formation of aneurysms in susceptible individuals.


O presente estudo avaliou as variantes anatômicas do sifão carotídeo e da parte posterior do polígono de Willis em pacientes com aneurismas. Foi realizada uma análise retrospectiva de angiografias cerebrais. O Grupo Controle foi composto por pacientes sem aneurismas. Aneurismas da artéria comunicante posterior (ACP) foram mais frequentes em mulheres (p<0,05), e aqueles da anterior (ACA) em homens (p<0,1). A incidência do tipo fetal da ACP foi maior nos casos com co-ocorrência de aneurisma da ACP (24 versus 8%, p<0,05). Pacientes com aneurisma da ACA tiveram maior incidência de hipoplasia A1 (p<0,0001, OR=32,13, IC95% 12,95-79,71) e menor frequência do da ACP fetal comparados com os controles (p=0,0125). O ângulo do sifão carotídeo era mais estreito em pacientes com aneurismas da ACP (27,3±19,1 versus 34,8±22,6, p=0,028). Em conclusão, um sifão carotídeo estreito e a presença de ACP fetal ou hipoplasia A1 podem causar estresse hemodinâmico, promovendo a formação de aneurismas em indivíduos suscetíveis.


Subject(s)
Female , Humans , Male , Middle Aged , Carotid Artery, Internal , Circle of Willis/pathology , Intracranial Aneurysm/etiology , Case-Control Studies , Cerebral Angiography , Carotid Artery, Internal/pathology , Circle of Willis , Intracranial Aneurysm , Retrospective Studies
8.
JCPSP-Journal of the College of Physicians and Surgeons Pakistan. 2011; 21 (4): 239-241
in English | IMEMR | ID: emr-110170

ABSTRACT

A lady with aortitis syndrome developed in-stent restenosis [ISR] of the innominate artery stent and critical stenosis of right internal carotid artery. The therapeutic challenge was gaining access to the carotid vessel, after treating the innominate artery ISR and all the while using distal protection to circumvent potential cerebral embolism. Percutaneous transluminal angioplasty [PTA] with or without stenting is a safe therapeutic option for re-vascularization of the supra aortic vessels. In the event of re-stenosis, re-treatment with PTA and stenting is safe. Ample evidence-base exists now for carotid artery stenting [CAS] in preference to carotid endarterectomy in patients with stenotic lesions of the carotid vessels


Subject(s)
Humans , Female , Carotid Stenosis/therapy , Catheterization , Brachiocephalic Trunk/pathology , Carotid Artery, Internal/pathology , Constriction, Pathologic , Embolic Protection Devices , Intracranial Embolism/prevention & control , Aortitis/therapy
9.
Neurosciences. 2010; 15 (2): 122-125
in English | IMEMR | ID: emr-125536

ABSTRACT

We report a case of meningovascular syphilis in a young adult woman presenting with left hemiparesis due to near occlusion of proximal cervical internal carotid with subacute middle cerebral artery territory infarction. Diagnosis was made on the basis of positive serum, and spinal fluid serology for syphilis, carotid Doppler, and magnetic resonance angiography, as well as improvement after intravenous penicillin therapy. In this case report, the imaging findings were described and related literature was reviewed


Subject(s)
Humans , Female , Adult , Syphilis, Cardiovascular/diagnostic imaging , Carotid Artery, Internal/microbiology , Carotid Artery, Internal/pathology , Ultrasonography, Doppler, Color , Brain/pathology , Brain/diagnostic imaging , Tomography, X-Ray Computed , Magnetic Resonance Imaging
10.
Indian J Pediatr ; 2009 Oct; 76(10): 1061-1062
Article in English | IMSEAR | ID: sea-142406

ABSTRACT

A newborn presented at 14 hrs of age with right sided clonic seizures and shrill cry. Magnetic Resonance Imaging of the brain showed left cerebral hemiatrophy with cystic changes in left fronto-parietal lobe and parasylvian region. The Magnetic Resonance Angiography revealed hypoplasia of left supraclinoid Internal Carotid Artery and hypoplasia and irregularity of vessel wall affecting the left Middle Cerebral Artery. Such an early presentation of this rare disorder has not been reported previously. Recognition of this anomaly has important implications during carotid and trans-sphenoidal surgery, in thromboembolic disease, and in the surveillance and detection of associated cerebral aneurysms.


Subject(s)
Apgar Score , Carotid Artery, Internal/abnormalities , Carotid Artery, Internal/pathology , Cerebral Angiography/methods , Follow-Up Studies , Humans , Imaging, Three-Dimensional/methods , Infant, Newborn , Magnetic Resonance Angiography/methods , Male , Phenobarbital/therapeutic use , Recurrence , Risk Assessment , Seizures/congenital , Seizures/diagnosis , Seizures/drug therapy , Seizures/etiology , Treatment Outcome , Vascular Malformations/complications , Vascular Malformations/diagnosis , Term Birth
11.
Arq. bras. endocrinol. metab ; 52(7): 1189-1193, out. 2008. ilus, tab
Article in English | LILACS | ID: lil-499731

ABSTRACT

Sellar and parasellar masses blocking inhibitory hypothalamic dopaminergic tonus can produce hyperprolactinemia. One of these conditions, seldom reported, is internal carotid artery aneurysm causing pituitary stalk compression and hyperprolactinemia, the majority of which is related to small increases in serum prolactin levels. The aim of this study is to report the case of a patient with an internal carotid aneurysm and severe hiperprolactinemia. A 72 years old female patient, on oncology follow-up for clinically controlled cervical carcinoma, was evaluated due to worsening chronic headaches. During the investigation, computed tomography and magnetic resonance imaging (MRI) showed a sellar mass associated with high prolactin level (1.403 µg/L) that initially was considered a macroprolactinoma, and treated with bromocriptine. However, subsequent pituitary MRI suggested an internal carotid aneurysm, which was confirmed by an angioresonance imaging of cerebral vessels. On low bromocriptine dose (1.25 mg/day), there was a prompt normalization of prolactin levels with a great increase (> 600 µg/L) after withdrawal, which was confirmed several times, suggesting HPD. We report a patient with internal carotid artery aneurysm with severe hyperprolactinemia never reported before in patients with HPD, and the need for a differential diagnosis with macroprolactinomas even considering high prolactin levels.


Massas selares e parasselares podem produzir hiperprolactinemia por bloquear o tônus inibitório hipotalâmico de dopamina. Uma destas condições, raramente reportada, é o aneurisma de artéria carótida interna causando compressão da haste hipofisária e hiperprolactinemia, a maioria com pequenas elevações da prolactina. O objetivo deste estudo é descrever o caso de uma paciente com aneurisma de carótida interna e grave hiperprolactinemia. Paciente feminina, 72 anos, em acompanhamento oncológico por carcinoma de colo de útero clinicamente controlado, avaliada por causa da piora de cefaléia crônica. Durante investigação, tomografia computadorizada e ressonância magnética (RM) de hipófise mostraram massa selar associada com altos níveis de prolactina (1.403 µg/L), sendo avaliado como macroprolactinoma e tratado com bromocriptina. Entretanto, RM subseqüente sugeriu aneurisma de carótida interna que foi confirmado por angiorressonância de vasos cerebrais. Em uso de baixas doses de bromocriptina (1,25 mg/dia), houve pronta normalização da prolactina com grande elevação (> 600 µg/L) após a retirada do medicamento, sendo confirmado por várias vezes sugerindo DHH. Reporta-se uma paciente com aneurisma de artéria carótida interna com grave hiperprolactinemia, nunca descrita anteriormente em pacientes com DHH, e a necessidade do diagnóstico diferencial com macroprolactinoma, mesmo considerando altos níveis de prolactina.


Subject(s)
Aged , Female , Humans , Carotid Artery Diseases/complications , Hyperprolactinemia/etiology , Intracranial Aneurysm/complications , Pituitary Neoplasms/diagnosis , Prolactinoma/diagnosis , Carotid Artery, Internal/pathology , Diagnosis, Differential , Hypothalamo-Hypophyseal System/physiology , Intracranial Aneurysm/diagnosis , Pituitary Gland/pathology , Pituitary Neoplasms/complications , Prolactin/blood , Prolactinoma/complications
12.
Arq. int. otorrinolaringol. (Impr.) ; 12(2): 289-294, abr.-jun. 2008. ilus
Article in English, Portuguese | LILACS | ID: lil-495789

ABSTRACT

Introdução: As afecções vasculares do osso temporal cursam com história clínica e exame físico semelhantes e podem ser diferenciados através de exames de imagem, os mais comuns são: paragangliomas, bulbo de jugular alto e artéria carótida aberrante. Os paragangliomas são tumores bem vascularizados formados por capilares e pré-capilares interpostos por células de origem neuroectodérmica. O bulbo jugular é a região anatômica correspondente à união do seio sigmóide e da veia jugular interna e é denominado bulbo de jugular alto quando há protusão da veia jugular interna para o interior da cavidade timpânica. A artéria carótida interna normalmente penetra no osso petroso pelo canal carotídeo separada da veia jugular interna pela bainha carotídea, no segmento vertical inicial está separada da orelha média por uma placa óssea. O trajeto anormal da artéria carótida interna pode ser explicado por malformação embrionária que impede a formação da placa óssea. Objetivo: O objetivo deste estudo é relatar cinco casos de afecções vasculares do osso temporal e discutir o diagnóstico diferencial e tratamento destas lesões.


Introduction: The vascular affections of temporal bone follow similar clinical symptoms and signs and can be distinguished through radiological investigation. The usual ones are: paraganglioma, high jugular bulb and aberrant internal carotid artery. The paraganglioma are vascular tumor formed by capillaries and pre-capillaries vessels originating from neuroectodermical cells. The jugular bulb is the anatomic point which joins sigmoid sinus and jugular vein; it is called high jugular bulb when the jugular vein protrudes into tympanic cavity. The carotid artery enters the etrous bone through the carotid canal that is apart from jugular vein by carotid sheath, in initial vertical segment it is apart from the middle ear by a bone plate. The abnormal course of the carotid artery can be explained by an embryological malformation that prevents bone plate formation. Objective: The target of this study is to report five cases of vascular affections of temporal bone and to discuss their differential diagnostic and therapeutic approach.


Subject(s)
Carotid Artery, Internal/pathology , Vascular Diseases/diagnosis , Temporal Bone/pathology , Carotid Body Tumor/diagnosis , Jugular Veins/pathology , Diagnosis, Differential
14.
Article in English | WPRIM | ID: wpr-36252

ABSTRACT

We report a case of pituitary apoplexy resulting in right internal carotid artery occlusion accompanied by hemiplegia and lethargy. A 43-yr-old man presented with a sudden onset of severe headache, visual disturbance and left hemiplegia. Investigations revealed a nodular mass, located in the sella and suprasellar portion and accompanied by compression of the optic chiasm. The mass compressed the bilateral cavernous sinuses, resulting in the obliteration of the cavernous portion of the right internal carotid artery. A border zone infarct in the right fronto-parietal region was found. Transsphenoidal tumor decompression following conservative therapy with fluid replacement and steroids was performed. Pathological examination revealed an almost completely infarcted pituitary adenoma. The patient's vision improved immediately after the decompression, and the motor weakness improved to grade IV+ within six months after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. However, clinicians should be aware of the possibility and the appropriate management of such an occurrence.


Subject(s)
Adult , Carotid Artery Diseases/diagnosis , Carotid Artery, Internal/pathology , Diagnosis, Differential , Embolization, Therapeutic , Humans , Magnetic Resonance Angiography , Male , Pituitary Apoplexy/complications , Tomography, X-Ray Computed
15.
Journal of Tehran University Heart Center [The]. 2008; 3 (2): 77-81
in English | IMEMR | ID: emr-88169

ABSTRACT

The presence of significant carotid stenosis in coronary artery bypass grafting [CABG] patients increases the risk of either transient ischemic attack or stroke. However, there is a dearth of data on the risk for patients with unilateral total occlusion of the carotid artery. We herein report our results of cardiac surgery in patients with unilateral total occlusion of the carotid artery. We examined 10,000 patients who underwent carotid artery duplex scanning before CABG or other cardiac procedures between January 2001 and September 2006 at Tehran Heart Center. The occlusions were detected via carotid Doppler screening and were confirmed through conventional or MR angiography. Among these patients, 15 [0.15%] patients had unilateral total occlusion of the internal carotid artery, and all of them underwent elective cardiac surgery. During cardiopulmonary bypass, the mean arterial pressure was maintained at above 60 mmHg with vasopressure drugs and increasing flow pump. There were 4 patients with left and 11 patients with right carotid occlusions. Four patients had a history of cerebrovascular accident. The mean cross-clamp time [min] and perfusion time [min] was 50.7 +/- 17.3 and 94.2 +/- 26.7, respectively. The mean graft number was 4.1 +/- 0.9. One of these patients expired intraoperatively because of low cardiac output. In one [6.66%] patient, postoperative cerebrovascular accident occurred on the contralateral side of the totally occluded region. All the patients recovered uneventfully. Our results suggest that CABG can be performed in patients with unilateral total occlusion of the internal carotid artery without ipsilateral stroke using our strategies


Subject(s)
Humans , Male , Female , Carotid Artery, Internal/pathology , Carotid Artery Diseases , Prospective Studies , Thoracic Surgery , Ischemic Attack, Transient , Stroke , Magnetic Resonance Angiography , Cardiac Output, Low , Postoperative Complications
16.
Säo Paulo med. j ; 125(6): 351-353, Nov. 2007. ilus
Article in English | LILACS | ID: lil-476095

ABSTRACT

CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP), which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP) by a ligament known as the caroticoclinoid ligament (CCL), which may be ossified, forming the caroticoclinoid foramen (CCF). Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons. CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.


CONTEXTO Y OBJETIVO: El extremo intermedio de la frontera posterior del hueso del sphenoid presenta el proceso anterior del clinoid (ACP), que está alcanzado generalmente para las operaciones que implican el espacio clinoidal y el sino cavernoso. El ACP es conectado a menudo con el proceso medio del clinoid (MCP) por un ligamento conocido como el ligamento del carotico-clinoid (CCL), que puede ser osificado, formando el agujero del clinoid del carotico (CCF). Las variaciones del ACP con excepción de la osificación, son raras. El CCL osificado puede tener efectos compresivos en la arteria carótida interna. El conocimiento así anatómico y radiológico del ACP y del espacio clinoidal es también importante mientras que funciona en la arteria carótida interna. La supresión del ACP se puede requerir para muchos cirugía basada cráneo y la presencia de cualquier anomalía tal como CCL osificado, puede plantear un problema para el neurocirujano. INFORME DEL CASO: Observamos la presencia de CCL osificado en un hueso del cráneo. Un estudio radiológico detallado del CCL y del CCF fue conducido. Las medidas morphometric fueron registradas y las fotografías fueron tomadas. El ACP fue conectado con el MCP y convertido en un CCF. En vista del hecho, los libros de textos de esa anatomía del estándar no proporcionan la descripción morfológica y la evaluación radiológica de CCL, el actual estudio puede ser importante para los neurocirujanos que funcionan en la región del ACP.


Subject(s)
Humans , Carotid Artery, Internal/pathology , Ligaments/anatomy & histology , Ossification, Heterotopic/pathology , Skull/pathology , Carotid Artery Diseases/etiology , Carotid Artery Diseases/pathology , Foramen Magnum , Ligaments/abnormalities , Skull , Sphenoid Bone/abnormalities , Sphenoid Bone/pathology
17.
Arq. bras. endocrinol. metab ; 50(3): 558-563, jun. 2006. ilus
Article in Portuguese | LILACS | ID: lil-433751

ABSTRACT

O aneurisma gigante com extensão selar é uma causa rara de hipopituitarismo, e está freqüentemente associado com aterosclerose, displasia fibromuscular ou radioterapia hipofisária. O presente caso é de uma paciente de 78 anos com aneurisma gigante de carótida interna esquerda, somente diagnosticado devido a quadro de pan-hipopituitarismo e síndrome de nervos cranianos (compressão dos nervos abducente e ópticos). A etiologia foi definida após tomografia computadorizada, ressonância nuclear magnética e arteriografia cerebral compatíveis com aneurisma. Ficou demonstrada associação com aterosclerose e displasia fibromuscular pela arteriografia. Não foi realizado tratamento cirúrgico após avaliação de risco/benefício. Obteve-se melhora clínica significativa após instituição de reposição hormonal com glicocorticóide e levotiroxina.


Subject(s)
Aged , Female , Humans , Adenoma/diagnosis , Aneurysm/diagnosis , Carotid Artery Diseases/diagnosis , Carotid Artery, Internal/pathology , Intracranial Aneurysm/diagnosis , Pituitary Neoplasms/diagnosis , Carotid Artery Diseases/complications , Diagnosis, Differential , Hypopituitarism/etiology , Magnetic Resonance Imaging
19.
Indian J Pediatr ; 2005 Aug; 72(8): 697-9
Article in English | IMSEAR | ID: sea-78455

ABSTRACT

Moyamoya disease is an obstruction of the internal carotids and of the afferent and efferent channels of Willis polygon, which causes a collateral circulation, responsible for the typical angiographic image of a "puff of smoke" (Moyamoya, in Japanese). Its etiology is unknown, and it might be congenital or acquired. The clinical features are cerebral ischemia, recurrent transient ischaemic attacks, sensorimotor paralysis, convulsions and migraine-like headaches. We report a 2 years and 9 months old boy with Down syndrome and Moyamoya disease who presented with focal convulsions.


Subject(s)
Carotid Artery, Internal/pathology , Child, Preschool , Circle of Willis/pathology , Down Syndrome/complications , Humans , Magnetic Resonance Angiography , Male , Moyamoya Disease/complications , Seizures/etiology
20.
Indian Heart J ; 2005 Jul-Aug; 57(4): 319-23
Article in English | IMSEAR | ID: sea-3084

ABSTRACT

BACKGROUND: The non-invasive technique of measuring carotid artery intima-media thickness has generated considerable interest as a marker of atherosclerosis, particularly in predicting clinical coronary events and coronary artery disease. In the present study, a postmortem comparative analysis of intima-media thickness of carotid artery with coronary artery atherosclerosis has been carried out. To date no such morphological tissue studies are available from our country. METHODS AND RESULTS: Right and left common carotid arteries with their branches were removed at postmortem in 40 cases with history of diabetes, hypertension or both. Intima-media thickness was measured and compared with coronary artery atherosclerosis. There were 10 control postmortem cases without history of diabetes or hypertension. Common carotid artery and internal carotid artery intima-media thickness were found to be good predictors of coronary events. There was also significant correlation (by Pearson's correlation formula) between the carotid artery intima-media thickness and the percentage of block in the coronary arteries. CONCLUSIONS: Internal carotid artery along with common carotid artery intima-media thickness measurement is a good predictor of coronary artery disease. However, carotid artery intima-media thickness has no bearing on the status of collateral circulation of the coronary arteries.


Subject(s)
Aged , Carotid Artery, Common/pathology , Carotid Artery, Internal/pathology , Coronary Artery Disease/pathology , Coronary Vessels/pathology , Diabetes Mellitus/pathology , Female , Humans , Hypertension/pathology , Male , Middle Aged , Predictive Value of Tests , Tunica Intima/pathology , Tunica Media/pathology
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