Transient ischaemic attacks and stroke due to extracranial aneurysm of internal carotid artery

Unruptured aneurysms in patients with transient ischemic attack or reversible ischemic neurological deficit. Report of eight cases

Thirty-five patients with unruptured aneurysms were treated between 1981 and 1987. Eight of them had either transient ischemic attacks or reversible ischemic neurological deficits as their presenting symptoms. Six of the eight patients underwent direct aneurysm surgery. All eight patients are well, and have had no recurrent attack during the follow-up period ranging from 2 to 7 years. The feasibility of surgical treatment for such aneurysms associated with reversible ischemic symptoms is discussed.

Cervical carotid aneurysm presenting as transient ischemia and recurrent laryngeal nerve palsy

Aneurysms of the extracranial carotid artery are rare. Neurological manifestations in patients with these lesions may be quite varied. This paper presents a unique patient who showed both hoarseness due to left recurrent laryngeal nerve paralysis as a local sign of compression, and ischemic syncopal attack as an embolic or flow-related symptom. Little has appeared in the otolaryngologic literature, despite the fact that many patients have symptoms that may initially lead them to see an otolaryngologist. A misleading needle biopsy of the mass in the neck was performed by a local otolaryngologist before the diagnosis was confirmed. The literature on the subject is briefly reviewed.

Internal carotid artery aneurysm: a singular anomaly

A 9-year-old Indian boy was found to have an aneurysm of the left internal carotid artery. The vessel was heavily atherosclerosed, and the distal segment of the artery was tortuous and dilated. Serum lipid estimations showed the presence of type IIB hyperlipoproteinemia, with evidence of the disease in the patient's identical twin sibling and 37-year-old father. There was also a marginal increase in serum triglycerides in a 4-year-old younger brother. The patient's 29-year-old mother was unaffected. The patient had suffered hemolytic disease as a newborn, which resulted in kernicterus and subsequent mental retardation. This incident is considered to have been the result of a proven glucose-6-phosphate dehydrogenase deficiency. The aneurysm was resected and arterial continuity was ensured by using an end-to-end anastomosis. Post-operative blood flow studies showed normal flow patterns in the reconstituted artery. Postoperatively, the patient's mental performance increased dramatically; it is hypothesized that such progress is the consequence of an improvement in the blood supply to the limbic system, following the operative procedure.

Aneurysms of the carotid arteries

Twenty-one patients with 22 carotid aneurysms have been managed between 1960 and 1982. The aneurysms were congenital (3), atherosclerotic (8), false aneurysms after previous carotid operation (10) and mycotic (1). Carotid ligation was performed on four patients, one of whom suffered a stroke and died. Carotid reconstruction was undertaken in 15 patients without operative mortality but with postoperative strokes in two. Autogenous repairs of the carotid are recommended.

Treatment of a high extracranial carotid artery aneurysm with CCA-MCA bypass and carotid ligation. Case report

✓ This article describes a patient who presented with a developmental aneurysm of the internal carotid artery. Because the aneurysm extended from the carotid bifurcation to the base of the skull, direct arterial reconstruction was precluded. A common carotid artery (CCA) to middle cerebral artery bypass was performed with a saphenous vein graft, followed by gradual occlusion of the distal CCA. The operative technique and a review of the treatment for high cervical carotid aneurysms are presented.

Embolization from a fusiform middle cerebral artery aneurysm

A 34-year-old man had a transient ischemic attack and subsequently a completed stroke. Arteriography revealed a large fusiform aneurysm of the left middle cerebral artery with intraluminal thrombus. At surgery, the thrombus was seen within the lumen of the aneurysm. Absolute evidence for embolization is lacking as no examination for this could be done. Embolization from intracranial aneurysms seems to occur exclusively in large or giant aneurysms. Turbulent flow and a "stagnant zone" probably promotes thrombus formation. The reasons for the relative rarity of subsequent embolization are discussed. Because embolization from intracranial aneurysm is so uncommon and because aneurysms usually produce focal deficit by other mechanisms, 4 criteria are presented to determine whether embolization is likely.

Cervical carotid aneurysm presenting as recurrent cerebral ischemia with head turning

Extracranial carotid artery aneurysms are uncommon lesions with protean manifestations. This report describes a patient in whom the presenting symptom of a right carotid aneurysm was recurrent right hemisphere ischemic attacks when he turned his head to the left. The angiographic and operative findings explained the mechanism(s) of his symptoms. The importance of such symptoms is that they should suggest a mechanical etiology and that the probability of a surgically correctable lesion exists. Arteriography is the only reliable means of making a definitive diagnosis and should be considered early in the evaluation.

Aneurysms of the extracranial carotid arteries

Aneurysms of the extracranial carotid arteries are unusual; they present difficulties in diagnosis and may cause death or cerebrovascular accidents in a majority of patients. This report describes three different types of aneurysm of the carotid arteries and their presentation and discusses their management.

Cerebral angioma and aneurysm of the cervical internal carotid artery

A case of internal carotid artery aneurysm in association with a congenital cerebral arterio-venous malformation is described. The carotid artery aneurysm was resected with primary anastomosis of the redundant artery, with satisfactory recovery.