Imaging Classification of Internal Carotid Artery Hypoplasia Based on Distal Ophthalmic Segment Occlusion

Bilateral hypoplasia of the internal carotid artery and ectasia of the internal jugular vein

Hypoplasia of the internal carotid artery and internal jugular vein ectasia are rare congenital abnormalities, whose diagnosis and treatment are not uniformly described. A 32-year-old neurologically asymptomatic woman with renal failure had a carotid artery duplex ultrasound scan as part of an evaluation for renal transplantation and was found to have bilateral internal carotid artery hypoplasia. Computed tomography angiography confirmed congenital bilateral internal carotid artery stenosis and left internal jugular vein ectasia. She had no neurologic deficits. She underwent antiplatelet treatment.

A Case Report of Migraine With Hypoplasia of the Internal Carotid Artery

Migraine, a widespread and incapacitating neurological disorder, affects numerous individuals worldwide, causing severe headaches and impairing their quality of life. The interplay of genetic, environmental, and neurovascular factors underlies the pathophysiology of migraine. This report highlights the case of a 25-year-old woman with recurrent, severe headaches, predominantly in the right frontal and temporal regions. She was diagnosed with migraine with aura, a diagnosis supported by her family history. No previous history of seizures was reported. A comprehensive work-up, including neuroimaging, revealed left internal carotid artery hypoplasia with compensatory collateral circulation. The coexistence of severe migraines and left internal carotid artery hypoplasia underscores the complex interrelationship between cerebrovascular anomalies and neurological symptoms. The rarity of this vascular variation emphasizes the need for attentive clinical evaluation and consideration of anatomical deviations in migraine patients. As medical knowledge progresses, further research is essential to unravel the mechanisms connecting vascular anomalies and neurological disorders, ultimately leading to personalized interventions for improved patient outcomes.

Differentiation Between Internal Carotid Artery Hypoplasia and Acquired Narrowing by Neurovascular Ultrasound: Case Series and Literature Review

Uniformly narrowed internal carotid artery (ICA) without proximal steno-occlusion or parietal anomalies is often subject to misdiagnosis due to lack of awareness. We combined our experiences of 4 cases with 29 previously published cases to form a retrospective series including 18 cases of ICA hypoplasia and 15 cases of ICA acquired narrowing. The ultrasonic manifestations of ICA acquired narrowing and ICA hypoplasia are extremely similar, but narrowed ICA without intracranial occlusion or bottle-neck-sign highly indicates ICA hypoplasia, whereas moyamoya vessels favor ICA acquired narrowing, thus promoting the understanding of and discriminability between the two on neurovascular ultrasound.

Congenital internal carotid artery hypoplasia: A systematic review

This review evaluates the current evidence for the clinical management of congenital internal carotid artery hypoplasia (CICAH). We summarise clinical presentations diagnostic standards, imaging recommendations, treatment and follow-up. The review was prompted by a case of CICAH in a 50-year-old female who presented to our neurosurgery clinic with an acute episode of vertigo. The patient underwent CT angiogram, which showed an unusually low right carotid bifurcation. The right internal carotid artery (ICA) was hypoplastic, and the A1 segment of the anterior cerebral artery (ACA) was absent. Skull base CT showed an ipsilateral hypoplastic carotid canal. To summarise current evidence for clinical management of CICAH we followed PRISMA guidelines to identify papers meeting our predefined inclusion criteria. We searched three databases using the terms 'ICA' and 'Hypoplasia'. We reviewed 41 papers meeting our criteria. 34 were clinical reports. We performed a data extraction and quality appraisal on these reports. We found that CICAH may be less rare than previously described. Blood pressure control in CICAH is crucial due to the increased risk of stroke and aneurysm formation. Follow-up imaging is strongly recommended. Carotid doppler sonography is a powerful and underutilised diagnostic tool, and carotid canal hypoplasia is not a pathognomic sign. In conclusion, clinicians should be alert to anatomic variations such as CICAH because these produce haemodynamic changes that may have serious clinical consequences. We recommend a central registry of patients with CICAH in order to understand the longer-term natural history of the condition.