RESUMO
Vertebral artery origin anomalies are typically incidental findings during angiography or post mortem examination. We present two cases of vertebral origin from the right common carotid artery in association with an aberrant right subclavian artery. We also review the embryonic development and the clinical significance of this anomaly.
Assuntos
Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Artéria Subclávia/anormalidades , Artéria Subclávia/cirurgia , Artéria Vertebral/anormalidades , Artéria Vertebral/cirurgia , Adulto , Angiografia Cerebral , Procedimentos Endovasculares , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
bilateral thalamic infarctions are rare and usually caused by vascular occlusions. When symptomatic, it is important to make a distinction between different vascular etiologies in order to provide an effective and timely therapeutic response. Clinical presentations may not adequately differentiate between the vascular etiologies alone. It is therefore important to use imaging technologies to distinguish appropriately the origin of the infarct so that proper treatment can be administered. Advanced imaging techniques, such as CT angiography and MR angiography, have proved useful for distinguishing between arterial and venous causes of bithalamic infarctions. Bilateral thalamic venous infarctions can be treated with anticoagulation medication and with thrombolysis in more severe cases. Bilateral thalamic arterial infarctions may be treated with thrombolysis.
Assuntos
Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/terapia , Infarto Cerebral/diagnóstico , Infarto Cerebral/terapia , Doenças Talâmicas/diagnóstico , Doenças Talâmicas/terapia , Anticoagulantes/uso terapêutico , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/fisiopatologia , Edema Encefálico/etiologia , Edema Encefálico/terapia , Angiografia Cerebral , Infarto Cerebral/epidemiologia , Infarto Cerebral/fisiopatologia , Diagnóstico Diferencial , Humanos , Angiografia por Ressonância Magnética , Doenças Talâmicas/epidemiologia , Doenças Talâmicas/fisiopatologia , Terapia Trombolítica/métodos , Tomografia Computadorizada por Raios X , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/terapiaRESUMO
IMPORTANCE OF THE FIELD: Intracranial atherosclerosis is quickly becoming the most common stroke mechanism worldwide. Accurate diagnosis is important in making treatment decisions. AREAS COVERED IN THE REVIEW: In this article the clinical and radiographic diagnosis of intracranial atherosclerosis is reviewed. An overview is provided of widely available invasive and non-invasive methods for the detection of intracranial atherosclerosis, including transcranial Doppler, magnetic resonance and computed tomography angiography, as well as conventional angiography. WHAT THE READER WILL GAIN: The reader will become familiar with the advantages and limitations of various imaging modalities used in the diagnosis of intracranial atherosclerosis. TAKE HOME MESSAGE: Non-invasive imaging modalities have a high negative predictive value in detecting intracranial atherosclerosis. The gold standard for confirmation of the diagnosis remains catheter angiography.
