Pseudostroke as a manifestation of mediastinal choriocarcinoma in an elderly man

We describe a rare clinical case: onset of acute neurological symptoms suggestive of a pesudostroke, caused by an imbalance in cerebral blood flow as a result of internal carotid artery compression by an enlarged lymph node secondary to metastases from a disseminated non-gestational mediastinal choriocarcinoma. This was accompanied by decompensation due to paraneoplastic coagulopathy.

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Impact of transient hypotension on regional cerebral blood flow in humans

Clinical Science ◽

10.1042/cs20140751 ◽

2015 ◽

Vol 129 (2) ◽

pp. 169-178 ◽

Cited By ~ 45

Author(s):

Nia C.S. Lewis ◽

Kurt J. Smith ◽

Anthony R. Bain ◽

Kevin W. Wildfong ◽

Tianne Numan ◽

...

Keyword(s):

Carbon Dioxide ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Vertebral Artery ◽

Regional Cerebral Blood Flow ◽

Internal Carotid ◽

Regional Cerebral Blood

Diameter reductions in the internal carotid artery (ICA) and vertebral artery (VA) contribute to the decline in brain blood with hypotension. The decline in vertebral blood flow with hypotension was greater when carbon dioxide was low; this was not apparent in the ICA.

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Clinical Utility of Quantitative Cerebral Blood Flow Measurements during Internal Carotid Artery Test Occlusions

Neurosurgery ◽

10.1227/00006123-200205000-00012 ◽

2002 ◽

Vol 50 (5) ◽

pp. 996-1005 ◽

Cited By ~ 1

Author(s):

Randolph S. Marshall ◽

Ronald M. Lazar ◽

William L. Young ◽

Robert A. Solomon ◽

Shailendra Joshi ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Clinical Utility ◽

Internal Carotid ◽

Flow Measurements ◽

Blood Flow Measurements

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Retinal macroaneurysm after carotid endarterectomy in patient with chronic ischemic retinopathy associated with hemodynamically significant stenosis of the internal carotid artery (clinical case)

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-274-277 ◽

2021 ◽

pp. 274-277

Author(s):

V.V. Tuzlaev ◽

◽

O.V. Kolenko ◽

V.V. Egorov ◽

I.Z. Kravchenko ◽

...

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Endarterectomy ◽

Clinical Case ◽

Internal Carotid ◽

Significant Stenosis ◽

Ischemic Retinopathy ◽

Retinal Macroaneurysm ◽

Intraretinal Hemorrhages

Purpose. To present a clinical case of development of retinal macroaneurysm after carotid endarterectomy (CE) in patient with chronic ischemic retinopathy (CIR) associated with hemodynamically significant stenosis of the internal carotid artery (ICA). Material and methods. Patient R., 74 years old, diagnosed with CIR of the 1st degree of severity of the right eye. In addition to standard ophthalmic examination methods, Doppler ultrasound with registration of blood flow in the orbital artery and spiral computed tomography of the ICA were performed. Results. Panretinal photocoagulation (PRP) of the retina led to obliteration of the retinal macroaneurysm, resorption of intraretinal hemorrhages, and stabilization of the course of CIR after CE of the ICA. Conclusion. The appearance of retinal macroaneurysm and intraretinal hemorrhages after CE in patient with CIR associated with hemodynamically significant ICA stenosis can be regarded as reperfusion complications after restoration of blood flow in the orbital artery, which requires timely retinal PRP of the retina. Key words: chronic ischemic retinopathy, retinal macroaneurysm, internal carotid artery, carotid endarterectomy.

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Dynamic Computed Tomography Angiography in Suspected Brain Death: A Noninvasive Biomarker

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.02.002 ◽

2014 ◽

Vol 65 (4) ◽

pp. 352-359 ◽

Cited By ~ 1

Author(s):

Santanu Chakraborty ◽

Reem A. Adas

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Brain Death ◽

Internal Carotid ◽

External Carotid Artery ◽

External Carotid ◽

Ancillary Test ◽

Organ Harvesting

Purpose Neurologic determination of death or brain death is primarily a clinical diagnosis. This must respect all guarantees required by law and should be determined early to avoid unnecessary treatment and allow organ harvesting for transplantation. Ancillary testing is used in situations in which clinical assessment is impossible or confounded by other factors. Our purpose is to determine the utility of dynamic computed tomographic angiography (dCTA) as an ancillary test for diagnosis of brain death. Materials and Methods We retrospectively reviewed 13 consecutive patients with suspected brain death in the intensive care unit who had dCTA. Contrast appearance timings recorded from the dCTA data were compared to findings from 15 controls selected from patients who presented with symptoms of acute stroke but showed no stroke in follow-up imaging. Results The dCTA allows us to reliably assess cerebral blood flow and to record time of individual cerebral vessels opacification. It also helps us to assess the intracranial flow qualitatively against the flow in extracranial vessels as a reference. We compared the time difference between enhancement of the external and internal carotid arteries and branches. In all patients who were brain dead, internal carotid artery enhancement was delayed, which occurred after external carotid artery branches were opacified. Conclusion In patients with suspected brain death, dCTA reliably demonstrated the lack of cerebral blood flow, with extracranial circulation as an internal reference. Our initial results suggest that inversion of time of contrast appearance between internal carotid artery and external carotid artery branches at the skull base could predict a lack of distal intracranial flow.

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Cerebral Blood Flow and Metabolism Measurement Using Positron Emission Tomography before and during Internal Carotid Artery Test Occlusions: Feasibility of Rapid Quantitative Measurement of CBF and OEF/CMRO2

Interventional Neuroradiology ◽

10.1177/159101991201800304 ◽

2012 ◽

Vol 18 (3) ◽

pp. 264-274 ◽

Cited By ~ 7

Author(s):

N. Kawai ◽

M. Kawanishi ◽

A. Shindou ◽

N. Kudomi ◽

Y. Yamamoto ◽

...

Keyword(s):

Positron Emission Tomography ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

False Negative ◽

Photon Emission ◽

Emission Tomography ◽

Positron Emission

Balloon test occlusion (BTO) of the internal carotid artery (ICA) combined with cerebral blood flow (CBF) study is a sensitive test for predicting the outcome of permanent ICA occlusion. However, false negative results sometimes occur using single photon emission tomography (SPECT). We have recently developed a rapid positron emission tomography (PET) protocol that measures not only the CBF but also the cerebral oxygen metabolism before and during BTO in succession. We measured acute changes in regional CBF and OEF/CMRO2 before and during BTO in three cases with large or giant cerebral aneurysms using the rapid PET protocol. Although no patients showed ischemic symptoms during BTO, PET studies exhibited mildly to moderately decreased CBF (9∼34%) compared to the values obtained before BTO in all cases. The average OEF during BTO was significantly increased (21% and 43%) than that of before BTO in two cases. The two cases were considered to be non-tolerant for permanent ICA occlusion and treated without ICA sacrifice. Measurement of the CBF and OEF/CMRO2 using a rapid PET protocol before and during BTO is feasible and can be used for accurate assessment of tolerance prediction in ICA occlusion.

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Assessing the Effects of Antihypertensive Medication on Cerebral Blood Flow: Demonstration in Internal Carotid Artery Occlusion

DICP ◽

10.1177/106002809102501201 ◽

1991 ◽

Vol 25 (12) ◽

pp. 1299-1301 ◽

Cited By ~ 3

Author(s):

Susan C. Fagan ◽

James R. Ewing ◽

Steven R. Levine ◽

Gretchen E. Tietjen ◽

Nabih M. Ramadan ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Antihypertensive Medication ◽

Internal Carotid ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Internal Carotid Artery Occlusion ◽

Bilateral Carotid

Dynamic cerebral blood flow (CBF) studies using acetazolamide or hypercapnia as a vasodilatory challenge have attempted to evaluate intracranial hemodynamics. We report two patients with asymptomatic internal carotid artery occlusion in whom the vasodilatory stimulus was a single oral dose of antihypertensive medication (prazosin hydrochloride or enalapril maléate). In both patients, changes in regional CBF occurred that were larger than those seen in nine normal controls. One patient experienced an improvement in regional CBF with a reduction in probe pair asymmetry. In the other patient, who had bilateral carotid artery disease, a decrease in regional CBF in all 16 probes (mean decrease 12 percent) and an accentuation of the predose asymmetry were observed. Both patients remained asymptomatic throughout the study. Assessing these effects on cerebral circulation may help identify patients at risk for iatrogenic focal cerebral ischemia and provide information regarding the functional status of the cerebral vasculature.

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