Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report / Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

Abstract Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks' duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.

Resumo Conexões embriológicas persistentes entre as circulações anterior e posterior são entidades raras. A artéria hipoglossa persistente é a segunda anastomose carotídeo-basilar persistente mais comum. Como está frequentemente associada à hipoplasia das artérias vertebrais, apresenta um desafio durante as intervenções endovasculares. Apresentamos o caso de uma mulher de 32 anos que apresentou cefaleia occipital com duração de quatro semanas. A angiografia por ressonância magnética mostrou artérias vertebrais hipoplásicas com artéria hipoglossa persistente surgindo do segmento cervical da artéria carótida interna esquerda e suprindo toda a circulação posterior com um aneurisma dissecante da artéria cerebral posterior direita. A oclusão endovascular do vaso parental foi realizada para o aneurisma da dissecção da artéria cerebral posterior pela passagem de cateter guia, microfio e microcateter pela artéria hipoglossa persistente, pois as artérias vertebrais eram hipoplásicas. Após a intervenção, a paciente não apresentou déficit neurológico e recebeu alta em uma condição estável.

Esophago-esophageal Intussusception: A Rare Presentation of Carcinoma Esophagus

Esophageal cancer is the third most common gastrointestinal malignancy and is among the ten most prevalent cancersworldwide. Common malignant neoplasms of esophagus include squamous cell carcinoma and adenocarcinoma. Squamouscell carcinoma is more common than adenocarcinoma, but the incidence of adenocarcinoma is on the rising trend nowadaysand found to be predominant in newly diagnosed patients and in cases with Barrett’s esophagus. Dysphagia and weight loss arethe principal complaints in the patient with carcinoma esophagus. Intussusception causing acute obstruction of small bowel andcolon is known. Few cases of gastroesophageal intussusception due to eating disorders, congenital obstructions like superiormesenteric artery syndrome, physical exertions like weight lifting, peptic ulcer disease, and pregnancy due to hyperemesisgravidarum are known. Our case, a 52-years-old gentleman presented to gastroenterology OPD with complaints of dysphagia tosolids and emaciation. For these complaints, upper GIscopy was advised. Gastroenterologists were unable to pass endoscopeso patient was referred for computed tomography of thorax and abdomen, which revealed circumferential irregular thickeningretro cardiac segment esophagus and lumen within lumen appearance of esophagus with metastasis to lymph nodes and liver.In adults, intussusceptions of bowel usually have a lead point, for example, mesenteric lipoma or a neoplastic process; in ourcase, it was carcinoma of esophagus