scholarly journals Transitory ischemic attack associated with a rare fenestration of the cervical segment of the internal carotid artery: a case report

2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Nasel Christian ◽  
Poetsch Angelina ◽  
Brunner Cornelia ◽  
Moser Ewald
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Antiplatelet Therapy ◽  
Internal Carotid ◽  
Initial Event ◽  
Transitory Ischemic Attack ◽  
Substantial Risk ◽  
Cervical Segment ◽  
Ischemic Attack ◽  
Vascular Variant

Abstract Background Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis range from dissections leading to the fenestration to the more common interpretation as a developmental vascular variant. However, most reported cases were symptomatic and presented with dissections, where even endovascular treatment of the fenestration of the cervical segment of the internal carotid artery became necessary. Here we report a case of a fenestration of the cervical segment of the internal carotid artery suffering a transitory ischemic attack and local pain in absence of any sign of dissection. Case presentation A 62-year-old Caucasian male patient was admitted to our institution because of an episode of amaurosis fugax, initially accompanied with headache. Magnetic resonance imaging revealed an intact fenestration of the cervical segment of the internal carotid artery on the symptomatic side. With antiplatelet therapy, all symptoms vanished within 2 months of the initial event. Conclusions Our findings support the interpretation of a fenestration of the cervical segment of the internal carotid artery as a developmental vascular variant, but also suggest a substantial risk for dissection and ischemic stroke. Even in case of an accidental finding, clinicians should be aware of this. At least in this case, antiplatelet therapy seemed beneficial.

scholarly journals Aberrant internal carotid artery presenting as a retrotympanic vascular mass

2014 ◽  
Vol 3 (10) ◽  
pp. 204798161455369 ◽  
Author(s):  
Simon Nicolay ◽  
Bert De Foer ◽  
Anja Bernaerts ◽  
Joost Van Dinther ◽  
Paul M Parizel
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Young Woman ◽  
Middle Ear ◽  
Internal Carotid ◽  
Preoperative Planning ◽  
Aberrant Internal Carotid Artery ◽  
Cervical Segment ◽  
Collateral Pathway ◽  
Vascular Variant

We report a case of a young woman with an aberrant right internal carotid artery (ICA) presenting as a retrotympanic reddish mass. This variant of the ICA represents the collateral pathway that is formed as a result of an embryological agenesis of the cervical segment of the ICA. The embryonic inferior tympanic artery is recruited to bypass the absent carotid segment. This hypertrophied vessel may be seen otoscopically and wrongfully considered to be a vascular middle ear tumor. Informing the otorhinolaryngologist of this important vascular variant not only obviates biopsy but also helps in careful preoperative planning of eventual middle ear procedures.

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) OPERATED ON BY ENDARTERECTOMY (CEA)

2021 ◽  
Vol 19 (1) ◽  
pp. 1-9
Author(s):  
Ewa Wilczek-Rużyczka ◽  
Andrzej Mirski ◽  
Maciej Korab ◽  
Mariusz Trystuła
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Human Brain ◽  
Transient Ischemic Attack ◽  
Internal Carotid ◽  
Event Related Potentials ◽  
Critical Stenosis ◽  
Left Brain ◽  
Related Potentials ◽  
Ischemic Attack

The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) protocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety.

scholarly journals Fenestration of the Internal Carotid Artery Associated with an Ischemic Attack —Case Report—

1993 ◽  
Vol 33 (5) ◽  
pp. 306-308 ◽  
Author(s):  
Hidemi NAKAMURA ◽  
Hiroshi YAMADA ◽  
Tomonori NAGAO ◽  
Katsuzo FUJITA ◽  
Norihiko TAMAKI
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Ischemic Attack

Exposure of the Distal Cervical Segment of the Internal Carotid Artery Using the Trans-spinosum Corridor: Cadaveric Study of Surgical Anatomy

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS354-ONS362 ◽  
Author(s):  
Sebastien C. Froelich ◽  
Khaled M. Abdel Aziz ◽  
Nicholas B. Levine ◽  
Myles L. Pensak ◽  
Philip V. Theodosopoulos ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Facial Nerve ◽  
Temporomandibular Joint ◽  
Internal Carotid ◽  
Cranial Base ◽  
Distal Portion ◽  
Carotid Sheath ◽  
Orbitozygomatic Approach ◽  
Cervical Segment

Abstract Background: Exposure of the most distal portion of the cervical segment of the internal carotid artery (ICA) is technically challenging. Previous descriptions of cranial base approaches to expose this segment noted facial nerve manipulation, resection of the glenoid fossa, and significant retraction or resection of the condyle. We propose a new approach using the frontotemporal orbitozygomatic approach to expose the distal portion of the cervical segment of the ICA via the trans-spinosum corridor. Methods: Six formalin-fixed injected heads were used for cadaveric dissection. Two blocs containing the carotid canal and surrounding region were used for histological examination. Results: The ICA lies immediately medial to the vaginal process. The carotid sheath attaches laterally to the vaginal process. With use of the trans-spinosum corridor, the surgeon's line of sight courses in front of the temporomandibular joint, through the foramen spinosum, spine of the sphenoid, and vaginal process. Removal of the vaginal process exposes the vertical portion of the petrous segment of the ICA. The loose connective tissue space between the adventitia and the carotid sheath is easily entered from above. Incision of the carotid sheath exposes the ICA without disruption of the temporomandibular joint. Conclusion: Control of the cervical segment of the ICA can be critical when dealing with cranial base tumors that invade or surround the petrous segment of the ICA. This novel technique through the trans-spinosum corridor can effectively expose the distal portion of the cervical segment of the ICA without causing manipulation of the facial nerve and while maintaining the integrity of the temporomandibular joint.

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