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Dejakum B, Kiechl S, Knoflach M, Mayer-Suess L. A narrative review on cervical artery dissection-related cranial nerve palsies. Front Neurol 2024; 15:1364218. [PMID: 38699055 PMCID: PMC11063253 DOI: 10.3389/fneur.2024.1364218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction This study aimed to emphasize the importance of cranial nerve (CN) palsies in spontaneous cervical artery dissection (sCeAD). Methods A search term-based literature review was conducted on "cervical artery dissection" and "cranial nerve palsy." English and German articles published until October 2023 were considered. Results Cranial nerve (CN) palsy in sCeAD is evident in approximately 10% of cases. In the literature, isolated palsies of CN II, III, VII, IX, X, and XII have been reported, while CN XI palsy only occurs in combination with other lower cranial nerve palsies. Dissection type and mural hematoma localization are specific to affected CN as CN palsies of II or III are solely evident in those with steno-occlusive vessel pathologies located at more proximal segments of ICA, while those with CN palsies of IX, X, XI, and XII occur in expansive sCeAD at more distal segments. This dichotomization emphasizes the hypothesis of a different pathomechanism in CN palsy associated with sCeAD, one being hypoperfusion or microembolism (CN II, III, and VII) and the other being a local mass effect on surrounding tissue (CN IX, X, XI, and XII). Clinically, the distinction between peripheral palsies and those caused by brainstem infarction is difficult. This differentiation is key, as, according to the reviewed cases, peripheral cranial nerve palsies in sCeAD patients mostly resolve completely over time, while those due to brainstem stroke do not, making cerebrovascular imaging appraisal essential. Discussion It is important to consider dissections as a potential cause of peripheral CN palsies and to be aware of the appropriate diagnostic pathways. This awareness can help clinicians make an early diagnosis, offering the opportunity for primary stroke prevention.
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Affiliation(s)
- Benjamin Dejakum
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage – Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage – Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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2
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Vigilante N, Khalife J, Badger CA, Shaikh H, Thomas AJ, Swendseid B, Jovin TG, Siegler JE, Tonetti DA. Surgical management of stylocarotid Eagle syndrome in a patient with bilateral internal carotid artery dissection: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23682. [PMID: 38285978 PMCID: PMC10829260 DOI: 10.3171/case23682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Eagle syndrome is characterized by an elongated styloid process, which can cause acute neurological symptoms when the projection impinges on local structures. One method by which Eagle syndrome can cause acute stroke is via internal carotid artery dissection. OBSERVATIONS A patient presented with acute aphasia and right-arm weakness. Imaging revealed a left internal carotid artery dissection, which was treated with stenting. Three years later, the patient presented with left-sided weakness, and imaging revealed a new right internal carotid artery dissection. Closer review of the patient's imaging revealed bilateral elongated styloid processes. The patient subsequently underwent staged bilateral styloidectomy and returned to his prior baseline postoperatively. LESSONS This case report describes a patient with Eagle syndrome who had two internal carotid artery dissections separated by several years. A literature review revealed that styloidectomy is well tolerated in patients with carotid dissection due to Eagle syndrome. Patients with carotid dissection due to Eagle syndrome remain at risk for contralateral dissection, and prophylactic contralateral styloidectomy should be considered.
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Affiliation(s)
| | - Jane Khalife
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 2Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Clint A Badger
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Hamza Shaikh
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Ajith J Thomas
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Brian Swendseid
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 4Division of Otolaryngology - Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey; and
| | - Tudor G Jovin
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 2Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - James E Siegler
- 5Department of Neurology, University of Chicago, Chicago, Illinois
| | - Daniel A Tonetti
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 2Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
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3
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Tuffley RH, Qayyum AA. Multiple spontaneous isolated arterial dissections: a rare case report. Am J Transl Res 2024; 16:356-362. [PMID: 38322547 PMCID: PMC10839373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/12/2023] [Indexed: 02/08/2024]
Abstract
Spontaneous dissections in multiple arteries are a rare condition with clinical presentation varying from asymptomatic conditions to sudden death. We present a rare case where a routine thoracic computed tomography (CT) scan showed a type B aortic dissection. Medical records showed that the patient previously had been diagnosed with bilateral spontaneous isolated internal carotid artery dissections, which caused an attack of amaurosis fugax a few months earlier. The patient was asymptomatic during the admission with type B aortic dissection. However, the patient had a high blood pressure which was medically treated. A new CT scan confirmed earlier findings and revealed a spontaneous isolated dissection in the superior mesenteric artery. No progression was seen when the scan was compared to a new CT scan performed 10 days later. The type B aortic dissection was considered to be chronic and stable with no need for vascular intervention. This case report illustrates a rare condition of four isolated arterial dissections. The present case demonstrates the necessity of further examinations, which should be considered carefully when a patient presents with several independent arterial dissections.
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Affiliation(s)
- Rebecca Hvidt Tuffley
- Department of Cardiology, Hvidovre Hospital, University of CopenhagenCopenhagen, Denmark
| | - Abbas Ali Qayyum
- Department of Cardiology, Hvidovre Hospital, University of CopenhagenCopenhagen, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of CopenhagenCopenhagen, Denmark
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4
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Trager RJ, Cupler ZA, Theodorou EC, Dusek JA. COVID-19 Does Not Increase the Risk of Spontaneous Cervical Artery Dissection. Cureus 2023; 15:e47524. [PMID: 38022016 PMCID: PMC10664733 DOI: 10.7759/cureus.47524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Case reports have raised the possibility of an association between coronavirus disease 2019 (COVID-19) and spontaneous cervical artery dissection (sCeAD), yet no large studies have examined this association. We hypothesized that adults with confirmed COVID-19 would have an increased risk of sCeAD over the subsequent six months compared to test-negative controls after adjusting for confounding variables. Methods We obtained data from a United States medical records network (TriNetX, Inc., Cambridge, MA) of >106 million patients, providing adequate power needed for this rare outcome. We identified two cohorts of adults meeting the criteria of (1) test-confirmed COVID-19 or (2) non-COVID-19 test-negative controls, from April 1, 2020, to December 31, 2022. Patients with previous COVID-19 or conditions predisposing to sCeAD were excluded. Propensity matching was used to control for variables associated with sCeAD and markers of healthcare utilization. Results The number of patients reduced from before matching (COVID-19: 491,592; non-COVID-19: 1,472,895) to after matching, resulting in 491,115 patients per cohort. After matching, there were 22 cases of sCeAD in the COVID-19 cohort (0.0045%) and 20 cases in the non-COVID-19 cohort (0.0041%), yielding a risk ratio of 1.10 (95% CI: 0.60-2.02; P = 0.7576). Both cohorts had a median of five healthcare visits during follow-up. Conclusions Our results suggest that COVID-19 is not a risk factor for sCeAD. This null finding alleviates the concern raised by initial case reports and may better direct future research efforts on this topic.
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Affiliation(s)
- Robert J Trager
- Department of Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, USA
- Department of Biostatistics and Bioinformatics, Clinical Research Training Program, Duke University School of Medicine, Durham, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA (Veterans Affairs) Health Care System, Butler, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Elainie C Theodorou
- Science Research and Engineering Program, Hathaway Brown School, Cleveland, USA
| | - Jeffery A Dusek
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, USA
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5
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Deen R, Austin C, Bullen A. Review article: Non-penetrating neck artery dissection in young adults: Not to be missed! Emerg Med Australas 2023; 35:384-389. [PMID: 36948224 DOI: 10.1111/1742-6723.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/10/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
Young adults who present to the ED with neck pain following non-penetrating, seemingly trivial trauma to the neck, are at risk of neck artery dissection and subsequent stroke. Sport-related neck injury is the chief cause. Physical examination may often be unremarkable, and although there may be reluctance to expose young patients to radiation, radiological imaging is central to making a diagnosis of arterial wall disruption. A comprehensive literature search was performed in relation to neck artery dissection, and the evidence was scrutinised. We discuss the typical mechanism of injury, symptoms, anatomical considerations and clinical aids in diagnosis of neck artery dissection. Although the incidence is low, neck artery dissection has a mortality of 7%. As such, it is important for front-line physicians to have a high suspicion of the diagnosis and a low threshold to organise radiological examinations, specifically computerised tomography. Early detection of neck artery dissection will trigger clinical protocols that call for multi-disciplinary team management of this condition. In general, guideline-based recommendation for the management of neck artery dissection involving an intimal flap is by anti-platelet therapy while treatment of neck artery dissection that results in a pseudo-aneurysm or thrombosis is managed by surgical intervention or endovascular techniques. Close follow up combined with antithrombotic treatment is recommended in these individuals, the goal being prevention of stroke.
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Affiliation(s)
- Raeed Deen
- Department of Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Calyb Austin
- Department of Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Bullen
- Department of Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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6
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Cupler ZA, Trager RJ, Daniels CJ. Letter to the Editor: Cervical Spinal Manipulative Therapy Unlikely Cause of Spontaneous Internal Carotid Artery Dissection. Vasc Endovascular Surg 2022; 56:545-546. [PMID: 35442124 DOI: 10.1177/15385744221088091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Zachary A Cupler
- 20091Butler VA Health Care System, Butler, PA, USA.,Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert J Trager
- Connor Whole Health, 114516University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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7
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Kemple D, Knauss H, Correa KP, Stolting A. Pediatric internal carotid artery dissection and stroke after minor head injury. J Am Coll Emerg Physicians Open 2021; 2:e12463. [PMID: 34179885 PMCID: PMC8212559 DOI: 10.1002/emp2.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/29/2021] [Accepted: 07/05/2021] [Indexed: 12/04/2022] Open
Abstract
Pediatric arterial ischemic stroke (AIS) is an important cause of juvenile brain injury. There are no well-established guidelines for universal management of childhood stroke. Although cerebral arteriopathies are the most common cause of pediatric AIS, head or neck trauma is an established risk factor.1 We report the case of a 6-year-old African American male who presented to the pediatric emergency department with aphasia and right-sided hemiparesis 4 days after a fall in gym class. Magnetic resonance angiography showed tandem occlusion of the left internal carotid artery (ICA) and middle cerebral artery. During endovascular exploration for thrombectomy, a dissection of the ICA also was discovered and recanalized. Following neurointerventional embolectomy, the patient sustained full neurologic recovery without recurrence at 2 years. The safety and efficacy of therapeutic embolectomy in children is not well documented and warrants additional discussion for establishing novel protocols.
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Affiliation(s)
- Daniel Kemple
- Department of Emergency Medicine, Promedica Toledo HospitalUniversity of ToledoToledoOhioUSA
| | - Hanna Knauss
- College of MedicineUniversity of ToledoToledoOhioUSA
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8
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Gniadek-Olejniczak K, Mroz J, Tomczykiewicz K, Staszewski J. [ Internal carotid artery dissection in the neurologist's practice - a case study]. Pol Merkur Lekarski 2021; 49:19-22. [PMID: 33713087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED Dissection of the interior carotid artery is rare in the general population. It can however be a potentially life-threatening condition. In the group of patients below 45 years of age, it constitutes a fairly common cause of cerebral stroke. A CASE REPORT The study describes the case of a patient with the right interior carotid artery dissection, sustained most probably in the course of work. The patient was admitted to hospital for a severe headache of a few days' duration accompanied by Horner's syndrome on the right side. Promptly undertaken diagnostic procedures allowed for immediate diagnosis and application of the right treatment. The check-up examinations performed showed a healed artery and withdrawal of the neurological syndrome. CONCLUSIONS The case emphasizes the role of prompt diagnosis and treatment in preventing the development of more serious complications. The article refers also to the standards of treating the dissection of the interior carotid artery which still arouse controversies.
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Affiliation(s)
- Katarzyna Gniadek-Olejniczak
- Military Institute of Medicin in Warsaw, Poland: Department of Rehabilitation with Neurologic Rehabilitation Ward
| | - Józef Mroz
- Military Institute of Medicin in Warsaw, Poland: Department of Rehabilitation with Neurologic Rehabilitation Ward
| | | | - Jacek Staszewski
- Military Institute of Medicin in Warsaw, Poland: Department of Neurology
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9
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Maeda T, Satow T, Hamano E, Hashimura N, Koge J, Tanaka K, Yoshimoto T, Inoue M, Koga M, Nishimura M, Takahashi JC. A Case of Internal Carotid Artery Dissection with Ischemic Onset, Followed by Subarachnoid Hemorrhage during Diagnostic Angiography. J Neuroendovasc Ther 2020; 14:420-427. [PMID: 37502655 PMCID: PMC10370533 DOI: 10.5797/jnet.cr.2019-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/15/2020] [Indexed: 07/29/2023]
Abstract
Objective Internal carotid artery (ICA) dissection is known to cause binary types of stroke, cerebral infarction, and subarachnoid hemorrhage (SAH). However, it is rare that these two pathologies take place in a clinical scenario. We report a case of ICA dissection with ischemic onset, which was followed by SAH on the same day during diagnostic angiography. Case Presentation A 60-year-old woman with chronic hypertension rapidly developed right hemiplegia. She had been suffering from slight headache and abnormal sensation in the right limbs 1 week before the ictus. MRI demonstrated small acute infarctions in the left middle cerebral artery (MCA) territory. The left ICA was not visualized on MRA. Diffusion-perfusion mismatch was indicated by the automated image postprocessing system. Endovascular recanalization was planned to prevent the progression of cerebral infarction. After advancing a 5MAX ACE, initial left ICA angiography was performed, resulting in extravasation of contrast medium from the C2 segment of the left ICA. 3D rotational angiography revealed left ICA dissection of the C2 segment. To secure hemostasis, the patient underwent internal trapping at the C1 and C2 segments of the left ICA. Collateral flow to the left MCA via an anterior communicating artery was observed. On day 28, the patient was transferred to a rehabilitation hospital with right hemiplegia and motor aphasia. Conclusion In cases of tandem lesions with preceding neurological symptoms, ICA dissection should be considered as one of the causes. Careful injection of contrast medium may be necessary if ICA dissection is strongly suspected.
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Affiliation(s)
- Takuma Maeda
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoki Hashimura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junpei Koge
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kanta Tanaka
- Department of Cerebrovascular Disease, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cerebrovascular Disease, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masaki Nishimura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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10
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Kalashnikova LA, Dobrynina LA, Dreval MV, Gubanova MV, Krotenkova MV, Konovalov RN, Legenko MS. [Intracerebral hemorrhage in the late period of internal carotid artery dissection]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:28-34. [PMID: 31825359 DOI: 10.17116/jnevro201911908228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cervical artery dissection is the common cause of ischemic stroke in young and middle-age patients. According to our previous studies, dissection is related to arterial wall dysplastic changes, which in their turn are due to mitochondrial cytopathy. The authors describe three male patients who at the age of 53, 25 and 35 years underwent internal artery (ICA) dissection with occlusion of its lumen and subsequent recanalization in one of them. In 3.5 months, 13.5 years and 3 years respectively, patients developed intracerebral hemorrhage (IСH), which was not related to arterial hypertension, cerebral arterial aneurysms and anticoagulants. IСH were located on the side of ICA occluded after dissection (2 patients) or bilaterally in the territory of patent ICA (1 patient). Multivoxel 1H-MR spectroscopy performed in one patient on 40 and 48 days after ICH revealed a high lactate peak in the externally unchanged hemispheric white matter. It is assumed that mitochondrial cytopathy in patients with dissection may involve large as well as small intracerebral arteries (mitochondrial microangiopathy), which could be the cause of ICH.
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Affiliation(s)
| | | | - M V Dreval
- Research Center of Nevrology, Moscow, Russia
| | | | | | | | - M S Legenko
- Research Center of Nevrology, Moscow, Russia
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11
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Chen MJ, Li HF, Mao S. Trigeminal Autonomic Cephalalgias Manifested As The Only Initial Symptom Of Ehlers-Danlos Syndrome Type IV. J Pain Res 2019; 12:3215-3220. [PMID: 31819605 PMCID: PMC6885569 DOI: 10.2147/jpr.s218580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/06/2019] [Indexed: 11/25/2022] Open
Abstract
Ehlers–Danlos syndrome (EDS) type IV is characterized by thin skin with visible veins, easy bruising, characteristic facial features, arterial and digestive complications, as well as rupture of the gravid uterus. It has never been previously reported that trigeminal autonomic cephalalgias (TACs) could manifest as the only initial symptom of EDS type IV. Here, we report a case of a 27-year-old man who presented atypical headache like TACs stimulated by right internal carotid artery dissection. About one month after his discharge, he suffered dissection of the right renal artery and splenic artery, in addition to partial infarction of the right kidney and spleen. Genetic testing revealed a novel splicing variant c.799-1G>A within COL3A1. He was ultimately diagnosed with Ehlers–Danlos syndrome type IV. This case expanded the genetic spectrum and clinical manifestation of EDS type IV and provided a significant implication for the diagnosis of EDS type IV when the initial symptom manifested as TACs, not the typical presentation of EDS type IV.
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Affiliation(s)
- Mei-Jiao Chen
- Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong-Fu Li
- Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shanying Mao
- Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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12
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Affiliation(s)
- Stacy C Brown
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., G.J.F.), Yale School of Medicine
| | - Guido J Falcone
- From the Division of Neurocritical Care and Emergency Neurology (S.C.B., G.J.F.), Yale School of Medicine
| | - Ryan M Hebert
- Department of Neurosurgery (R.M.H.), Yale School of Medicine
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health (S.Y.)
| | - Brian Mac Grory
- Department of Neurology, The Warren Alpert Medical School of Brown University (B.M.G., C.S.)
| | - Christoph Stretz
- Department of Neurology, The Warren Alpert Medical School of Brown University (B.M.G., C.S.)
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13
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Forró C, Mészáros Z, Sipos M, Kerényi RZ, Barsi P, Rudas G, Bereczki D, Vastagh I. [Cervical artery dissection - retrospective analysis of 19 cases]. Orv Hetil 2019; 160:861-868. [PMID: 31131609 DOI: 10.1556/650.2019.31333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cervical artery dissection is a common cause of stroke in young adults. It might occur shortly after a forceful neck trauma or a minor injury. However, spontaneous dissection is also common, which is associated with genetic, anatomical or environmental risk factors. Cervical artery dissection can produce a broad spectrum of clinical presentation varying from local symptoms to focal neurological deficits determined by the arterial territory involved. Early recognition is important since immediate initiation of treatment can significantly improve patient outcomes. While clinical features may raise suspicion for dissection, the diagnosis has to be confirmed by neuroimaging findings. The purpose of this paper is to give an overview on cervical (carotid and vertebral) artery dissections while presenting 19 cases. During three years, we evaluated the clinical features, risk factors, diagnostic and therapeutic procedures of these patients admitted with extracranial artery dissection. The prognosis of the disease can vary, 42% of our patients became asymptomatic. Orv Hetil. 2019; 160(22): 861-868.
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Affiliation(s)
- Csilla Forró
- II. Sz. Neurológiai Klinika, Maros Megyei Sürgősségi Kórház 540133 Marosvásárhely (Târgu Mureș), str. Secuilor Martiri 6B/7 Románia.,Neurológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Zsófia Mészáros
- Neurológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Márton Sipos
- Automatizálási és Alkalmazott Informatikai Tanszék, Budapesti Műszaki és Gazdaságtudományi Egyetem, Villamosmérnöki és Informatikai Kar Budapest
| | | | - Péter Barsi
- Szentágothai János Tudásközpont, MR Kutatóközpont, Semmelweis Egyetem Budapest
| | - Gábor Rudas
- Szentágothai János Tudásközpont, MR Kutatóközpont, Semmelweis Egyetem Budapest
| | - Dániel Bereczki
- Neurológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.,MTA-SE Neuroepidemiológiai Kutatócsoport, Budapest
| | - Ildikó Vastagh
- Neurológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.,Bajcsy-Zsilinszky Kórház és Rendelőintézet Budapest
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14
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Song JX, Lin XM, Hao ZQ, Wu SD, Xing YX. Ocular manifestations of internal carotid artery dissection. Int J Ophthalmol 2019; 12:834-839. [PMID: 31131245 DOI: 10.18240/ijo.2019.05.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
Internal carotid artery dissection (ICAD) results from disruption of the intima of the arterial wall, and can lead to intrusion of blood into the arterial wall and form an intramural hematoma. The hematoma can compress the true lumen of the vessel, causing functional stenosis or occlusion. The classic triad signs of ICAD include pain in the ipsilateral neck, head and orbital regions; a (partial) Horner syndrome; and cerebral or retinal ischemia. However, not all ICAD patients present with this classic signs. In some cases, ocular manifestations are the initial (and sometimes the only) findings. We summarize the ocular manifestations associated with ICAD in 3 categories: visual symptoms, oculosympathetic palsy, and ocular motor nerve palsy.
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Affiliation(s)
- Jin-Xin Song
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China.,Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xue-Mei Lin
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Zhao-Qin Hao
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Song-Di Wu
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Yong-Xin Xing
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
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15
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Affiliation(s)
| | | | - Amit Herwadkar
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Martin Punter
- University of Manchester, Manchester, United Kingdom.,Salford Royal NHS Foundation Trust, Manchester, United Kingdom
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16
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Iwasa M, Mima Y, Ito A, Abe Y, Ueda N, Otsubo R. [A case of bilateral cervical internal carotid artery dissection following herpes zoster of the trigeminal nerve]. Rinsho Shinkeigaku 2018; 58:292-296. [PMID: 29710022 DOI: 10.5692/clinicalneurol.cn-001108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 62 year-old man, who was taking prednisolone for nephrotic syndrome, was diagnosed with herpes zoster of the trigeminal nerve and treated with oral valacyclovir. One month later, he reported pain from the right side of the head and vomiting. MRI revealed an acute infarction in the right frontal lobe and dissection of the internal carotid artery of the right cervix. Trauma or other potential triggers were not observed. In consideration of the preceding condition of varicella zoster virus infection, acyclovir was administered in addition to unfractionated heparin, but an intramural hematoma emerged in the left internal carotid artery. Furthermore, evidence showing progression of these lesions was found. On the fifth day, prednisolone was increased to 1 mg/kg/day, and progression of vascular lesions was not observed. This case may prove valuable because it suggests a relationship between cervical artery dissection and herpes zoster.
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Affiliation(s)
- Mariko Iwasa
- Department of Neurology, Yodogawa Christian Hospital
| | - Yohei Mima
- Department of Neurology, Yodogawa Christian Hospital
| | - Aya Ito
- Department of Neurology, Yodogawa Christian Hospital
| | - Yuko Abe
- Department of Neurology, Yodogawa Christian Hospital
| | - Naoko Ueda
- Department of Neurology, Yodogawa Christian Hospital
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17
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Ikota M, Kusaka G, Tanaka Y. Superficial Temporal Artery-middle Cerebral Artery Anastomosis for Ischemic Stroke due to Dissection of the Intracranial Internal Carotid Artery with Middle Cerebral Artery Extension. NMC Case Rep J 2018; 5:39-44. [PMID: 29725566 PMCID: PMC5930238 DOI: 10.2176/nmccrj.cr.2017-0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022] Open
Abstract
A 31-year-old man presented with a sudden-onset headache, right hemiparesis, and dysarthria on day 0 and was diagnosed with acute ischemic stroke due to dissection of the left intracranial internal carotid artery with middle cerebral artery extension. His symptoms progressed despite the institution of treatment, suggesting progression of the dissection. On day 5 after symptom onset, the patient underwent superficial temporal artery-middle cerebral artery anastomosis. No new ischemic stroke event occurred after surgery. Cerebral angiography performed 6 months after surgery showed spontaneous resolution of the dissection. The patient recovered to a modified Rankin Scale score of 2 and was able to return to work. The results of the present case suggest that superficial temporal artery-middle cerebral artery anastomosis is an effective treatment for ischemic stroke due to dissection of the intracranial internal carotid artery with middle cerebral artery extension.
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Affiliation(s)
- Masashi Ikota
- Department of Neurosurgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Gen Kusaka
- Department of Neurosurgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Yuichi Tanaka
- Department of Neurosurgery, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
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18
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Narula N, Siddiqui F, Katyal N, Avula A, Chalhoub M. Internal Carotid Artery Dissection with Lidocaine Nerve Block Injection Trauma: A Rare Case Report. Cureus 2018. [PMID: 29531880 PMCID: PMC5837233 DOI: 10.7759/cureus.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Internal carotid artery dissection (ICAD) accounts for 25% of cerebrovascular accidents in young and middle-aged patients. Dissection occurs when the intimal wall of an artery is damaged as a result of trauma or defect. ICAD development after dental work is a relatively uncommon phenomenon. Our study highlights a rare presentation of ICAD that resulted from a direct lidocaine nerve block injection in a patient undergoing pulpotomy for a right maxillary second premolar tooth. We have described the case and reviewed the literature on this rare but potentially life-threatening phenomenon.
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Affiliation(s)
| | - Faraz Siddiqui
- Pulmonary and Critical Care, Staten Island University Hospital
| | | | - Akshay Avula
- Pulmonary and Critical Care, Staten Island University Hospital
| | - Michel Chalhoub
- Pulmonary and Critical Care, Staten Island University Hospital
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19
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Qureshi AI, Waqas MA, Jadhav V, Saleem MA, Campbell J, Wallery SS. Long Acting Liposomal Bupivacaine for Percutaneous Sympathetic Stellate Ganglion Blockade: A Technical Note. J Vasc Interv Neurol 2017; 9:49-53. [PMID: 29163750 PMCID: PMC5683018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION We describe the use of long acting liposomal bupivacaine for percutaneous stellate ganglion blockade to treat severe headaches following internal carotid artery dissection. METHODS A 43-year old woman developed right-sided refractory headache after right internal carotid artery dissection. Patient underwent percutaneous stellate ganglion block using bupivacaine hydrochloride (0.25%-20 ml) in the past with short acting relief. Liposomal bupivacaine (EXPAREL) 13.3 mg/mL (1.3%) solution diluted with preservative-free normal saline: a total solution of 20 ml (52 mg of bupivacaine) was injected at the level of the lower portion of body of the sixth cervical vertebra, medial to the right internal carotid artery. The response to sympathetic block was assessed by a neurologist not involved in the procedure. RESULTS After the stellate ganglion block with bupivacaine hydrochloride, patient was headache free immediately after the block but with recurrence of pain on Day 3 with return to peak intensity by Day 4. After the stellate ganglion blockade with liposomal bupivacaine hydrochloride, patient reported recurrence of pain on Day 15 post injection with return to peak intensity by Day 17. The patient reported an episode of aura which consisted of visual scintillations on Day 2 which lasted for five days and resolved spontaneously. CONCLUSION Liposomal bupivacaine injection for stellate ganglion blockade can result in a more prolonged effect compared with bupivacaine hydrochloride.
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Affiliation(s)
- Adnan I. Qureshi
- Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
- University of Illinois and Mercy health, Rockford, IL, USA
| | | | | | - Muhammad A. Saleem
- Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
- Mercyhealth, Janesville, WI, USA
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20
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Lumsden S, Rosta G, Bismuth J, Lumsden AB, Garami Z. Spontaneous Recanalization After Carotid Artery Dissection: The Case for an Ultrasound-Only Monitoring Strategy. Methodist Debakey Cardiovasc J 2017; 13:243-247. [PMID: 29744017 PMCID: PMC5935284 DOI: 10.14797/mdcj-13-4-243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Dissection of the internal carotid artery (ICA) accounts for 5% to 25% of ischemic strokes in young adults. We report a case of spontaneous recanalization of a traumatic ICA dissection in which carotid duplex (CDU) and transcranial color-coded duplex ultrasound (TCCD) were used. A 47-year-old male presented with intermittent episodes of headache, blurry vision, anisocoria, and loss of taste sensation following a whiplash injury while body surfing. Magnetic resonance angiogram (MRA) of the neck revealed absent flow in the cavernous ICA and a clot at the skull base. Carotid duplex, used to further evaluate flow, demonstrated reverberating color Doppler and spectrum signal. A TCCD showed ICA occlusion and smaller-caliber intracranial ICA. The patient reported for follow-up after 1 month on anticoagulation therapy. Upon his return, CDU and TCCD were normal and the ICA showed normal color and spectrum signals. Computed tomography angiogram confirmed ultrasound findings of a dramatic improvement of ICA patency. Additionally, the patient reported that his headaches had resolved. Extracranial CDU and TCCD are useful for monitoring patient progress in cases of spontaneous recanalization following carotid artery dissection. These inexpensive and noninvasive imaging modalities proved to be critical in the initial and follow-up evaluations of the extracranial and intracranial vascular system, providing a strong alternative to expensive magnetic resonance imaging and invasive angiograms and offering more hemodynamic information than "static" MRA.
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MESH Headings
- Anticoagulants/therapeutic use
- Blood Flow Velocity
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/physiopathology
- Carotid Artery, Internal, Dissection/diagnostic imaging
- Carotid Artery, Internal, Dissection/drug therapy
- Carotid Artery, Internal, Dissection/etiology
- Carotid Artery, Internal, Dissection/physiopathology
- Cerebrovascular Circulation
- Computed Tomography Angiography
- Hemodynamics
- Humans
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Predictive Value of Tests
- Regional Blood Flow
- Remission, Spontaneous
- Time Factors
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Transcranial/methods
- Water Sports/injuries
- Whiplash Injuries/diagnostic imaging
- Whiplash Injuries/drug therapy
- Whiplash Injuries/etiology
- Whiplash Injuries/physiopathology
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Affiliation(s)
| | - Gabor Rosta
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
- UNIVERSITY OF SZEGED - FACULTY OF MEDICINE, SZEGED, HUNGARY
| | - Jean Bismuth
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Alan B Lumsden
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Zsolt Garami
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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21
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Esianor BI, Haider AS, Engelhardt MI, Osumah T, Vayalumkal S, Thakur R, Leonard D, Haithcock J, Layton KF. Intracranial Ischemic Infarct Due to Blunt Force Trauma in a High School Football Player. Cureus 2017; 9:e1659. [PMID: 29147634 PMCID: PMC5675602 DOI: 10.7759/cureus.1659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ischemic stroke is an uncommon cause of death among teenagers and young adults; however, the etiologies differ when compared to ischemic strokes in older individuals. Large-vessel atherosclerosis and small-vessel disease causing ischemic stroke are rare for the teenage population, while cervicocerebral arterial dissections account for up to 20% of ischemic strokes. Here, we present the case of a 16-year-old male who developed internal carotid artery dissection (ICAD) after a head injury and subsequently developed ischemic stroke and seizures.
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22
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Abstract
Intravascular ultrasound (IVUS) can provide valuable information regarding endoluminal morphology. We present the first description of IVUS-guided intracranial and extracranial carotid artery stent placement for arterial dissection. A 41-year-old female with a sudden-onset headache and blurred vision underwent a computed tomography (CT) angiogram imaging that revealed bilateral carotid artery dissections (BCAD) and a left vertebral artery dissection (VAD). Endovascular treatment (EVT) of a long segment right carotid artery dissection (CAD) was performed employing two Carotid WALLSTENT™ Monorails™ (8 x 36 mm, 10 x 31 mm) (Boston Scientific, Marlborough, MA). With the help of the IVUS, the distal stent was placed up to the petrous carotid artery, followed by the placement of the second stent in the immediate proximal location with some overlap that extended down to the carotid artery bulb. Intraoperative angiography and post-stenting IVUS revealed excellent stent placement with good resolution of the dissection and good luminal patency with pseudolumen obliteration. Stent use for intracranial circulation dissections will continue to be a favorable option given the decreased morbidity of endovascular therapy in this location. As endovascular surgeons become more facile with the use of IVUS, using it as a guide for stent placement and post-stenting confirmation will help them to ensure proper positioning and improved patency rates.
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Affiliation(s)
| | - Namath S Hussain
- Department of Neurosurgery, Loma Linda University Medical Center
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23
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Cai X, Guan J, Ren S, Wei Y, Peng X, Qiu W, Chen J. Treatment of internal carotid artery dissection with Willis covered stent: A case report of recurrent limb weakness and no response to medical therapy. Exp Ther Med 2016; 11:1983-1986. [PMID: 27168838 DOI: 10.3892/etm.2016.3112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/15/2016] [Indexed: 12/12/2022] Open
Abstract
Internal carotid artery dissection (ICAD) is a major cause of ischemic stroke in young and middle-aged patients. Patients may be asymptomatic or present with symptoms ranging from headache and neck pain to severe cerebral ischemic events. Conventional treatment is medical anticlotting therapy or involves the use of interventional tools, such as endovascular treatment. Anticoagulation or antiplatelet therapy are the primary treatment modalities used to prevent thromboembolic complications from arterial dissections, however, they are unsuitable in certain cases of dissecting aneurysms. In the current study reports the case of a 52-year-old male patient presenting with the primary complaint of left limb weakness. Computed tomography angiography revealed a right ICAD located in the oropharyngeal segment. Subsequently, digital subtraction angiography was performed to assess the oropharyngeal segment. Antithrombotic therapy resulted in no improvement; therefore, endovascular treatment with the insertion of a Willis covered stent was performed, resulting in an improved outcome.
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Affiliation(s)
- Xueli Cai
- Department of Neurology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Jianhong Guan
- Department of Neurology, Yanbian University Hospital, Yanbian, Jilin 133000, P.R. China
| | - Shaojun Ren
- Department of Neurology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Yixin Wei
- Department of Neurology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Xiao Peng
- Department of Neurology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Weiwen Qiu
- Department of Neurology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Jun Chen
- Department of Tumor Radiotherapy and Chemotherapy, Ningbo Yinzhou People's Hospital, Ningbo, Zhejiang 315040, P.R. China
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24
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Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 2016; 8:e498. [PMID: 27014532 PMCID: PMC4794386 DOI: 10.7759/cureus.498] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD. Methods Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria. Results Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was “very low.” Conclusions The quality of the published literature on the relationship between chiropractic manipulation and CAD is very low. Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection. This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.
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Affiliation(s)
| | - Emily P Sieg
- Department of Neurosurgery, Penn State Hershey Medical Center
| | - Omar Zalatimo
- Department of Neurosurgery, Penn State Hershey Medical Center
| | | | - Michael Glantz
- Department of Neurosurgery, Penn State Hershey Medical Center
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25
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Yub Lee S, Won Youn S, Kyun Kim H, Kwon Y. Inadvertent carotid artery occlusion due to a stent-related accordion effect: clinical experience with a retrievable stent to unfold the vascular wall and restore flow. Neuroradiol J 2015; 28:62-6. [PMID: 25924175 DOI: 10.15274/nrj-2014-10114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Inadvertent occlusion of an internal carotid artery (ICA) during stenting may be a catastrophic situation requiring a bailout operation to prevent permanent neurologic sequelae. The underlying mechanisms of ICA occlusion may include filter-related flow arrest, arterial dissection, vasospasm, and the accordion effect, and timely differential diagnosis is crucial for appropriate management. We present herein a case of stenting-related accordion effect that led to complete ICA occlusion, wherein temporary placement of a retrievable intracranial stent for rescue was successful in achieving flow restoration, but further complicated by engagement with the filter. The differential diagnosis, preventive measures, and management of the accordion effect are discussed.
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Affiliation(s)
- Sang Yub Lee
- Department of Radiology, The Armed Forces Capital Hospital; Sungnam, Korea
| | - Sung Won Youn
- Department of Radiology, Catholic University of Daegu School of Medicine; Daegu, Korea
| | - Ho Kyun Kim
- Department of Radiology, Catholic University of Daegu School of Medicine; Daegu, Korea
| | - Younghoon Kwon
- Department of Medicine, University of Minnesota; Minneapolis, MN, USA
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26
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Qi B, Lu ZC, Wu W, Li YP. Bilateral dissecting aneurysms of the internal carotid arteries misdiagnosed as skull base tumors: A case report. Oncol Lett 2015; 10:931-933. [PMID: 26622598 DOI: 10.3892/ol.2015.3334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 01/13/2015] [Indexed: 11/06/2022] Open
Abstract
A 45-year-old female presented with a five-year history of intermittent headaches and a two-month history of left hypoglossal nerve palsy. Computed tomography and magnetic resonance imaging of the head revealed space-occupying lesions in the base of the skull with accompanying bone erosion, which were suggestive of skull base chordomas. However, an endoscopic endonasal transsphenoidal biopsy was also performed and pathological analysis of the lesion suggested a thrombosis. Cranial magnetic resonance angiography revealed old dissecting aneurysms of the bilateral internal carotid arteries (ICAs), which led to a definitive diagnosis. The patient was successfully treated with anticoagulants and antiplatelet agents. The present case study suggests that, for patients with space-occupying lesions of the skull base and symptoms of cranial nerve palsy, the possibility of an ICA dissection should be prioritized during the differential diagnosis.
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Affiliation(s)
- Bin Qi
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhi-Cheng Lu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wei Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yi-Ping Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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27
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Habs M, Pfefferkorn T, Cyran CC, Grimm J, Rominger A, Hacker M, Opherk C, Reiser MF, Nikolaou K, Saam T. Age determination of vessel wall hematoma in spontaneous cervical artery dissection: a multi-sequence 3T cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2011; 13:76. [PMID: 22122756 PMCID: PMC3283525 DOI: 10.1186/1532-429x-13-76] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 11/28/2011] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Previously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR) in determining the age of vessel wall hematoma (VWH) in patients with spontaneous cervical artery dissection (sCAD). METHODS 35 consecutive patients (mean age 43.6 ± 9.8 years) with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner's syndrome) and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images. RESULTS The mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p < 0.001 for trend). Agreement was moderate between VWH types in our study and the previously proposed time scheme of signal evolution for cerebral hemorrhage, Cohen's kappa 0.43 (p < 0.001). There was a strong agreement of CMR VWH classification compared to the time scheme which was proposed for carotid intraplaque hematomas with Cohen's kappa of 0.74 (p < 0.001). CONCLUSIONS Signal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas.
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Affiliation(s)
- Maximilian Habs
- Dept. of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Thomas Pfefferkorn
- Dept. of Neurology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Clemens C Cyran
- Dept. of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Jochen Grimm
- Dept. of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, University of Munich, Grosshadern Campus, Munich, Germany
| | - Marcus Hacker
- Department of Nuclear Medicine, University of Munich, Grosshadern Campus, Munich, Germany
| | - Christian Opherk
- Dept. of Neurology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Maximilian F Reiser
- Dept. of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Konstantin Nikolaou
- Dept. of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Tobias Saam
- Dept. of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
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