1/14. Severe stenosis of the internal carotid artery presenting as loss of consciousness due to the presence of a primitive hypoglossal artery: a case report.BACKGROUND: Symptoms of ischemic attacks in the internal carotid system usually involve focal cerebral dysfunction, i.e., hemiparesis or aphasia. However, an ischemic attack in the vertebrobasilar artery system usually presents with combined symptoms. The variety of manifestations included in the vertebrobasilar profile makes the potential pattern of symptoms considerably more variable and complex than that in the carotid system. Manifestations can include syncope and also vertigo. METHOD AND RESULTS: A 42-year-old woman experienced frequent attacks of faintness with vertigo. Angiography demonstrated severe stenosis of the left internal carotid artery with a persistent primitive hypoglossal artery just distal to the stenosis. The right internal carotid artery was normal and cross circulation through the anterior communicating artery was not well developed. Both vertebral arteries were hypoplastic. The patient underwent carotid endarterectomy and, thereafter the episodes of syncope completely disappeared. CONCLUSION: It was supposed that global ischemia including the brain stem occurred because of stenosis of the left internal carotid artery attributable to the presence of a primitive hypoglossal artery.- - - - - - - - - - ranking = 1keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
2/14. Usefulness of the combination of pre- and intraoperative selective intraarterial calcium injection to detect residual insulinomas.In a 35-year-old woman diagnosed with insulinoma selective intraarterial calcium injection was positive for proximal gastroduodenal artery and inferior pancreaticoduodenal artery involvement preoperatively. Although non-invasive imaging studies were negative, a mass was detected at the pancreatic uncus by intraoperative ultrasonography. Gastroduodenal artery calcium injection was performed after enucleation of the tumor. Following calcium injection, the insulin level was inappropriately increased and further pancreaticoduodenectomy was performed. After excision, another tumor was detected at the head of the pancreas by histopathological examination. As shown, selective intraarterial calcium injection is useful to localize tumors preoperatively and intraoperatively.- - - - - - - - - - ranking = 0.014642162416594keywords = artery (Clic here for more details about this article) |
3/14. carotid sinus syndrome secondary to head and neck malignancy: case report and literature review.We report two cases of carotid sinus syndrome secondary to head and neck malignancy. The underlying mechanisms unique to head and neck malignancy and treatments of the syndrome are discussed.- - - - - - - - - - ranking = 0.070909013121187keywords = carotid (Clic here for more details about this article) |
4/14. Blunt basal head trauma: aspects of unconsciousness.Two cases of street violence directed to the skull base level and transverse to the cervical axis are described. No skeletal damage. The violence resulted in the so-called "traumatic subarachnoid haemorrhage", an often used, unspecified forensic "diagnosis"; it was here revealed to be due to rupture of the wall of the posterior inferior cerebellar artery (p.i.c.a). However, this was only one of the possible explanations for the acute symptoms of unconsciousness (concussion) and almost immediate death. The careful examination of these two cases and of a series of control cases revealed that at the trauma, stress and strain may have occurred to arterial branches serving as feeding perforant vessels to the medulla oblongata; in these cases they were coursing directly from the p.i.c.a. region.--The type of direct impact has often been regarded as mild! However, its location suboccipitally as in these cases can become dangerous. The resulting direct or indirect deficit of brain stem functions are discussed in these cases as well as "concussion-related symptoms" resulting after other types of head and neck injury.- - - - - - - - - - ranking = 0.0048807208055314keywords = artery (Clic here for more details about this article) |
5/14. Complex intimal flaps in acute aortic dissection.A 43-year-old man was emergently admitted and diagnosed as acute aortic dissection (Stanford type A). While being prepared for emergent operation he fell into hemodynamic hazard with repeated ventricular fibrillation and loss of consciousness. Massive aortic regurgitation and coronary disturbance due to a back-and-forth movement of an intimal flap through the aortic valve were the causes of the cardiogenic catastrophy. In addition, a completely torn intimal flap was intussuscepted into the origin of the brachiocephalic artery. This was thought to disturb the cerebral perfusion. Acute aortic dissection with such complex intimal flaps is very rare. In such cases cardiopulmonary bypass should be established to maintain the patient's cardiac function as soon as possible after diagnosis and the operation should be performed with sufficient brain protection.- - - - - - - - - - ranking = 0.0048807208055314keywords = artery (Clic here for more details about this article) |
6/14. Inflammatory aneurysm due to neurocysticercosis.A 69-year old man presented with a subarachnoid hemorrhage associated with a large intracerebral hematoma in the right temporal lobe. The oblique views of cranio-orbital computerized tomographic angiography (CTA) were suspicious for an aneurysm on a middle cerebral artery branch. At surgery, a cystic mass was found in the Sylvian fissure, associated with an aneurysm on a distal branch of the anterior temporal artery. The aneurysm was not situated at a bifurcation of the artery and was located beneath the cyst. It was secured by trapping. Pathological examination revealed that the cystic lesion was neurocysticercosis and that the aneurysm was inflammatory. We report a ruptured inflammatory aneurysm of a distal branch of the anterior temporal artery associated with neurocysticercosis, and present the histological findings. We believe this is the first report of such an inflammatory aneurysm with histological confirmation.- - - - - - - - - - ranking = 0.019522883222125keywords = artery (Clic here for more details about this article) |
7/14. Crossed cerebellar diaschisis and loss of consciousness during temporary balloon occlusion of the internal carotid artery.We encountered a case of crossed cerebellar diaschisis during temporary balloon occlusion of the internal carotid artery in a 59-year-old woman. The rapidity of the diaschisis was unusual and SPECT scanning was adequate to show the early defect.- - - - - - - - - - ranking = 0.53444799585156keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
8/14. Usefulness of delayed enhancement magnetic resonance imaging for detecting cardiac rupture caused by small myocardial infarction in a case of cardiac tamponade.Delayed enhancement magnetic resonance imaging (DE-MRI) has excellent spatial resolution and compared with other cardiac imaging techniques it can detect a small myocardial infarction (MI) or a subendocardial infarction. A 76-year-old man was admitted for loss of consciousness because of cardiac tamponade. The cause of tamponade was unknown, but electrocardiography and blood test suggested a recent MI. The removal of 100 ml bloody fluid by immediate pericardiocentesis normalized his hemodynamics, and he regained consciousness. Neither echocardiography nor scintigraphy could determine the location of the MI or rupture, but DE-MRI clearly demonstrated a transmural enhancement in a very narrow range of the lateral wall of the left ventricle. coronary angiography revealed a severely stenotic lesion in the obtuse marginal branch of the left circumflex artery. DE-MRI is a powerful tool for diagnosing small MI that are undetectable with other imaging. Therefore, DE-MRI should be applied in cases with cardiac tamponade by unknown causes.- - - - - - - - - - ranking = 0.0048807208055314keywords = artery (Clic here for more details about this article) |
9/14. 'Cardiogenic vertigo'--true vertigo as the presenting manifestation of primary cardiac disease.BACKGROUND: A 90-year-old woman presented to a hospital emergency department with a brief loss of consciousness that was heralded by spinning vertigo lasting approximately 2 min. She had a long history of intermittent brief episodes of rotatory vertigo, presyncope, and non-vertiginous dizziness, occurring either with or without loss of consciousness. Although initially attributed to symptomatic carotid artery stenosis, these episodes persisted, despite surgical restoration of carotid artery blood flow 1 year after her first syncope. Her medical history was otherwise notable for hypertension, mild depression and a gradual decline in gait and balance function attributed to left hip arthritis and older age. INVESTIGATIONS: Bedside history and examination, non-contrast head CT scan, electrocardiogram, transthoracic echocardiogram, and bedside cardiac telemetry. diagnosis: sick sinus syndrome or severe reflex bradycardia with asystole causing recurrent, episodic vertigo, presyncope, non-vertiginous dizziness and syncope (Stokes-Adams attacks). MANAGEMENT: Placement of a temporary pacing wire, followed by surgical implantation of a single-chamber ventricular (VVI) pacemaker.- - - - - - - - - - ranking = 0.21377919834063keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
10/14. Failure to awaken after general anaesthesia secondary to paradoxical venous embolus.A patient is presented who failed to regain consciousness after an apparently uneventful nine-hour revision of a total hip replacement. There were no clinically important haemodynamic changes during the operation, and oxygen saturation, capnography and acid base balance were normal throughout. Postop CT of the head showed a large left MCA infarct with midline shift. At autopsy, the patient was found to have a previously unsuspected patent foramen ovale, and a venous embolus in the left internal carotid artery, which probably had originated from the periprostatic venous plexus with a large infarct in the distribution of the left anterior and middle cerebral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.- - - - - - - - - - ranking = 0.10688959917031keywords = carotid, carotid artery, artery (Clic here for more details about this article) |
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