Giant cavernous internal carotid aneurysm presenting with dizziness and bradycardia: A case report and a review of literature.

Giant cavernous carotid aneurysms are rare pathologic entities that are typically benign and are considered less life-threatening due to the low risk of rupture of bleeding. They present with clinical features usually due to localized mass effects on adjacent neural structures, mainly the III, IV, V, and VI cranial nerves. There are various treatment options, including occlusion of the feeding vessel, immediate surgery on the aneurysm, bypass procedures, and use of endovascular devices. We present a case of a 36-year-old male presented to the emergency department with 5 days history of right retro-orbital pain and diplopia. The patient's imaging workup revealed a right giant cavernous carotid aneurysm. Along with the conventional symptoms, physical examination revealed sinus bradycardia. Internal carotid artery occlusion was performed, and his symptoms gradually resolved.

Multiple Migrated Superior Vena Cava Stents With Cardiac Injury - A Stepwise Open Cardiotomy Strategy to Mitigate Potential Fatality.

Iatrogenic injuries with migrated interventional stents can sometimes be life-threatening. The interventional retrieval management is generally the treatment of choice, as surgical procedures carry a high mortality risk with only a few cases reported. We report a patient with two stents migrated into the right atrium from superior vena cava resulting in cardiac perforation. She was successfully treated using pericardiocentesis followed by surgical intervention with rapid post-operative resolution of symptoms. The technique presented here substantiates the steps for a safe and effective removal of these multiple displaced stents with minimal postprocedural complications.

Acute Management of Iatrogenic Injury to Vertebral Artery With Central Venous Catheter in a Critically Ill Patient.

Vertebral artery (VA) injury during catheterization is quite rare given its anatomical position, but can be catastrophic when it is not discovered early on and managed accordingly. A multidisciplinary approach to the management of such injury has to weigh-in the benefits and risks of open surgery versus endovascular intervention. This can be done after thorough assessment of the patient's condition and accessibility of the injured vessel. We report a case of a 90-year-old female admitted as a case of pneumonia associated with decreased level of consciousness. She acquired an iatrogenic injury due to insertion of central venous catheter (CVC) into her dominant right VA as confirmed via CT angiography (CTA). This case report aims to highlight the role of endovascular intervention in the acute management of VA injury in a critically ill patient.

Epidural Corticosteroids, Lumbar Spinal Drainage, and Selective Hemodynamic Control for the Prevention of Spinal Cord Ischemia in Thoracoabdominal Endovascular Aortic Repair: A New Clinical Protocol.

INTRODUCTION: In patients undergoing thoracoabdominal aorta repair, spinal cord ischemia (SCI) remains one of the most common and important complications resulting in transient paraparesis through to permanent flaccid paraplegia. In this manuscript, after a brief introduction to spinal cord ischemia complication and its prevention in thoracoabdominal endovascular aortic repair (TEVAR), we propose a new clinical protocol potentially able to prevent such complication. METHODS: The proposed protocol suggests the use of high dosages of corticosteroids by epidural route, along with drainage of cerebrospinal fluid and controlled vascular hypertension, to reduce the incidence of SCI in TEVAR. Moreover, we paid particular attention to the control of the hemodynamic parameters to obtain adequate peripheral tissue perfusion (oxygen delivery), including in the spinal cord. RESULTS: We applied this new protocol in 50 consecutive patients treated with TEVAR for thoracoabdominal aortic aneurysms (TAAs); 47 patients completed the procedure: 27 patients Crawford type I and 20 Crawford type II. Three patients died during surgery because of untreatable aneurysm rupture. The results show that in all patients there were no cases of SCI, after 5 days from TEVAR. DISCUSSION: To the best of our knowledge, there are no clinical studies on the use of epidural corticosteroids in patients undergoing treatment of aortic syndrome (both in "open surgery" and endovascular aortic repair). This initial study on 50 consecutive patients has shown that the clinical protocol used could be of great interest to prevent one of the worse complications of TEVAR. Its limitations are the low number of patients studied till now, and the non-randomized protocol adopted. Further studies would be necessary. CONCLUSION: Our experience and the results obtained with this new perioperative protocol with epidural corticosteroid and accurate hemodynamic control have been encouraging and it seems a valid proposal to be explored in future by well-structured prospective, randomized protocols.

Solitary bone plasmacytoma: the unusual case of extra-cranial mini brain.

Solitary plasmacytoma is an uncommon tumor. We present a case in an unusually young patient demonstrating the mini brain sign that has been published in a couple of reports as a diagnostic radiological pattern produced by plasmacytoma. Identification of "mini brain appearance" on imaging can direct the radiologist and clinicians to the diagnosis of plasmacytoma and obviate the necessity of pre-operative biopsy.

Endovascular treatment of isolated bilateral internal iliac artery aneurysms with a branched endograft: a case report.

Isolated bilateral internal iliac artery (IIA) aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery (CIA). Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery (EIA). Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic. Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support.