scholarly journals Spontaneous Post-Partum Cervical Carotid Artery Dissection in a Patient with Reversible Cerebral Vasoconstriction Syndrome

2011 ◽  
Vol 17 (4) ◽  
pp. 486-489 ◽  
Author(s):  
M. Soltanolkotabi ◽  
S.A. Ansari ◽  
A. Shaibani ◽  
T.B. Singer ◽  
M.C. Hurley
Keyword(s):  
Carotid Artery ◽  
African American Woman ◽  
Post Partum ◽  
American Woman ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Cardiac Monitoring ◽  
Artery Dissection ◽  
Antiplatelet Medication ◽  
Cerebral Arteriopathy

Post-partum cervicocephalic artery dissection (pp-CAD) is a rare and poorly understood condition. To our knowledge, only 21 cases have been reported. Reversible cerebral segmental vasoconstriction (RCSV) was first described by Call and Fleming in 1988, and its association with pp-CAD has only been reported in three cases. However, in those cases it is unclear whether the pp-CAD may have been caused by straining during labor and therefore merely coincidental to the intracranial arteriopathy. We describe a 41-year-old right-handed African-American woman who developed the syndrome of pp-CAD (headaches, trace subarachnoid hemorrhage and diffuse cerebral arteriopathy on angiogram) two weeks after delivery. In this unique case, the patient had fortuitously undergone an MR study twice over a four day period which included the carotid bifurcations. During that time the patient was an inpatient, on bed rest and subject to continuous cardiac monitoring. The interval studies documented a true spontaneous right internal carotid artery dissection occurring without obvious cause. The patient had noted moderate right neck pain developing between the two MR studies but experienced no neurological deficits. Subsequent conventional angiography confirmed the presence of postpartum cerebral arteriopathy and the cervical dissection. The patient was managed conservatively with antiplatelet medication and had an otherwise uneventful course. We hypothesize whether transient arterial wall abnormalities, postpartum hormonal changes or subtle connective tissue aberrations play a similar role in the pathogenesis of these two associated conditions.

Endovascular recanalization of symptomatic flow-limiting cervical carotid dissection in an isolated hemisphere

2011 ◽  
Vol 30 (6) ◽  
pp. E16 ◽  
Author(s):  
Clemens M. Schirmer ◽  
Basar Atalay ◽  
Adel M. Malek
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Hemodynamic Compromise ◽  
Endovascular Recanalization

Object Internal carotid artery dissection (ICAD) is a common cause of stroke in young patients, which may lead to major transient or permanent disability. Internal carotid artery dissection may occur spontaneously or after trauma and may present with a rapid neurological deterioration or with hemodynamic compromise and a delayed and unstable neurological deficit. Endovascular intervention using stent angioplasty can be used as an alternative to anticoagulation and open surgical therapy in this setting to restore blood flow through the affected carotid artery. Methods The authors present the cases of 2 patients with flow-limiting symptomatic ICAD leading to near-complete occlusion and without sufficient collateral supply. Both patients had isolated cerebral hemispheres without significant blood flow from the anterior or posterior communicating arteries. In both cases, the patients demonstrated blood pressure–dependent subacute unstable neurological deficits as a result of the hemodynamic compromise resulting from the dissection. Results Both patients underwent careful microwire-based selection of the true lumen followed by confirmatory microinjection and subsequent exchange-length microwire-based recanalization using tandem telescoping endovascular stenting. In both cases the neurological state improved, and no permanent neurological deficit ensued. Conclusions The treatment of ICAD may be difficult in patients with subacute unstable neurological deficits related to symptomatic hypoperfusion, especially in the setting of a hemodynamically isolated hemisphere. Anticoagulation alone may be insufficient in these patients. Although there is no widely accepted guideline for the treatment of ICAD, the authors recommend stent-mediated endovascular recanalization in cases of symptomatic flow-limiting hemodynamic compromise, especially in cases of an isolated hemisphere lacking sufficient communicating artery compensatory perfusion.

scholarly journals Malignant Middle Cerebral Artery Infarction Secondary to Traumatic Bilateral Internal Carotid Artery Dissection. A Case Report

2016 ◽  
Vol 2 (3) ◽  
pp. 135-141 ◽  
Author(s):  
Zoltán Bajkó ◽  
Rodica Bălaşa ◽  
Anca Moţăţăianu ◽  
Laura Bărcuţean ◽  
Adina Stoian ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ct Scan ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Clinical Manifestations ◽  
Duplex Ultrasound ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Middle Cerebral Artery Infarction

Abstract Traumatic bilateral dissection of the carotid arteries is a rare condition with potentially life-threatening complications. The case of a 57-year-old male patient with acute onset left sided hemiparesis, twelve hours after a blunt head injury, caused by a horse kick, is reported. A cerebral CT scan revealed right middle cerebral artery (MCA) territory infarction. Based on Duplex ultrasound and Angio CT scan findings, a diagnosis of bilateral ICA dissection was established. Despite antithrombotic treatment, the patient presented with a progressive worsening of his neurological status. The control CT scan evidenced malignant right MCA territory infarction that required decompressive craniotomy. The patient was discharged with significant neurological deficits. Together with this case, the aetiologies, clinical manifestations, diagnostic and therapeutical options and outcome of carotid artery dissection are discussed.

scholarly journals Eagle syndrome: A case report of stylocarotid syndrome with internal carotid artery dissection

2017 ◽  
Vol 23 (4) ◽  
pp. 433-436 ◽  
Author(s):  
Travis W Smoot ◽  
Ammar Taha ◽  
Nicholas Tarlov ◽  
Blake Riebe
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rare Complication ◽  
Styloid Process ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Eagle Syndrome ◽  
Stylohyoid Ligament

Eagle syndrome is defined by an elongated styloid process or a calcified stylohyoid ligament that impinges on surrounding structures and causes a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. The vascular variant, stylocarotid syndrome, can present as headache, transient ischemic attack, or stroke. Carotid artery dissection is a rare complication of stylocarotid syndrome. We report a case of stylocarotid syndrome in a 60-year-old man who presented with a right internal carotid artery (ICA) dissection and focal neurological deficits. Computed tomography with three-dimensional reformatting was used in the evaluation of his pathology. His dissecting right ICA was stented with subsequent symptom resolution. Improved recognition of the relationship between an elongated styloid or calcified stylohyoid ligament and symptomatology may lead to optimal etiology recognition and directed treatment.

Traumatic carotid artery dissection: diagnosis and treatment

1989 ◽  
Vol 71 (6) ◽  
pp. 854-857 ◽  
Author(s):  
Clarence B. Watridge ◽  
Michael S. Muhlbauer ◽  
Robbie D. Lowery
Keyword(s):  
Carotid Artery ◽  
Anticoagulation Therapy ◽  
Arterial Occlusion ◽  
Arterial Embolization ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
High Morbidity ◽  
Diagnostic Study ◽  
Content Type

✓ Early diagnosis and successful management of traumatic carotid artery dissections require a high index of clinical suspicion. The diagnostic study of choice is cerebral arteriography. In this paper, 24 cases of traumatic carotid artery dissection are described. Presenting signs and symptoms include Horner's syndrome, dysphasia, hemiparesis, obtundation, and monoparesis. Patients detected early with mild neurological deficits fared well with treatment, while those with profound neurological deficits and delayed diagnoses had poor outcomes. Aggressive nonsurgical treatment is advocated including anticoagulation therapy for prevention of progressive thrombosis and arterial occlusion and/or distal arterial embolization with resultant cerebral ischemia. Direct surgical thromboendarterectomy is considered to carry high morbidity and mortality rates.

scholarly journals Unusual Posttraumatic Vascular and Cerebral Injuries in Young Patients

2018 ◽  
Vol 32 (2) ◽  
pp. 224-229
Author(s):  
Emilia Marciuc ◽  
M. Barcan ◽  
B. Dobrovăţ ◽  
Roxana Popescu ◽  
Cornelia Tudorache ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Motor Vehicle ◽  
Young Patients ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Cervical Region ◽  
Artery Dissection ◽  
Left Internal Carotid Artery ◽  
Vehicle Collision ◽  
Additional Imaging

Abstract Blunt carotid artery injury is a relatively rare but potentially lethal injury that predominantly occurs in high-impact mechanisms such as motor-vehicle collision. Any simptoms or neurological deficits following a multiple trauma patient mandates a thorough evaluation and consideration of BCI. This is a case report on two young patients with neurologic simptoms developed after blunt trauma in the cervical region. Both patients had left internal carotid artery dissection diagnosed on a CT-angiography, followed by middle cerebral artery territory infarction. Although it can be a delayed onset with no signs of vascular demage, we believe that, by implementing a protocol with additional imaging for early detection, we can prevent a devastating outcome.

Rare case of bilateral carotid artery dissection presenting with Foix-Chavany-Marie syndrome

2020 ◽  
Vol 13 (11) ◽  
pp. e239080
Author(s):  
Rajveer Singh ◽  
Alex Rebello ◽  
Nandita Prabhat ◽  
Dheeraj Khurana
Keyword(s):  
Carotid Artery ◽  
Sudden Onset ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
First Case ◽  
Bilateral Carotid ◽  
Common Causes ◽  
History Of ◽  
Bilateral Carotid Artery

Carotid artery dissection is one of the most common causes of ischaemic stroke in young and middle-aged population. We report a case of bilateral carotid artery dissection presenting with opercular syndrome or Foix-Chavany-Marie syndrome. This 46-year-old obese and hypertensive man with a history of fall from bike 1 week prior, presented with sudden onset of anarthria, dysphagia and deviation of angle of mouth. His speech and dysphagia gradually improved over 10 days to normal, but he developed pseudobulbar affect and difficulty in calculations 4 weeks later. MRI showed acute infarcts in bilateral operculum. CT angiography showed dissection in bilateral cervical ICAs. He was managed conservatively with oral anticoagulation, given for 6 months. Probability of dissection must be considered in patients with a history of trauma or falls developing focal neurological deficits. To our knowledge, this is the first case report of bilateral ICA dissection presenting with Foix-Chavany-Marie syndrome.

Endovascular Management of Acute Carotid Artery Dissection with a Waxing and Waning Neurological Deficit

2003 ◽  
Vol 10 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Enrico Sbarigia ◽  
Cesare Battocchio ◽  
Maria A. Panico ◽  
Davide Zaccagnini ◽  
Filippo M. Salvatori ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Color Doppler ◽  
Signs And Symptoms ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Neurological Status ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Doppler Study

Purpose: To evaluate the feasibility and efficacy of emergent carotid stenting for an acute internal carotid artery (ICA) dissection. Case Report: A 51-year-old man was admitted to our emergency department's stroke unit 1 hour after the onset of left hemiparesis. Computed tomographic and transcranial Doppler scans showed no pathological findings, but the color Doppler study detected a double lumen in the right carotid bifurcation extending to the proximal ICA. Within the first 2 hours after admission, the patient's neurological status began to fluctuate; the NIH Stroke Scale (NIHSS) and Rankin scores evaluated each hour after admission ranged from 0 to 12 and from 0 to 3, respectively. Emergency carotid angiography confirmed the dissection of the bulb and proximal right ICA, which prompted implantation of 2 Wallstents from the internal to common carotid artery. Forty-eight hours later, the patient was almost totally asymptomatic with an NIHSS score of 1 and a Rankin score of 0; he was discharged on postoperative day 3. At 3 months, the patient was free of neurological symptoms and the stented carotid artery was patent. Conclusions: In patients with fluctuating neurological signs and symptoms consistent with carotid artery dissection that are refractory to medical therapy, a stent can be placed to prevent permanent neurological deficits provided that the anatomical conditions are suitable.

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