Bilateral extracranial aneurysms of the internal carotid artery. Case report

Blunt trauma lesions of the extracranial internal carotid artery in patients with head injury

Blunt trauma lesions of the extracranial internal carotid artery (ICA) are rare. In our hospital 18 patients with such an injury were diagnosed. All patients were involved in traffic accidents. Most of them had sustained head injuries with fractures of the skull, mandible or maxilla. The onset of neurological signs, most frequently hemiparesis, was usually delayed. 50 percent had bilateral ICA lesions but the clinical presentation was similar to those with unilateral lesions. Mortality of patients with ICA lesions was substantial (28%).

Extracranial carotid artery aneurysms following accidental injury: ten years experience

Extracranial carotid artery aneurysms secondary to accidental injury are rare. We have seen eight lesions of this type in the last 10 years. The aneurysm was produced by blunt trauma in four patients, penetrating shrapnel injury in two, stabbing and electrical injury in one each. The left side was involved in seven patients. The internal and common carotid artery were each involved in four patients and the lesion was unilocular in five. These lesions often produce non-specific symptoms and may mimic neoplastic or inflammatory masses: a mistaken diagnosis of tonsillar abscess in one patient resulted in incision and drainage before an intravenous digital subtraction angiogram (IV-DSA) correctly identified the abnormality. IV-DSA is ideal for pre-operative assessment of these patients. Awareness of these lesions is essential since definitive surgical repair is possible. All patients in the present study underwent successful surgical repair.

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.

Surgical management of aneurysms of the distal extracranial internal carotid artery

Results, complications, and operative techniques of the surgical management of 20 aneurysms of the distal extracranial internal carotid artery (ICA) in 19 patients are reviewed. The proximity of these aneurysms to the styloid process is not considered as a chance occurrence, and the possibility is raised that these lesions are related to trauma from that structure. False aneurysms from spontaneous dissections are believed to occur only in those dissections that begin distally; they are not found in dissections that begin proximally. Treatment was individualized and dependent upon: 1) the size and location of the aneurysm; 2) symptomatology; and 3) hemodynamic considerations based upon intraoperative cerebral blood flow (CBF) measurements determined from the clearance of xenon-133 injected into the ipsilateral ICA. Methods of treatment included: resection of the the aneurysm with placement of an interposition saphenous vein graft in seven patients; resection of the aneurysm with end-to-end anastomosis of the ICA in five; ICA ligation in three; clipping of the aneurysm in one; and extracranial-to-intracranial bypass in four. One patient sustained a postoperative cerebral ischemic complication from embolization which resulted in a mild permanent impairment in right hand dexterity. There were no other cerebral ischemic complications in the group, largely attributable, it is thought, to the use of intraoperative CBF measurements and continuous electroencephalograms. Four patients had transient dysphagia from traction damage to the pharyngeal and superior laryngeal nerves, and one patient with preoperative difficulty in swallowing required a gastrostomy. Long-term results have been excellent. Use of the operating microscope facilitated the suturing of the distal anastomosis in cases in which the ICA was reconstructed by an interposition vein graft or end-to-end anastomosis.

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.

Extracranial carotid and vertebral artery aneurysms

Extracranial carotid aneurysms are uncommon, and in the past their management has not always been satisfactory. These aneurysms may be caused by arteriosclerosis, infection or trauma, or they may be congenital. Neurologic symptoms are common. Surgery is recommended for symptomatic aneurysms in patients of all ages. Non-growing aneurysms in old patients can be conservatively managed. Six cases of carotid and one case of vertebral artery aneurysm are reported. The mode of clinical presentation, etiologic factors, angiographic findings and methods of management are discussed.

Carotid fibromuscular dysplasia and paresis of lower cranial nerves (Collect-Sicard syndrome). Case report

A patient suffered the acute onset of unilateral pareses of the ninth through 12th cranial nerves (Collet-Sicard syndrome). Ipsilateral retrograde jugular phlebography and carotid angiography revealed irregular aneurysmal changes of the internal carotid artery at the base of the skull, causing compression of the internal jugular vein below the jugular foramen. This finding is discussed in relation to the clinical symptoms and signs, and possible mechanisms are examined. Family history as well as the clinical and roentgenological findings were compatible with a diagnosis of fibromuscular dysplasia.

The role of extracranial carotid abnormalities in the genesis of cerebral aneurysms

The incidence of extracranial internal carotid artery (ICA) abnormalities, namely kinks, coils, and stenoses, was evaluated in a consecutive unselected series of 76 cases of single supratentorial saccular aneurysms submitted to bilateral carotid angiography. These patients were compared with a control group of 120 patients who had undergone either uni- or bilateral carotid angiography for causes other than cerebrovascular occlusive diseases or intracranial arterial aneurysms. Both groups had a total of 152 angiograms. Extracranial carotid abnormalities were significantly higher in aneurysm patients (p less than 0.001). Arterial kinks and coils were seen on 42 of 152 angiograms in the saccular aneurysm group and 17 of 152 in the control group (p less than 0.001); however, there was no significant difference regarding ICA stenoses (0.16 greater than p greater than 0.15). In the 76 aneurysm patients, abnormalities were mostly either located or more pronounced on the side opposite the aneurysm (in 22 as opposed to 11 on the same side, p less than 0.004). It is suggested that extracranial ICA anomalies have a role in the pathogenesis of intracranial arterial aneurysms, possibly by increasing the hemodynamic stress on the side opposite to the carotid lesion. The combination of the hydrodynamic theory, suggested by the present study, with other possible factors, might lead to a better understanding of the mechanism underlying development of human cerebral arterial aneurysms.

Asymptomatic aneurysm of the extracranial internal carotid artery: report of a case

A rare case of saccular aneurysm of the right internal carotid artery is presented. The patient was asymptomatic, and the aneurysm was discovered incidentally at examination after a fall. The diagnosis was confirmed angiographically, and the aneurysm was surgically excised with end-to-end anastomosis of the artery.

Extra-cranial aneurysm of the internal carotid artery treated by proximal ligation

A case of aneurysm of the extra-cranial section of the internal carotid artery extending to the base of the skull is described. Treatment comprised proximal vessel ligation, the tolerance of the patient's cerebral circulation to this procedure first being assessed by measuring the back pressure across the circle of Willis after temporary carotid artery occlusion. The value of this technique is discussed.

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.

Unusual presentation of traumatic extracranial internal carotid artery aneurysm

A young man presented with apparent transient ischemic attacks following a motorcycle accident in which he sustained minor injuries only. Computerized axial tomography demonstrated a small right frontal infarct, and angiography revealed an aneurysm of the right internal carotid artery in its extracranial course. This was thought to be traumatic in origin.

Bilateral aneurysms of the cervical internal carotid arteries

An unusual case of bilateral aneurysms of the internal cervical carotid arteries in a 38 year old man with right hemiplegia and aphasia is described.

Congenital aneurysm of the extracranial carotid arteries

Images

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

Images