Colour-duplex ultrasonography of the temporal and ophthalmic arteries in the diagnosis and follow-up of giant cell arteritis.

OBJECTIVE: To evaluate the diagnostic value of colour-duplex ultrasonography (CDU) of the temporal and ophthalmic arteries in the diagnosis of giant cell arteritis (GCA) and its usefulness in the follow-up of the disease. Furthermore, to examine the relationship between CDU abnormalities in ophthalmic arteries and blindness. METHODS: This is a prospective study of all patients with clinical suspicion of GCA or polymyalgia rheumatica (PMR) seen consecutively at the Internal Medicine Department at Vall d'Hebron University Hospital, Spain, between March 2003 and July 2006. Patients were evaluated with regard to the sensitivity and specificity of the dark halo sign in the temporal artery for the diagnosis of GCA, as well as the sensitivity and specificity of the presence of stenosis in temporal and/or ophthalmic arteries. Additionally, the usefulness of the dark halo sign in the follow-up of GCA was addressed. RESULTS: Forty-seven patients (30 with GCA, 17 with PMR) and 13 controls were included in the study. The sensitivity and specificity for the diagnosis of biopsy-proven GCA were higher for the temporal halo (72% in both cases) than for temporal artery stenosis (41% and 89%, respectively), or for ophthalmic artery stenosis (58% and 89%, respectively). Disappearance of the halo was observed in 50% of patients six months after diagnosis, although all patients were in clinical remission, and laboratory parameters were within normal values. CONCLUSION: CDU of the temporal arteries may be a valid tool in the diagnosis of GCA. However, its role in the follow up of the disease deserves re-evaluation. CDU of the ophthalmic arteries is less useful for CGA diagnosis and no relationship with blindness is suspected.

Infarto del territorio de la arteria cerebral posterior por disección carotídea / Posterior cerebral artery territory infarcts due to carotid dissection

Introducción. Cerca del 20% de los ictus en individuosmenores de 45 años se deben a disección de las arterias cervicocefálicasy ante su sospecha la resonancia magnéticadebe considerarse como el examen de primera elección. Lacirculación fetal posterior es una variante en el desarrolloembriogénico que puede ocasionar un infarto en el territorioposterior ante una disección o estenosis carotídea.Caso clínico. Presentamos el caso de un paciente de51 años con un infarto agudo occipitotemporal izquierdo yevidencia por ecografía dúplex de una oclusión de la arteriacarótida interna y de la arteria cerebral posterior izquierda, asícomo un probable origen carotídeo de la arteria cerebral posterior.La resonancia magnética craneal confirmó los hallazgosy mostró una disección en el segmento distal de la arteria carótidainterna izquierda con presencia de trombo mural.Conclusiones. Los infartos del territorio posterior causadospor disección carotídea espontánea son una entidadrara y se han comunicado pocos casos en la bibliografía.Realizamos una revisión de la bibliografía a este respecto (AU)

Introduction. About 20% of strokes in individualsunder 45 years of age are due to cervicocephalic arterydissection. The magnetic resonance should be the firstoption in the diagnostic process when this etiology issuspected. Posterior fetal circulation is a variant in theembryogenic development that may cause posteriorterritory infarcts in carotid dissections or stenosis Case report. We report the case of a 51 year-old malepatient, with left occipitotemporal acute infarct andocclusion of the internal carotid and left posterior cerebralarteries as well as a probable carotid origin of theposterior cerebral artery. These findings were found inthe duplex doppler sonography and were confirmed inthe cranial magnetic resonance which also showed a dissectionin the distal segment of the left internal carotidartery with a mural clot.Conclusions. Posterior territory strokes due to spontaneouscarotid dissection are rare and there are fewcases reported in the literature. We have reviewed theprevious literature on this topic (AU)

[Posterior cerebral artery territory infarcts due to carotid dissection]. / Infarto del territorio de la arteria cerebral posterior por disección carotídea.

INTRODUCTION: About 20% of strokes in individuals under 45 years of age are due to cervicocephalic artery dissection. The magnetic resonance should be the first option in the diagnostic process when this etiology is suspected. Posterior fetal circulation is a variant in the embryogenic development that may cause posterior territory infarcts in carotid dissections or stenosis. CASE REPORT: We report the case of a 51 year-old male patient, with left occipitotemporal acute infarct and occlusion of the internal carotid and left posterior cerebral arteries as well as a probable carotid origin of the posterior cerebral artery. These findings were found in the duplex doppler sonography and were confirmed in the cranial magnetic resonance which also showed a dissection in the distal segment of the left internal carotid artery with a mural clot. CONCLUSIONS: Posterior territory strokes due to spontaneous carotid dissection are rare and there are few cases reported in the literature. We have reviewed the previous literature on this topic.

[Reversible segmental cerebral vasoconstriction: the value of duplex transcranial Doppler in its diagnosis and follow up]. / Vasoconstriccion segmentaria cerebral reversible: utilidad del duplex transcraneal en el diagnostico y seguimiento.

INTRODUCTION: Reversible segmental cerebral vasoconstriction, also known as Call Fleming syndrome, is a clinical entity that consists of segmental vasoconstriction of the arteries in the brain, which can course with focal neurological deficits and which is characteristically reversible. Diagnosis and follow up of reversible segmental cerebral vasoconstriction is performed using cerebral arteriography, but no previous evaluation has been conducted of the role that duplex transcranial Doppler can play in this syndrome. CASE REPORT: Here we describe the case of a 57 year old female patient who began suffering from sudden bouts of headaches with no other accompanying clinical features. After ruling out the possibility of a subarachnoid haemorrhage by means of a spinal tap, a suspicion diagnosis of reversible segmental cerebral vasoconstriction was made through duplex transcranial Doppler and this was later confirmed by arteriography, which revealed a segmental stenosis in the upper branch of the left middle cerebral artery. Following treatment with nimodipine, the patient presented a clear clinical improvement and the reversibility of the cerebral vasoconstriction was confirmed by duplex transcranial Doppler. CONCLUSION: Contrast enhanced duplex transcranial Doppler would enable us to obtain an early diagnostic approximation in patients in whom segmental vasoconstriction is suspected; it could also constitute the choice non invasive follow up method in these patients.

[Transient cerebral and bone marrow ischemia in patients with atrioseptal aneurysm]. / Isquemia cerebral y medular transitoria en pacientes con aneurisma atrioseptal.

The relationship between atrioseptal aneurysm and ischemic stroke has not been clearly demonstrated. We present three patients with transient cerebrovascular events and one patient with transient medullar ischemia related with the presence of atrioseptal aneurysm. Other causes of cerebrovascular disease have been excluded. Following anticoagulation treatment all the patients remain asymptomatic.