Cough-induced transient ischemic attack treated with revascularization of the external carotid artery.

A 65-year-old man presented with right arm and face weakness associated with severe coughing fits. A computed tomography angiogram revealed an occlusion of the left common and internal carotid arteries and an incomplete circle of Willis. An arch angiogram demonstrated reconstitution of the left external carotid artery, which collateralized with the intracranial left internal carotid artery. The patient underwent left subclavian-to-external carotid artery bypass with reversed saphenous vein, with complete resolution of symptoms over 1 year of follow-up. Cough-induced hemispheric transient ischemic attack is a rarely described hemodynamic phenomenon that can be managed with revascularization of the external carotid artery in select patients.

Carotid artery stenting: a therapeutic alternative in subtotal internal carotid artery occlusions.

Carotid artery stenting (CAS) is emerging as a less invasive modality for treating atherosclerotic occlusive disease of the internal carotid artery (ICA). Randomized trials like the SAPPHIRE trial have demonstrated that CAS is not inferior to carotid endarterectomy (CEA) in the treatment of carotid artery stenosis, and maybe even superior in high-risk symptomatic patients. However, patients with subtotal ICA occlusions with thrombus are excluded from randomized CAS trials and CAS registries. To our knowledge, carotid angioplasty with stenting has not been attempted in these cases. We present three cases of symptomatic subtotal ICA occlusions successfully treated with CAS without any periprocedural complications. With careful patient selection and technical expertise, endovascular management could be considered as a treatment option in subtotal carotid occlusions.

Psychological or physiological: why are tetraplegic patients content?

OBJECTIVE: To assess the effects of spinal cord injury (SCI) on perceived health-related quality of life (QOL). BACKGROUND: SCI is physically disabling, socially handicapping, and romantically limiting. Nevertheless, little is known about post-SCI neurocognitive and psychosocial life. Better understanding of the cognitive and emotional worlds of SCI patients is essential to better address and meet their needs and expectations. METHODS: Twenty subjects with high-cord (T6 and above) complete (American Spinal Injury Association [ASIA] A) SCI (High SCI) were compared with 10 subjects with low-cord (T7 and below) ASIA A SCI (Low SCI) and with 11 Able-Bodied control subjects. Satisfaction with Life and Short Form-36 instruments were used to assess physical and emotional aspects of QOL. Analyses of variance were used to assess potential differences across groups. RESULTS: Overall, satisfaction with life was the same among the groups. Expectedly, High SCI and Low SCI subjects reported lower physical functioning than Able-Bodied subjects (p < 0.0001). But, oddly, there were no differences in perceived physical role, physical health, or social functioning. Furthermore, High SCI subjects reported better perceived mental health than Able-Bodied control subjects (p = 0.004) and a trend over Low SCI subjects (p = 0.06), better perceived emotional role in society (p = 0.02), and greater vitality (p = 0.01) than Low SCI subjects and Able-Bodied subjects. CONCLUSIONS: Despite severe physical impairment and disability and frequent medical complications, subjects with complete spinal cord injury at high anatomic levels report better than average quality of life, being overall content. Reasons for these findings are unclear. Psychological adaptive reactions are likely, but the possible role of physiologic and neurocognitive changes needs further exploration.