11/177. Endovascular repair of radiation-induced bilateral common carotid artery stenosis and pseudoaneurysms: a case report.BACKGROUND: radiation-induced damage to small and medium-sized vessels has been observed in both animals and humans. Changes may appear in the immediate postradiation period or many years later. In this case, we report an unusual presentation of bilateral radiation-induced carotid artery stenoses associated with pseudoaneurysms, and a previously unreported application of a recently established treatment. CASE DESCRIPTION: A 72-year-old African-American male presented with recurrent right hemispheric transient ischemic attacks (TIA) and neck pain. Thirteen years previously, the patient had received radiation therapy for laryngeal carcinoma. Diagnostic carotid angiography demonstrated moderate radiation-induced bilateral carotid artery stenosis and associated common carotid pseudoaneurysms. The patient was treated with bilateral endovascular stents and electrolytically detachable coils in staged procedures. At his most recent follow-up, there is no evidence of re-stenosis and the patient remains asymptomatic. CONCLUSIONS: This case illustrates a novel and successful treatment for the endovascular repair of post-radiation bilateral carotid artery stenosis and pseudoaneurysms. In our practice, we have seen three such cases of radiation-induced vasculopathy. Therefore, patients with a previous history of radiation therapy for head and neck neoplasms merit cautious monitoring and judicious use of stents and secondary coils, when necessary.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
12/177. Acute monocular blindness associated with spontaneous common carotid artery dissection.The evaluation of patients with loss of vision is common in the emergency department. Central retinal artery occlusion (CRAO) is a potentially reversible cause of acute monocular blindness. When evaluating a patient with CRAO, the potential underlying causes should be considered while simultaneously initiating treatment. We present a case of spontaneous common carotid artery dissection manifesting as CRAO and propose that spontaneous carotid artery dissection be included in the differential diagnosis of CRAO.- - - - - - - - - - ranking = 3.5194627980465keywords = blindness (Clic here for more details about this article) |
13/177. Spontaneous thrombosis of intracavernous internal carotid artery aneurysm and parent artery occlusion in patients with positive balloon test occlusion--two case reports.Two patients with giant intracavernous internal carotid artery (ICA) aneurysms were intolerant to balloon test occlusion of the ICA, and later developed spontaneous thrombosis of the aneurysm and the parent ICA without ischemic sequelae. Case 1: A 60-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. An unsuccessful extracranial-to-intracranial bypass graft operation was complicated by transient postoperative ophthalmoplegia. The patient did not tolerate balloon test occlusion of the right ICA after attempted bypass surgery, and was treated conservatively. The patient presented with acute onset of headache 3 years later. Case 2: A 50-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. The patient was managed conservatively after a positive balloon test occlusion of the right ICA. The patient suffered transient hypopituitarism and acute onset of headache 2 years later. Spontaneous thrombosis of the aneurysms and occlusion of the parent ICA were found in both patients. Neither had major hemispheric infarcts, but the first patient had asymptomatic infarcts, which were presumed to be thromboembolic in nature. patients with intracavernous ICA aneurysms who have positive balloon test occlusions appear to develop tolerance to spontaneous and gradual occlusion of the ICA without significant sequelae. However, these patients have an increased risk of developing embolic infarctions. The role for anticoagulation and repeat hemodynamic tests remains unclear.- - - - - - - - - - ranking = 2keywords = transient (Clic here for more details about this article) |
14/177. Bilateral carotid aneurysms secondary to radiation therapy.A patient was seen with symptomatic, rapidly expanding aneurysms that developed in both carotid arteries 4 years after bilateral radiation to the neck, left combined mandibular resection, and radical neck dissection. The presenting symptoms were pain and transient ischemic attacks of cerebrovascular insufficiency. The aneurysms were treated uneventfully be resection and vein-graft replacement at 15-day intervals. microscopy demonstrated typical radiation changes. Effects of radiation on arteries are reviewed.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
15/177. skull base resection with cervical-to-petrous carotid artery bypass to facilitate repair of distal internal carotid artery lesions.PURPOSE: To demonstrate a direct operative approach to vascular lesions of the internal carotid artery (ICA) at the level of the skull base. methods: Between January 1993 and October 1999, five patients underwent lateral skull base resection with cervical-to-petrous carotid artery saphenous vein bypass for repair of distal ICA lesions. This report describes operative methods, morbidity, graft patency, and long-term outcome with this experience. RESULTS: Of the five patients with skull base ICA lesions, all had aneurysmal disease. Three were atherosclerotic and two were dysplastic. Preoperative neurologic symptoms including transient ischemic attacks (2) and Horner's syndrome with vascular headaches (1) were completely resolved after operation. Preoperative dysphagia (2) was resolved in one patient and clinically improved in the other. postoperative complications included transient paresis in the cranial nerve (CN) VII distribution, as well as permanent loss of the eustachian tube and chorda tympani nerve in all five patients. One patient had lasting paresis in the CN XI distribution as well as a mild stroke resulting in arm weakness. No residual arm weakness was detected at one year. There were no graft occlusions by duplex ultrasound at 45.8 months mean objective follow-up, and no ipsilateral stroke or mortality at 51.2 months mean clinical follow-up. CONCLUSIONS: saphenous vein bypass from the cervical-to-petrous ICA is technically feasible and provides a valuable reconstruction option for patients with skull base ICA lesions.- - - - - - - - - - ranking = 2keywords = transient (Clic here for more details about this article) |
16/177. Shaking limb transient ischemic attacks: unusual presentation of carotid artery occlusive disease: report of two cases.OBJECTIVE AND IMPORTANCE: Shaking limb transient ischemic attacks (TIAs) represent a rare clinical syndrome that has been ascribed to focal cerebral ischemia attributable to insufficient brain perfusion, usually resulting from carotid artery occlusive disease. The techniques conventionally used to evaluate this condition are contrast angiography, carotid artery ultrasonography, and magnetic resonance angiography. Treatment consists of internal carotid artery (ICA) endarterectomy or, in the case of complete ICA occlusion, extracranial-intracranial bypass. In this report, two patients with shaking limb TIAs are presented. For one patient, preoperative evaluations included single-photon emission computed tomographic studies with acetazolamide vasodilator challenge; for the second patient, computed tomographic angiography was used to assess vascular anatomic features. CLINICAL PRESENTATION: Two patients with severe carotid artery disease presented with brief, recurrent, shaking limb TIAs. Angiograms obtained for Patient 1 demonstrated complete ICA occlusion in association with severe external carotid artery stenosis, whereas preoperative single-photon emission computed tomographic scans revealed a lack of cerebrovascular reserve in response to acetazolamide challenge. Carotid artery duplex ultrasonography and computed tomographic angiography demonstrated severe stenosis of the ICA for Patient 2. INTERVENTION: Patient 1 underwent a left external carotid artery endarterectomy. Patient 2 underwent a right ICA endarterectomy. CONCLUSION: After surgery, the shaking limb episodes ceased for both patients. Postoperative single-photon emission computed tomographic scans for Patient 1 demonstrated increased cerebral blood flow in response to acetazolamide challenge. These data provide support for the concept that shaking limb TIAs are related to hemodynamic failure and that improvements in cerebral blood flow through conducting vessels can alleviate the condition.- - - - - - - - - - ranking = 5keywords = transient (Clic here for more details about this article) |
17/177. BB embolus causing monocular blindness in a 9-year-old boy.PURPOSE: To report a case of monocular blindness resulting from intravascular bullet migration. DESIGN: Observational case report. methods: A 9-year-old boy presented to the emergency room with a penetrating BB gun injury to the chest. RESULTS: Carotid angiography localized the bullet to the right internal carotid artery. He subsequently suffered blindness in the right eye, a right pupil-involving third nerve palsy, left hemiparesis, and a probable left homonymous hemianopia. CONCLUSION: BB gun injuries may result in devastating ophthalmologic as well as systemic consequences due to bullet embolization.- - - - - - - - - - ranking = 4.2233553576558keywords = blindness (Clic here for more details about this article) |
18/177. Ring-stripping retrograde common carotid endarterectomy: case report.CONTEXT: Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy. OBJECTIVE: To demonstrate the feasibility of retrograde common carotid endarterectomy. DESIGN: Retrospective case report study. SETTING: Tertiary care private hospital. PARTICIPANTS: Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded. MAIN MEASUREMENTS: Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency. RESULTS: There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up. CONCLUSION: There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
19/177. Transient aphasia and persistent amnesia after surgery for internal carotid artery--posterior communicating artery aneurysm.We report a case of transient aphasia and persistent amnesia after clipping of a ruptured cerebral aneurysm to treat a subarachnoid hemorrhage. Postoperatively, aphasia was identified and magnetic resonance imaging (MRI) showed an abnormal intensity area in the left anterior thalamus. Single photon emission computed tomography (SPECT) revealed a wider area of low perfusion surrounding the left thalamus and left frontotemporal lobe than that shown by the MRI. His aphasia resolved over the subsequent 12-week period. He was left with an isolated disturbance of memory; in the absence of any dementia, aphasia or disturbance of consciousness, his condition was classified as one of amnesia. SPECT 14 weeks after admission revealed an area of low perfusion limited to the left thalamus. These findings suggest that the persistence of amnesia in this case was caused by the infarction of the mammillothalamic tract, and the recovery from aphasia may have resulted from the disappearance of surrounding edema.- - - - - - - - - - ranking = 1keywords = transient (Clic here for more details about this article) |
20/177. Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery.OBJECT: The lack of a specified intraoperative method for monitoring anterior choroidal artery (AChA) blood flow insufficiency (BFI) led the authors to devise a method for checking the BFI in this artery during aneurysm surgery. To this end, the authors relied on the intraoperative motor evoked potentials (MEPs) elicited by electrical stimulation of the hand motor cortex. methods: The study population consisted of 108 patients with internal carotid artery (ICA) aneurysms who underwent surgery via a standard frontotemporal craniotomy. After the dura mater had been opened, a grid electrode strip with 16 small electrodes was inserted subdurally into the hand motor cortex from the edge of the craniotomy. To check BFI in the AChA, the hand motor cortex was stimulated at an intensity level between 10 and 18 mA. The MEPs were successfully recorded from the contralateral thenar muscles in all 108 patients. There was no postoperativemotor paresis in 88 patients in whom the MEPs remained unchanged during the performance of various surgical maneuvers. Among the other 20 patients, 19 manifested transient MEP changes, but 15 of those patients experienced no postoperative motor paresis. In four patients who exhibited transient MEP changes, either after aneurysm clipping or during temporary occlusion of the ICA and/or AChA, hemiparesis occurred postoperatively but disappeared within 24 hours. In one patient with an ICA-posterior communicating artery aneurysm, the MEP disappeared and did not reappear by the time of dural closure. Severe hemiplegia developed in this patient and a computerized tomography scan obtained postoperatively revealed a new low-density area in the internal capsule. CONCLUSIONS: The findings of this study suggest that the monitoring method that is introduced here is safe and reliable for detecting intraoperative BFI in the AChA.- - - - - - - - - - ranking = 2keywords = transient (Clic here for more details about this article) |
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