Internal carotid artery thrombosis in COVID 19 / Trombosis de arteria carótida interna en COVID 19

Abstract Case description: 37-year-old female with PCR-RT swab for COVID-19 positive, with neurological manifestation as a result of internal carotid artery occlusion. Clinical findings: Nasal congestion and sneezing of 5 days duration; pulsatile headache in the left hemicranium 3 days prior to admission, with intensity 6/10 according to the visual analogue scale, accompanied by phosphenes, photophobia and diplopia; with subsequent developing right hemiparesis over a 26-hour period. Treatment and result: She was given medical management with oral antiplatelet agents and anticoagulants (subcutaneous and oral) during his hospitalization, it was not possible to perform thrombolysis and thrombectomy due to the high risk of complications. He was discharged at 14 days, without functional limitation, symmetrical strength in upper and lower limbs, bilateral visual acuity 20/20, denying headache. Clinical relevance: The case presented here describes a pattern in how data supporting an association between COVID-19 and stroke in young populations with or without typical vascular risk factors, sometimes with only mild respiratory symptoms, is increasing. Prospective studies are required to further evaluate this association, as well as anticoagulation studies to prevent these potentially life-threatening events.

Resumen Descripción del caso: Mujer de 37 años con hisopado PCR-RT para COVID-19 positivo, con manifestación neurológica por oclusión de la arteria carótida interna. Hallazgos clínicos: Congestión nasal y estornudos de 5 días de duración; cefalea pulsátil en hemicráneo izquierdo 3 días antes del ingreso, con intensidad 6/10 según la escala visual analógica, acompañada de fosfenos, fotofobia y diplopía; con posterior desarrollo de hemiparesia derecha durante un período de 26 horas. Tratamiento y resultado: Se le brindó manejo médico con antiagregantes plaquetarios orales y anticoagulantes (subcutáneos y orales) durante su internación, no fue posible realizar trombólisis y trombectomía por alto riesgo de complicaciones. Fue dado de alta a los 14 días, sin limitación funcional, fuerza simétrica en miembros superiores e inferiores, agudeza visual bilateral 20/20, negando cefalea. Relevancia clínica: Se describe un patrón que indica cómo están aumentando los datos que apoyan una asociación entre COVID-19 y el accidente cerebrovascular en poblaciones jóvenes con o sin factores de riesgo vascular típicos, a veces con solo síntomas respiratorios leves. Se requieren estudios prospectivos para evaluar más a fondo esta asociación, así como estudios de anticoagulación para prevenir estos eventos potencialmente mortales.

Diagnóstico de trombosis carotídea asintomática en el postoperatorio de la disección cervical radical modificada / Diagnosis of asymptomatic carotid thrombosis in the posoperative period in modified radical cervical dissection

RESUMEN Introducción: El tratamiento del carcinoma papilar de tiroides (CPT) implica la tiroidectomía total (TT) con disección cervical radical modificada en caso de evidenciarse adenopatías. Existen diversas complicaciones vasculares y neurológicas asociadas a este proceso, en este caso vamos a describir la trombosis carotídea como una rara lesión secundaria en el postoperatorio (0,1%). Material y métodos: Caso clínico diagnosticado y tratado en nuestro centro. Caso clínico: Mujer de 55 años diagnosticada de CPT e intervenida realizando TT y disección yugular modificada. Durante el postoperatorio inició con clínica de tos irritativa y disfagia, por lo que se le realizó una tomografía computarizada (TC) cervical en el que se apreciaba trombosis de la arteria carótida común izquierda con repermeabilización distal. En la resonancia magnética nuclear (RMN) cerebral no se encontraron alteraciones. Se inició tratamiento anticoagulante y posteriormente antiagregante. La lesión no progresó consiguiendo una evolución favorable. Conclusiones: La trombosis carotídea se trata de una complicación extremadamente rara de la disección cervical. Debe sospecharse para llevar a cabo un diagnóstico temprano e iniciar el tratamiento lo antes posible, para evitar así la progresión de la enfermedad con secuelas que podrían ser irreversibles.

ABSTRACT Introduction: The treatment of papillary thyroid carcinoma (PTC) involves total thyroidectomy (TT) with modified radical cervical dissection in case of evidence of lymphadenopathy. There are several vascular and neurological complications associated with this process, in this case we will describe carotid thrombosis as a rare secondary lesion in the postoperative period (0.1%). Material and methods: Clinical case diagnosed and treated in our center. Case report: A 55-year-old woman diagnosed with PTC and operated on with TT and modified jugular dissection. During the postoperative period, he started with a clinic of irritative cough and dysphagia. A cervical computed tomography (CT) scan showed thrombosis of the left common carotid artery with distal repermeabilization. In cerebral nuclear magnetic resonance (NMR) no alterations were found. Anticoagulant treatment and antiplatelet therapy were started. The lesion did not progress, achieving a favorable evolution. Conclusions: The carotid thrombosis is an extremely rare complication of cervical dissection. It should be suspected to carry out an early diagnosis and start the treatment as soon as possible, thus preventing the progression of the disease with sequelae that could be irreversible.

Utilidad de la ecografía Doppler en el diagnóstico de la trombosis carotidea traumática / Usefulness of Doppler echography for the diagnosis of traumatic carotid thrombosis

Los traumatismos del sistema arterial carotideo son raros y tienen alta mortalidad. Se presenta un caso de trombosis de la arteria carótida interna derecha por una herida por arma de fuego a nivel del cuello con el objetivo de evidenciar en la práctica médica la utilidad de la ecografía Doppler para el diagnóstico temprano de estas lesiones, a pesar de reportarse en la literatura la angiografía, la resonancia magnética nuclear y la angiorresonancia como estudios de elección. Con este caso se pudo afirmar que la trombosis carotidea traumática tiene una incidencia baja, pero no descartable en los traumas de la región cervical. Por esta causa, son frecuentes las complicaciones neurológicas dadas por la oclusión arterial y la ecografía Doppler resultó muy útil en el diagnóstico temprano del paciente.

Carotid artery system traumas are rare and show high mortality rates. The case of right internal carotid artery thrombosis caused by a gunshot injury in the neck was presented in this report to show evidence of the usefulness of Doppler echography in the medical practice for the early diagnosis of these lesions in spite of the fact that literature highlights angiography, nuclear magnetic resonance and angioresonance as the imaging studies of choice. This case confirmed that carotid thrombosis due to trauma has low incidence but it can not be ignored in the cervical región traumas. For these reasons, the neurological complications stemming from artery occlusion are frequent and Doppler echography turned to be very useful for the early diagnosis of this illness in a patient.

Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms / Trombose espontânea da artéria carótida interna: a história natural dos aneurismas gigantes intracavernosos

OBJECTIVE: To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA), with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome. METHOD: There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5 percent) of which 20 (50 percent) were giant aneurysms. Among those cases, 5 patients evolved with STICA (25 percent). Symptoms and findings at presentation were recorded and compared with those at outcome. RESULTS: Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80 percent), diabetes mellitus (40 percent) and dislipidemy (40 percent). All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA. CONCLUSION: STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.

OBJETIVO: Relatar cinco casos de aneurismas gigantes intracavernosos que evoluíram com trombose espontânea da artéria carótida interna (TEACI), estudando-se: prevalência, apresentação clínica, história natural, fatores associados e prognóstico neurológico. MÉTODO: Análise de 711 pacientes consecutivos com diagnóstico de 802 aneurismas cerebrais submetidos a tratamento clínico ou cirúrgico num período de 19 anos. Foram identificados 40 aneurismas intracavernosos, sendo que 20 desses eram gigantes. Dentre esses, 5 pacientes com aneurismas gigantes intracavernosos que evoluíram com TEACI (25 por cento). Os sintomas e sinais neurológicos da apresentação foram registrados e comparados ao término do acompanhamento. RESULTADOS: Todos pacientes apresentavam cefaléia hemicraniana, apresentavam oftalmoplegia e dor retro-orbitária. Freqüentemente estavam associados a fatores ateroscleróticos como HAS (80 por cento), diabetes melito (40 por cento) e dislipidemia (40 por cento) e após a TEACI evoluíram com melhora desses sintomas. Após a TEACI, 4 pacientes tiveram regressão do déficit, sendo que em 2 a regressão do déficit foi total. Quatro pacientes apresentavam hipostesia no território de V1 e V2. Todos apresentaram melhora desse sintoma. CONCLUSÃO: A TEACI é uma evolução comum em aneurismas intracavernosos gigantes, e está associada à melhora importante dos sintomas. No entanto pode ser catastrófica naqueles pacientes sem circulação colateral eficiente.

Effects of scorpion venom active peptides on platelet aggregation, thrombosis in carotid artery and plasma 6-keto-PGF_(1?) and TXB_2 in rabbits and rats / 中成药

Objective: To investigate the mechanism of scorpion venom active peptides(SVAPs) on platelet aggregation. Methods: Platelet aggregation in vivo and vitro was determined by turbidimetry. Carotid thrombosis model was induced by electrostimulation. The determination of 6 keto PGF 1 and TXB 2 were performed by radioimmunoassay. Results: SVAPs 0.125,0.25,0.5mg?ml -1 significantly inhibited the rabbit platelet aggregation triggered by thrombase 0.03u.ml -1 , ADP 10u.ml -1 in vitro( P