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Ripa M, Shah NA, Schipa C, Aceto P, Donati T. The Relationship between Ischemic Optic Neuropathy and Internal Carotid Artery Dissection: A Systematic Review. J Clin Med 2024; 13:2486. [PMID: 38731015 PMCID: PMC11084818 DOI: 10.3390/jcm13092486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background: To evaluate and review the current evidence regarding the association between ischemic optic neuropathy (ION) and internal carotid artery dissection (ICAD). Methods: We systematically reviewed studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA), searching three databases (Scopus, Pubmed, and Embase) for relevant articles that clearly described the correlation between ION and ICAD. All studies that examined the association between ICAD and the development of ION were synthesized. Quality assessment using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and Case Series were conducted. Results: Our search yielded 198 manuscripts published in the English language. Following study screening, fourteen studies were selected. The number of participants with ION following ICAD ranged from one to four, with sixteen patients experiencing either anterior ION, posterior ION, or a combination of both. The anterior or posterior ischemic optic neuropathy (AION and PION) patients' ages were 48.75 ± 11.75 and 49.62 ± 12.85, respectively. Fourteen out of sixteen patients experienced spontaneous ICAD, whereas the traumatic etiology was ascertained in two patients. Conclusions: Hence, albeit rare, ophthalmologists should consider ICAD a potential cause of ION, especially in young adults with concomitant cephalic pain and vision reduction.
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Affiliation(s)
- Matteo Ripa
- Department of Ophthalmology, Sankara Eye Hospital, Jaipur 302039, Rajasthan, India
| | - Neeraj Apoorva Shah
- Department of Ophthalmology, Sankara Eye Hospital, Jaipur 302039, Rajasthan, India
| | - Chiara Schipa
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Paola Aceto
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Tommaso Donati
- Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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2
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McGuire LS, Kumar P, Ryoo JS, Alaraj A. Selective endovascular treatment of cervical arterial dissection using quantitative magnetic resonance angiography. Interv Neuroradiol 2024; 30:64-71. [PMID: 35656756 PMCID: PMC10956450 DOI: 10.1177/15910199221106040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The role of endovascular treatment in cervical artery dissection (CAD) is equivocal. This study compared cerebral blood flow in CAD between medically and endovascularly treated patients using quantitative magnetic resonance angiography (QMRA). METHODS Retrospective chart review was completed for patients with CAD. Inclusion criteria were adults (>18 years) with diagnosis of dissection of the internal carotid artery or vertebral artery who received QMRA. The cases were reviewed for clinical presentation, diagnosis, management, and imaging, and in particular, patients who underwent endovascular treatment were evaluated. RESULTS Forty-one patients were included, 46.3% female and mean age 46.0+/- 11.9 years. 21 patients (51.2%) had contralateral (ICA) dissections while 19 (46.3%) had vertebral artery (VA) dissections, and 1 had both involved. Five patients underwent stenting, angioplasty, or both. Baseline characteristics between patients who underwent medical versus endovascular treatment were similar, although patients undergoing stenting/angioplasty were more likely to have diabetes (p = 0.015) and prior anticoagulation use (p = 0.007). All endovascular patients demonstrated ischemia on MRI versus 53.1% of those undergoing medical management (p = 0.047). Comparing ipsilateral vessel flow over time in these two patient groups showed those who underwent stenting or angioplasty had lower baseline flows, albeit non-significant (p = 0.629). Patients who underwent endovascular treatment had lower distal flow compared to the medical management group. CONCLUSION This study represents the first to assess vessel flow using QMRA in patients who underwent endovascular treatment of CAD. In combination with progressive symptoms, QMRA may serve as a useful adjunct in the selection of patients for endovascular intervention in arterial dissections.
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Affiliation(s)
- Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Prateek Kumar
- Department of Neurology, University of Illinois at Chicago, Chicago, IL, USA
| | - James S. Ryoo
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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3
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Poblete RA, Zhong C, Patel A, Kuo G, Sun PY, Xiao J, Fan Z, Sanossian N, Towfighi A, Lyden PD. Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment. Neurol Int 2024; 16:95-112. [PMID: 38251054 PMCID: PMC10801491 DOI: 10.3390/neurolint16010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this population, post-traumatic cerebral infarction (PTCI) acutely after TBI is an important but under-recognized complication that is associated with negative functional outcomes. In this comprehensive review, we describe the incidence and pathophysiology of PTCI. We then discuss the diagnostic and treatment approaches for the most common etiologies of isolated PTCI, including brain herniation syndromes, cervical artery dissection, venous thrombosis, and post-traumatic vasospasm. In addition to these mechanisms, hypercoagulability and microcirculatory failure can also exacerbate ischemia. We aim to highlight the importance of this condition and future clinical research needs with the goal of improving patient outcomes after TBI.
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Affiliation(s)
- Roy A. Poblete
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Charlotte Zhong
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Anish Patel
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Grace Kuo
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Philip Y. Sun
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Jiayu Xiao
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Zhaoyang Fan
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Nerses Sanossian
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Amytis Towfighi
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
| | - Patrick D. Lyden
- Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA; (C.Z.); (A.P.); (G.K.); (J.X.); (Z.F.); (N.S.); (A.T.); (P.D.L.)
- Zilkha Neurogenetic Institute, Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA
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Caesar KS, Maharaj DA, Ramlakhansingh A, Sinanan A, Ramsingh R. Collateral damage: a case report of vertebral artery dissection and stroke in the young with persistent primitive trigeminal artery. Oxf Med Case Reports 2023; 2023:omac076. [PMID: 36694603 PMCID: PMC9853924 DOI: 10.1093/omcr/omac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/23/2022] [Accepted: 05/29/2022] [Indexed: 01/21/2023] Open
Abstract
Stroke in the young is an uncommon condition resulting in significant morbidity and as result trammels the integrity of healthcare systems [1]. We present an unusual case of a 37-year-old male presenting with neurologic signs of right parietal lobe infarction with evidence of vertebral artery dissection and persistent carotid-vertebrobasilar anastomosis as a conduit for thromboembolism.
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Affiliation(s)
- Kymmi S Caesar
- Correspondence address. Caribbean Vascular and Vein Clinic Limited (CVVCL), St. Clair Medical Center, 18 Elizabeth St., Port of Spain Trinidad, W.I. E-mail ; Tel: 1-868-485-9268
| | - Dale A Maharaj
- St Clair Medical Center, Port of Spain, Trinidad, West Indies
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Kim YS, Tehrani ASS, Lee HS. Sudden unilateral hearing loss and vertigo following isolated cerebellar hypoperfusion without infarction due to vertebral artery dissection. BMC Neurol 2022; 22:489. [PMID: 36536304 PMCID: PMC9762102 DOI: 10.1186/s12883-022-03024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The definition of sudden sensorineural hearing loss (SSNHL) is broadly accepted as acute sensorineural hearing loss of more than 30 dB over at least three consecutive frequencies in a pure-tone audiogram (PTA). Acute audiovestibular loss is common with ischaemic stroke in the territory of the anterior inferior cerebellar artery (AICA). However, cases in which SSNHL and vertigo occur with hypoperfusion alone are very rare. We describe a patient who developed unilateral SSNHL and vertigo as initial symptoms caused by cerebellar hypoperfusion by vertebral artery (VA) dissection without the occurrence of infarction. CASE PRESENTATION A 51-year-old man suddenly developed acute hearing loss (AHL) in his left ear and vertigo. On neurological examination, he had vibration-induced right-beating nystagmus and left-beating nystagmus after a head-shaking test. Additionally, he had apogeotropic nystagmus during head turns to either side. The head impulse test (HIT) was normal. PTA showed mild unilateral SSNHL in the left ear. Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) showed territorial perfusion deficits in the left posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) without infarction. Two months later, the patient had no vertigo but still had hearing impairment in his left ear. A follow-up PTA documented persistent unilateral SSNHL in the left ear. Additionally, perfusion computed tomography (CT) showed that perfusion deficits remained in the left cerebellum along the PICA and AICA territories. CONCLUSIONS Our case highlights a case of AHL and vertigo presented by isolated cerebellar hypoperfusion without infarction. It is necessary to consider the possibility of a central cause in patients with AHL and vertigo, and it is important to confirm this possibility through brain magnetic resonance imaging (MRI), including PWI, and magnetic resonance angiography (MRA).
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Affiliation(s)
- Young Seo Kim
- Department of Neurology, Institute of Wonkwang Medical Science, Wonkwnag University School of Medicine, Iksan, South Korea ,grid.413112.40000 0004 0647 2826Department of Neurology, Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Jeollabuk-do 54538 South Korea
| | - Ali S. Saber Tehrani
- grid.21107.350000 0001 2171 9311Department of Neurology, Division of Neuro-Visual and Vestibular Disorders, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Hak Seung Lee
- Department of Neurology, Institute of Wonkwang Medical Science, Wonkwnag University School of Medicine, Iksan, South Korea ,grid.413112.40000 0004 0647 2826Department of Neurology, Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Jeollabuk-do 54538 South Korea
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6
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Zhang Z, Yang X, Ling L, Zhou M. A typically progressive dissection of the internal carotid artery with recurrent hiccups: A case report with continuous 2-year data recording. IBRAIN 2022; 9:124-129. [PMID: 37786522 PMCID: PMC10529161 DOI: 10.1002/ibra.12074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 10/04/2023]
Abstract
Patients with internal carotid artery dissection (ICAD) usually report headache, neck pain, Horner's syndrome, and ischemic stroke. Because the posterior cranial nerve is involved, some patients may show different forms of posterior cranial nerve paralysis. There have been no reports of patients with ICAD showing repeated hiccups. Here, to help clinicians identify ICAD early and gain a better understanding of the atypical manifestations of the disease, we report an atypical case of recurrent hiccup symptoms caused by ICAD.
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Affiliation(s)
- Zong‐Min Zhang
- Department of GeriatricsAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Xin‐Xin Yang
- Department of Anesthesiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Li Ling
- Department of GeriatricsAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Man‐Hong Zhou
- Department of EmergencyKweiChow Moutai HospitalRenhuaiGuizhouChina
- Department of emergencyAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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7
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Identification of Cervical Artery Dissections: Imaging Strategies and Literature Review. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Ranjbar M, Badihian N, Yazdi M, Milani S, Taheri M, Khorvash F, Saadatnia M. "Incidence, characteristics and prognosis of cervical artery dissection-induced ischemic stroke in central Iran". BMC Neurol 2022; 22:227. [PMID: 35729625 PMCID: PMC9210700 DOI: 10.1186/s12883-022-02754-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Ischemic stroke is the most common presentation of cervical artery dissection (CAD). Information regarding CAD-induced stroke is scarce, especially in the Middle East. Here we investigated the incidence of CAD-induced stroke, its characteristics, and the clinical course in central Iran. METHODS This is an observational study conducted in the city of Isfahan, Iran. We recruited patients with ischemic stroke during 2017-2019. We analyzed characteristics of the CAD-induced stroke patients with regards to the involved vessel (internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD)). We assessed functional outcome (modified Rankin Scale [mRS]) and recanalization status after 1 year of follow-up. RESULTS Among 3630 ischemic stroke patients, 51(1.4%) had CAD-induced stroke (mean age: 41.8 ± 12.6; 40.4% female; 28 and 19 ICAD and VAD cases, respectively). The crude incidence rate of CAD-induced stroke was 1.20/100,000/year (0.66/100,000/year and 0.45/100,000/year for strokes due to ICAD and VAD, respectively). mRS ≤ 2 was present in 63.8% of the patients after 1 year of follow-up. History of exercise during the last days before stroke occurrence was associated with a better follow-up mRS (β = -3.1, p-value: 0.037). Administration of anticoagulant or double-antiplatelets was related neither to mRS nor recanalization results. Trauma (27.7%), smoking (21.3%), and headache disorders/migraine (21.3%) were the most common reported factors. CONCLUSION We found a crude incidence rate of 1.20/100,000/year for CAD-induced stroke. Trauma, smoking, and headache disorders were the most common reported factors among our patients. CAD-induced stroke had a favorable long-term prognosis regardless of the type of the involved vessel or the used medication.
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Affiliation(s)
- Mahta Ranjbar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, 73461-81746, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negin Badihian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Yazdi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahaboddin Milani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, 73461-81746, Iran. .,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Saadatnia
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan, 73461-81746, Iran. .,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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9
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Magro I, Nurimba M, Doherty J. Headache in Pregnancy. Otolaryngol Clin North Am 2022; 55:681-696. [PMID: 35490045 DOI: 10.1016/j.otc.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Headache is a common symptom in pregnancy. The differential diagnosis for headache in pregnancy is broad and includes conditions that range in acuity and severity. Most headaches in pregnancy are migraine or tension-type headaches. However, pregnant women are at an increased risk of vascular causes of headache due to hormone changes and increased hypercoagulability in pregnancy. A careful history, physical examination, and possible diagnostic workup should be performed. Treatment of headache in pregnancy varies according to the etiology, but care should be taken when performing diagnostic studies and considering pharmacologic treatments, given the possible risk to the mother and fetus.
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Affiliation(s)
- Isabelle Magro
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Margaret Nurimba
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Joni Doherty
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Shi K, Zhang N, Li Y, Sun H, Huang Y, Zhang M, Ma S, Du S, Cheng Y, Qu H, Zhan S. Be careful of Collet-Sicard syndrome: A rare result of carotid artery dissection. Headache 2022; 62:389-394. [PMID: 35294055 DOI: 10.1111/head.14276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kaili Shi
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Nan Zhang
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanling Li
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Sun
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yizhou Huang
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Meijuan Zhang
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuyin Ma
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuang Du
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuxuan Cheng
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huiyang Qu
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuqin Zhan
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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11
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Mooney N, White LM, Chandran A, Bonello M. Vertebral artery dissection managed by interventional radiology. BMJ Case Rep 2022; 15:e245914. [PMID: 35228219 PMCID: PMC8886384 DOI: 10.1136/bcr-2021-245914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/04/2022] Open
Abstract
A 21-year-old patient presented with sudden-onset headache, visual disturbance and left hand incoordination. She was diagnosed with a left vertebral artery dissection of the V3 segment resulting in multiple cerebellar and cerebral infarcts. There were no risk factors for dissection other than recent COVID-19 infection. She was treated initially with antiplatelets, followed by anticoagulation, but experienced recurrent ischaemia. Although guidance suggests endovascular repair may be beneficial for patients with cerebral artery dissection (CAD) who experience recurrent strokes on medical therapy, evidence is limited. After multidisciplinary team consideration of the individual patient anatomy and risks and benefits of different endovascular techniques, the patient was treated with endovascular coiling. At 10 months follow-up, she had no further strokes and improving neurological symptoms. The case highlighted COVID-19 as a potential trigger for CAD and the use of endovascular coiling in preventing catastrophic cerebral ischaemia in CAD refractive to medical therapy.
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Affiliation(s)
- Nicole Mooney
- Department of Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Laura M White
- Department of Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Arun Chandran
- Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael Bonello
- Department of Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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12
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Parvez S, Kaushik M, Ali M, Alam MM, Ali J, Tabassum H, Kaushik P. Dodging blood brain barrier with "nano" warriors: Novel strategy against ischemic stroke. Theranostics 2022; 12:689-719. [PMID: 34976208 PMCID: PMC8692911 DOI: 10.7150/thno.64806] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic stroke (IS) is one of the leading causes of death and disability resulting in inevitable burden globally. Ischemic injury initiates cascade of pathological events comprising energy dwindling, failure of ionic gradients, failure of blood brain barrier (BBB), vasogenic edema, calcium over accumulation, excitotoxicity, increased oxidative stress, mitochondrial dysfunction, inflammation and eventually cell death. In spite of such complexity of the disease, the only treatment approved by US Food and Drug Administration (FDA) is tissue plasminogen activator (t-PA). This therapy overcome blood deficiency in the brain along with side effects of reperfusion which are responsible for considerable tissue injury. Therefore, there is urgent need of novel therapeutic perspectives that can protect the integrity of BBB and salvageable brain tissue. Advancement in nanomedicine is empowering new approaches that are potent to improve the understanding and treatment of the IS. Herein, we focus nanomaterial mediated drug delivery systems (DDSs) and their role to bypass and cross BBB especially via intranasal drug delivery. The various nanocarriers used in DDSs are also discussed. In a nut shell, the objective is to provide an overview of use of nanomedicine in the diagnosis and treatment of IS to facilitate the research from benchtop to bedside.
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13
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Postpartum Acute Basilar Artery Occlusion Secondary to Vertebral Artery Dissection. Case Report and Literature Review. J Crit Care Med (Targu Mures) 2021; 7:294-301. [PMID: 34934820 PMCID: PMC8647675 DOI: 10.2478/jccm-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/16/2021] [Indexed: 11/21/2022] Open
Abstract
Female patients in the peripartum and postpartum periods have an increased risk of stroke than nonpregnant women. Cerebrovascular complications of pregnancy represent a significant cause of maternal mortality and morbidity and are potentially disabling. Acute basilar artery occlusion secondary to spontaneous vertebral artery dissection in the postpartum period is an infrequent entity and a major diagnostic and treatment challenge. In the present case, a 37-year-old female patient, eight weeks after caesarean delivery, presented with a history of sudden cervical pain, followed by headache and dizziness. Some hours later, she was found unconscious by her family and was transferred to the emergency department, where a neurological status assessment suggested vertebrobasilar stroke. The imagistic workup revealed right vertebral artery dissection and basilar artery occlusion without constituted ischemic lesions. The patient underwent endovascular intervention with dilation of the narrowed vertebral artery and stent retriever basilar artery thrombectomy, with a favourable clinical outcome. This report first presents the details of this case and the relevant literature data on postpartum arterial dissections and the subsequent ischemic complications and available treatment options.
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14
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Vitturi BK, Gagliardi RJ. Effectiveness of statins in patients with stroke due to cervical artery dissection: A preliminary study. Med Clin (Barc) 2021; 157:313-317. [PMID: 32826077 DOI: 10.1016/j.medcli.2020.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Statin therapy has become one of the most important advances in stroke secondary prevention. Nevertheless, statin therapy in patients who present an ischemic stroke following cervical artery dissection (CAD) has not yet been supported by clinical evidence. This study aimed to investigate the effect of statins on neurological outcomes after a stroke due to CAD. METHODS We conducted a prospective cohort study including consecutive patients diagnosed with a stroke due to CAD. Subjects were classified into non-statin, simvastatin 20mg, simvastatin 40mg, and high-potency statin groups. After 2 years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS Among the 54 patients included in our cohort, there were 16 (29.6%) patients without statins, 22 (40.7%) with simvastatin 20mg, 12 (22.2%) with simvastatin 40mg and 4 (7.5%) with high-potency statins. Using simvastatin 40mg was associated with a significantly lower incidence of stroke recurrence. Patients with simvastatin 40mg and high-potency statins presented the best functional recovery throughout the follow-up (p<.01). DISCUSSION The use of statins in patients with CAD-related stroke may improve functional outcomes in specific cases. Statins do not prevent stroke recurrence and major cardiovascular events in this type of stroke.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, 01221-020 São Paulo, Brazil.
| | - Rubens José Gagliardi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, 01221-020 São Paulo, Brazil
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15
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Southerland AM, Green IE, Worrall BB. Cerebral aneurysms and cervical artery dissection: Neurological complications and genetic associations. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:241-251. [PMID: 33632443 DOI: 10.1016/b978-0-12-819814-8.00033-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dissections and aneurysms are two of the more common nonatherosclerotic arteriopathies of the cerebrovascular system and a significant contributor to neurovascular complications, particularly in the young. Specifically, ruptured intracranial aneurysms (IA) account for nearly 500,000 cases of subarachnoid hemorrhage annually with a 30-day mortality approaching 40% and survivors suffering often permanent neurologic deficits and disability. Unruptured IAs require dedicated assessment of risk and often warrant serial radiologic monitoring. Cervical artery dissection, affecting the carotid and vertebral arteries, accounts for nearly 20% of strokes in young and middle-aged adults. While approximately 70% of cervical artery dissection (CeAD) cases present with stroke or TIA, additional neurologic complications include severe headache and neck pain, oculosympathetic defect (i.e., partial Horner's syndrome), acute vestibular syndrome, and rarely lower cranial nerve palsies. Both aneurysms and dissections of the cerebrovascular system may occur frequently in patients with syndromic connective tissue disorders; however, the majority of cases are spontaneously occurring or mildly heritable with both polygenic and environmental associations. Fibromuscular dysplasia, in particular, is commonly associated with both risk of CeAD and IA formation. Further research is needed to better understand the pathophysiology of both IA and CeAD to better understand risk, improve treatments, and prevent devastating neurologic complications.
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Affiliation(s)
- Andrew M Southerland
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
| | - Ilana E Green
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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16
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Gomez‐Rojas O, Hafeez A, Gandhi N, Berghea R, Halalau A. Bilateral Vertebral Artery Dissection: A Case Report with Literature Review. Case Rep Med 2020; 2020:8180926. [PMID: 33101417 PMCID: PMC7568148 DOI: 10.1155/2020/8180926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/24/2020] [Accepted: 04/13/2020] [Indexed: 12/20/2022] Open
Abstract
Vertebral artery dissection (VAD) is a rare cause of ischemic stroke in young patients. The largely nonspecific symptoms and delayed presentation pose a serious diagnostic challenge. Medical management with either anticoagulation or antiplatelet therapy is recommended, but there are no reports of successful dual therapy. We report a case of spontaneous bilateral vertebral artery dissections (VADs) treated with both anticoagulation and antiplatelet therapy and a literature review on clinical presentation and the current medical and surgical management options. A 37-year-old healthy female presented to the emergency department with worsening neck pain and headache for two weeks despite over-the-counter medication, block therapy, yoga, and deep tissue neck massage. She denied any trauma but admitted to multiple roller coaster rides over the past few months. CT angiography was concerning for VADs, and MRI brain revealed multiple strokes in the left posterior inferior cerebellar artery (PICA) territory. Cerebral arteriography confirmed the diagnosis of VADs. The patient was initiated on warfarin, along with atorvastatin and aspirin. She was discharged home with no complications and followed up with neurology as an outpatient. MR angiography after three months revealed complete resolution of the dissection. The patient did not report any bleeding complications from dual therapy.
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Affiliation(s)
- Olga Gomez‐Rojas
- Office of Occupational Health, Alexander von Humboldt Peruvian German School, Lima, Peru
| | - Adam Hafeez
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nikhil Gandhi
- Internal Medicine Department, Ascension Health, St.John Hospital, Detroit, MI, USA
| | - Ramona Berghea
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Alexandra Halalau
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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17
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Saal-Zapata G, Durand W, Valer D, Rodríguez R. Internal Carotid Artery Dissection Treated with C-Guard Stent. Int J Angiol 2020; 31:61-66. [PMID: 35221855 DOI: 10.1055/s-0040-1708839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Internal carotid dissection is the most common cause of stroke in the young population. Stroke, the presence of a pseudoaneurysm, and decreased artery lumen with cerebral flow impairment are indications for treatment. Medical therapy with antithrombotic drugs and endovascular therapy with stenting are the main available options. The C-Guard stent is an open cell mesh-covered dual layer stent that has been mainly used in cases of internal carotid artery stenosis with a post-operative reduction in stroke incidence. Thus, we present two cases of internal carotid artery dissections of the cervical segment treated with the open cell dual-layer C-Guard stent without complications.
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Affiliation(s)
- Giancarlo Saal-Zapata
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Peru
| | - Walter Durand
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Peru
| | - Dante Valer
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Peru
| | - Rodolfo Rodríguez
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Peru
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18
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Rafailidis V, Notas K, Destanis E, Kouskouras K, Chryssogonidis I, Xerras C, Charitanti-Kouridou A, Tegos T. Extracranial internal carotid artery occlusive dissection – multimodality presentation in a case series. VASA 2019; 48:244-250. [DOI: 10.1024/0301-1526/a000768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract. Background: Carotid dissection is a rare disease, mainly affecting young and middle-aged patients potentially ending up in stroke. Multimodality imaging plays an essential role, both in terms of prompt and accurate diagnosis and follow-up of this entity. Patients and methods: We herein present a case series of patients with internal carotid artery dissection and compare the various imaging findings of ultrasonography, multidetector computed tomography angiography and magnetic resonance angiography, with a purpose to illustrate the value of multimodality imaging in the diagnosis of carotid dissection. Results: Ultrasound represents the first-line imaging modality for the evaluation of a suspected carotid pathology. Digital subtraction angiography is considered the gold standard method for evaluation of carotid luminal abnormalities and is currently reserved for those patients selected for endovascular surgery. Nevertheless, the widespread availability of modern cross-sectional techniques such as multi-detector computed tomography angiography and magnetic resonance angiography has made angiography marginalised. Computed tomography and magnetic resonance angiography offered accurate delineation of vascular lumen and providing valuable information for the vascular wall composition. Conclusions: Careful interpretation of imaging findings on various imaging modalities can lead to early and accurate diagnosis of carotid dissection.
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Affiliation(s)
- Vasileios Rafailidis
- Radiology Department, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Konstantinos Notas
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Evangelos Destanis
- Radiology Department, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Konstantinos Kouskouras
- Radiology Department, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Ioannis Chryssogonidis
- Radiology Department, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Chrysostomos Xerras
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Afroditi Charitanti-Kouridou
- Radiology Department, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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19
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Surgical Treatment of Spontaneous Internal Carotid Artery Dissection with Abducent Nerve Palsy: Case Report and Review of Literature. World Neurosurg 2019; 125:10-14. [PMID: 30711658 DOI: 10.1016/j.wneu.2019.01.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sixth-nerve palsy often develops as a result of trauma, neoplasm, or vascular disease affecting the pons. Less commonly, this palsy can be caused by pathology of the internal carotid artery in the cavernous sinus region. Here, we describe a rare case of spontaneous dissection of the internal carotid artery in the cavernous sinus accompanied by acute sixth nerve palsy that was successfully treated with surgery. CASE DESCRIPTION An 18-year-old man presented suddenly and spontaneously with isolated abducent nerve palsy. His magnetic resonance angiography identified a dissection of the right internal carotid artery in the cavernous sinus. We successfully treated it with high-flow bypass and ligation of the internal carotid artery (ICA). CONCLUSIONS Intracavernous ICA dissection is a possible cause of sixth nerve palsy. While most cases likely result from compromised arterial blood supply to the affected nerve, compression of the cranial nerves by the expanded artery can occur in some cases. Surgical treatment is a safe and effective option for relieving nerve compression after intracavernous ICA dissection.
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20
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Druk IV, Drokina OV, Smyalovsky DV, Smyalovsky VE, Shilova MA, Korsakov MV, Goltyapin VV. [Dissection of the internal carotid artery in a patient with connective tissue dysplasia having risk variants of several candidate genes]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:5-12. [PMID: 32207712 DOI: 10.17116/jnevro20191191225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spontaneous dissection of the vessels of the neck is one of the main causes of ischemic stroke in young patients under 45 years of age. According to morphological studies, dissection of the vessels of the neck can be based on dysplastic changes in the arterial wall in arteriopathies, Marfan syndrome, Ehlers-Danlos syndrome, undifferentiated connective tissue dysplasia. The article presents a case of spontaneous dissection of the internal carotid artery in a 30-year-old patient with clinical manifestations of undifferentiated connective tissue dysplasia and carriage of homozygous variants of candidate genes: 4G/4G of the PAI-1 (-675, 4G/5G), T/T of the MTHFR C677T, 5A/5A of the MMP-3 (-1171 5A/6A) and A/A of the MMP-9 (8202A/G).
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Affiliation(s)
- I V Druk
- Omsk State Medical University, Omsk, Russia
| | | | | | - V E Smyalovsky
- Omsk State Medical University, Omsk, Russia; Clinical Diagnostic Center, Omsk, Russia
| | - M A Shilova
- Sechenov First Moscow State Medical University, Moscow, Russia
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21
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Raina R, Krishnappa V, Das A, Amin H, Radhakrishnan Y, Nair NR, Kusumi K. Overview of Monogenic or Mendelian Forms of Hypertension. Front Pediatr 2019; 7:263. [PMID: 31312622 PMCID: PMC6613461 DOI: 10.3389/fped.2019.00263] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022] Open
Abstract
Monogenic or Mendelian forms of hypertension are described as a group of conditions characterized by insults to the normal regulation of blood pressure by the kidney and adrenal gland. These alterations stem from single mutations that lead to maladaptive overabsorption of electrolytes with fluid shift into the vasculature, and consequent hypertension. Knowledge of these various conditions is essential in diagnosing pediatric or early-onset adult hypertension as they directly affect treatment strategies. Precise diagnosis with specific treatment regimens aimed at the underlying physiologic derangement can restore normotension and prevent the severe sequelae of chronic hypertension.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General, Akron, OH, United States.,Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, United States.,Department of Pediatric Nephrology, Akron Children's Hospital, Akron, OH, United States
| | - Vinod Krishnappa
- Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, OH, United States.,Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Abhijit Das
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Harshesh Amin
- Department of Internal Medicine, Carolinas Health Care System Blue Ridge, Morganton, NC, United States
| | | | - Nikhil R Nair
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, United States
| | - Kirsten Kusumi
- Department of Pediatric Nephrology, Akron Children's Hospital, Akron, OH, United States
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22
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Mes M, Palczewski P, Szczudlik P, Łusakowska A, Maj E, Gawel M. Hypoglossal nerve palsy as an isolated syndrome of internal carotid artery dissection: A review of the literature and a case report. Neurol Neurochir Pol 2018; 52:731-735. [PMID: 30082078 DOI: 10.1016/j.pjnns.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/11/2018] [Accepted: 06/25/2018] [Indexed: 11/18/2022]
Abstract
A review of literature on the dissection of internal carotid artery was presented with a presentation of a rare case of patient with transient left hypoglossal nerve palsy caused by mechanic compression from intramural hematoma in higher extracranial portion of dissected carotid artery confirmed in MRI and CT scans. The clinical presentation and management are discussed.
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Affiliation(s)
- Martyna Mes
- (1)Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Palczewski
- (2)I Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Szczudlik
- (1)Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Łusakowska
- (1)Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Maj
- (3)II Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Malgorzata Gawel
- (1)Department of Neurology, Medical University of Warsaw, Warsaw, Poland.
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23
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Jo H, Choi EH, Song J, Chung JW, Bang OY. Carotid artery dissection caused by Eagle syndrome. PRECISION AND FUTURE MEDICINE 2017. [DOI: 10.23838/pfm.2017.00191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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