Limb-Shaking Transient Ischemic Attacks in a Patient with Previous Bilateral Neck Irradiation: The Role of Collateral Flow

Nasopharyngeal carcinoma (NPC) is commonly treated with bilateral neck radiation, which is closely associated with the complication of carotid-occlusive disease. This leads to cerebral hemodynamic compromise and possible ischemic stroke. Another manifestation is limb-shaking transient ischemic attacks (LS-TIAs), characterized by rhythmic jerks which can be easily mistaken as a focal motor seizure. We describe a case of unilateral LS-TIAs from bilateral carotid occlusion that resolved with contralateral carotid revascularization. Our patient is a 65-year-old gentleman who had no significant co-morbidities other than a past history of bilateral neck irradiation for NPC 8 years before. He presented with left-sided limb weakness and subsequently left-sided limb involuntary movements whenever he sat up or stood. His symptoms did not respond to anti-epileptic therapy. Clinical and neurological examination was significant for a left pronator drift and weak left finger abduction. Computed tomography and magnetic resonance imaging of the brain revealed infarcts in the right periventricular and watershed areas; MR angiogram showed bilateral internal carotid artery occlusion. Single photon emission computed tomography showed reduced blood flow in the right frontal, temporal, and parietal regions, that reduced further after acetazolamide challenge. He was diagnosed as having LS-TIA secondary to carotid-occlusive disease. Attempts at endovascular opening the right internal carotid artery failed. Following successful left carotid angioplasty and stenting, his symptoms gradually resolved. The left internal carotid artery remained patent at the 3-month follow-up; the right side remained occluded. Our case supports the hypothesis that LS-TIAs are due to hemodynamic compromise and may respond to improved collateral cerebral blood flow.

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An unexpected cause of upper airway obstruction

The Journal of Laryngology & Otology ◽

10.1017/s0022215100129846 ◽

1995 ◽

Vol 109 (3) ◽

pp. 252-254 ◽

Cited By ~ 7

Author(s):

A. A. W. M. Meulenbroeks ◽

G. D. Vos ◽

J. M. H. Van der Beek ◽

P. J. E. H. M. Kirslaar

Keyword(s):

Computed Tomography ◽

Case Report ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Upper Airway ◽

Computed Tomography Scan ◽

Parapharyngeal Abscess ◽

The Right ◽

Tomography Scan

AbstractA three-year old bot wiht a swelling on the right side of his neck was suspected of having parapharyngeal abscess after clinical examination and CT scan(computed tomography scan) of this region. Later it became clear, that the swelling was caused by an aneurysm of the internal carotid artery. This case report describes the pitfalls and difficulties encountered in the diagnostic course and treatment planning.

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A case of cerebral infarction caused by occlusion of the left internal carotid artery following limb shaking of the right arm and leg that persisted for three weeks

Nosotchu ◽

10.3995/jstroke.33.246 ◽

2011 ◽

Vol 33 (2) ◽

pp. 246-250

Author(s):

Ichiro Deguchi ◽

Yoshihiko Nakazato ◽

Mikiko Ninomiya ◽

Toshimasa Yamamoto ◽

Naotoshi Tamura ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Infarction ◽

Internal Carotid ◽

Left Internal Carotid Artery ◽

The Right ◽

Limb Shaking

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Endovascular treatment of tandemic occlusions in acute ischemic stroke

Ukrainian Interventional Neuroradiology and Surgery ◽

10.26683/2786-4855-2021-2(36)-73-81 ◽

2021 ◽

Vol 36 (2) ◽

pp. 73-81

Author(s):

D.V. Shcheglov ◽

V.N. Zahorodnii ◽

S.V. Konotopchik ◽

A.A. Pastushin

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Internal Carotid ◽

Left Vertebral Artery ◽

The Right ◽

The Brain

The observation of endovascular treatment of acute tandem occlusion of internal carotid artery (ICA), anterior cerebral artery (ACA) and middle cerebral artery (MCA) in combination with the thrombosis of the right ICA and the critical stenosis of the left vertebral artery is presented.Man, 61 years old. He was delivered to the Center of endovascular neuroradiology, NAMS of Ukraine on January 15, 2021 with an ischemic stroke clinic in the left internal carotid artery basin. He fell ill acutely ‒ against the background of complete well-being, sensorimotor aphasia and right-sided hemiplegia appeared. Upon admission on the NIHSS (National Institutes of Health Stroke Scale) ‒ 18 points. On the performed initial multispiral computed tomography of the brain according to ASPECTS (Alberta Stroke Program Early CT score) ‒ 8 points. In the endovascular operating room, cerebral angiography was performed, followed by surgery aimed at restoring cerebral blood flow. The time from the onset of the disease to the puncture was 330 minutes, the duration of the operation was 135 minutes, thus the time from the onset of the disease to reperfusion was 465 minutes. Angiography revealed acute thrombosis of the left ICA starting from the orifice, M1-segment of the left MCA and A2-segment of the left ACA. Partial compensation of the basin through the supra-block anastomosis (external carotid artery ‒ ICA), as well as from the vertebro-basilar system through the network of leptomeningeal arteries. Collaterals ‒ ACG 3. Thrombosis of the right ICA and critical stenosis (95 %) of the V1-segment of the left vertebral artery were also revealed. The operation was performed ‒ recanalization of thrombosis of the left ICA orifice followed by balloon angioplasty, thrombectomy from the MCA and ACA pools. The end result is eTICI 2c reperfusion. There were no complications during this operation. The patient was discharged the next day (transferred to the neurological department at the place of residence). Control multispiral computed tomography of the brain showed positive dynamics (ASPECTS ‒ 1 point).

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A case of stenosis of the right internal carotid artery with limb shaking of the left arm and leg

Nosotchu ◽

10.3995/jstroke.36.42 ◽

2014 ◽

Vol 36 (1) ◽

pp. 42-46

Author(s):

Satoko Ninomiya ◽

Toshimoto Seno ◽

Noriyuki Fumoto ◽

Shinji Onoue ◽

Haruhisa Ichikawa ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

The Right ◽

Limb Shaking

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Role of Extradural Clinoidectomy and Optic Unroofing in Resection of an Anterior Clinoidal Meningioma with Encasement of the Internal Carotid Artery and Its Branches

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1729996 ◽

2021 ◽

Author(s):

Sima Sayyahmelli ◽

Zhaoliang Sun ◽

Emel Avci ◽

Mustafa K. Başkaya

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Vision Loss ◽

Internal Carotid ◽

Extent Of Resection ◽

World Health ◽

Who Grade ◽

The Right ◽

Supraclinoid Internal Carotid Artery

AbstractAnterior clinoidal meningiomas (ACMs) remain a major neurosurgical challenge. The skull base techniques, including extradural clinoidectomy and optic unroofing performed at the early stage of surgery, provide advantages for improving the extent of resection, and thereby enhancing overall outcome, and particularly visual function. Additionally, when the anterior clinoidal meningiomas encase neurovascular structures, particularly the supraclinoid internal carotid artery and its branches, this further increases morbidity and decreases the extent of resection. Although it might be possible to remove the tumor from the artery wall despite complete encasement or narrowing, the decision of whether the tumor can be safely separated from the arterial wall ultimately must be made intraoperatively.The patient is a 75-year-old woman with right-sided progressive vision loss. In the neurological examination, she only had light perception in the right eye without any visual acuity or peripheral loss in the left eye. MRI showed a homogeneously enhancing right-sided anterior clinoidal mass with encasing and narrowing of the supraclinoid internal carotid artery (ICA). Computed tomography (CT) angiography showed a mild narrowing of the right supraclinoid ICA with associated a 360-degree encasement. The decision was made to proceed using a pterional approach with extradural anterior clinoidectomy and optic unroofing. The surgery and postoperative course were uneventful. MRI confirmed gross total resection (Figs. 1 and 2). The histopathology was a meningothelial meningioma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence and has shown improved vision at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/vt3o1c2o8Z0

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Developmental Anatomy of the Eustachian Tube: Implications for Balloon Dilation

Otolaryngology ◽

10.1177/0194599821994817 ◽

2021 ◽

pp. 019459982199481

Author(s):

Isabelle Magro ◽

David Pastel ◽

Jace Hilton ◽

Mia Miller ◽

James Saunders ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Eustachian Tube ◽

Internal Carotid ◽

Tertiary Care ◽

Balloon Dilation ◽

Care Hospital ◽

Developmental Anatomy ◽

Nasal Floor

Objective To describe the developmental anatomy of the eustachian tube (ET) and its relationship to surrounding structures on computed tomography. Study Design Case series with chart review. Setting A tertiary care hospital. Methods ET anatomy was assessed with reformatted high-resolution computed tomography scans from 2010 to 2018. Scans (n = 78) were randomly selected from the following age groups: <4, 5 to 7, 8 to 18, and >18 years. The following were measured and compared between groups: ET length, angles, and relationship between its bony cartilaginous junction and the internal carotid artery and between its nasopharyngeal opening and the nasal floor. Results The distance between the bony cartilaginous junction and internal carotid artery decreased with age between the <4-year-olds (2.4 ± 0.6 mm) and the 5- to 7-year-olds (2.0 ± 0.3 mm, P = .001). The ET length increased among the <4-year-olds (32 mm), 5- to 7-year-olds (36 mm), and 8- to 18-year-olds (41 mm, P < .0001). The cartilaginous ET increased among the <4-year-olds (20 mm), 5- to 7-year-olds (25 mm), and 8- to 18-year-olds (28 mm, P < .0001). The ET horizontal angle increased among the <4-year-olds (17°), 5- to 7-year-olds (21°), and 8- to 18-year-olds (23°, P≤ .003), but the ET sagittal angle did not statistically change after 5 years of age. The height difference between the nasopharyngeal opening of the ET and the nasal floor increased among the <4-year-olds (4 mm), 5- to 7-year-olds (7 mm), and 8- to 18-year-olds (11 mm, P < .0001). Conclusion The ET elongates with age, and its angles and relationship to the nasal floor increase. Although some parameters mature faster, more than half of the ET growth occurs by 8 years of age, and adult morphology is achieved by early adolescence.

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Cervical artery dissection—an easily neglected cause of stroke: a case report

BMC Neurology ◽

10.1186/s12883-020-02006-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ya -Hui Lian ◽

Xin Chen ◽

De- Rui Kong ◽

Wei Chen ◽

Ming-Chao Shi ◽

...

Keyword(s):

Young People ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Vascular Occlusion ◽

Artery Dissection ◽

High Signal ◽

Cervical Artery Dissection ◽

Cervical Artery ◽

The Right

Abstract Background In recent years, the incidence of stroke has gradually increased in young people. There are many reasons causing stroke, including atherosclerosis, artery embolization, and cervical artery dissection and so on. However, cervical artery dissection is a major cause of stroke in young people. We present a case of ischemic stroke caused by dissection, whose distal vascular occlusion due to detachment of the thrombosis in the right internal carotid artery. Case presentation A 33-year-old male patient was admitted to the hospital because of stroke. Imaging examination showed that there was no visualization of the right middle cerebral artery and there were a large number of mural thrombus in the C1 segment of the right internal carotid artery. After emergency surgery, the patient had vascular recanalization and the symptoms were significantly improved. Magnetic resonance imaging showed a high signal in the C1 segment of the right internal carotid artery, the abnormal signal disappeared after antiplatelet therapy. Conclusions When a patient has symptoms of stroke, we need to explore the root cause of stroke. Especially in young people, cervical artery dissection is an important reason that can’t be ignored. Through review and analysis of this case, we hope to improve the understanding of radiologists and clinicians about the cervical artery dissection, reduce the rate of misdiagnosis, and improve patients’ prognosis.

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Intrasellar Intercarotid Communicating Artery Associated with Agenesis of the Right Internal Carotid Artery: Case Report

Neurosurgery ◽

10.1227/00006123-198812000-00019 ◽

1988 ◽

Vol 23 (6) ◽

pp. 770-773 ◽

Cited By ~ 6

Author(s):

Masahiko Udzura ◽

Hiroo Kobayashi ◽

Yoshio Taguchi ◽

Hiroaki Sekino

Keyword(s):

Magnetic Resonance Imaging ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Spatial Relationship ◽

Resonance Imaging ◽

Anomalous Artery ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Relationship Of

Abstract A 54-year-old man with a right hemiparesis was found to have an intrasellar intercarotid communicating artery associated with agenesis of the right internal carotid artery. Magnetic resonance imaging (MRI) studies demonstrated the spatial relationship of the anomalous artery to the surrounding structures, thus suggesting an embryonic enlargement of the capsular artery as a source of this anomalous artery.

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