Unilateral agenesis of the internal carotid artery presented as transient ischaemic attack: a case report

Dysgenesis of the internal carotid artery (ICA) is a rare vascular disorder with a variety of different grades (agenesis, aplasia, and hypoplasia). The left internal carotid artery is reported to be affected by dysgenesis three times more often than the right one. Most of the patients with dysgenesis of the internal carotid artery are asymptomatic. We report a case of a patient with right internal carotid artery agenesis presented to our hospital as transient ischaemic attack. CT scans at skull base level with bone settings showed absence of the right carotid canal, consistent with congenital agenesis of the internal carotid artery. MR imaging of the brain revealed signal void of the intracranial portion of right internal carotid artery. Maximum intensity projection reconstruction confirmed the agenesis of the right ICA, with the right middle cerebral artery fed through a dilated posterior communicating artery and the right anterior cerebral artery supplied by the anterior communicating artery (fetal type of collateral flow). In patients with agenesis of the internal carotid artery non-invasive imaging techniques are currently the mainstay of diagnosis.     

Topoanatomic relations of the ophthalmic artery viewed in four horizontal layers

In the present paper we have studied the gross anatomy of the ophthalmic artery in 200 human cadaver dissections viewed in four horizontal layers. The ophthalmic artery can be divided into the origin, intracranial, intracanalicular and intraorbital parts. The most common origin of the artery was from the medial half of the anterior side of the internal carotid artery (ICA) in its upper curve (52%), followed by the medial half of the superior side (44%), and in only 4% from the medial side of the upper curve of the ICA. We have examined the topographic anatomy of the ophthalmic artery in detail, and found a rare anastomosis of the ophthalmic artery with the frontal branch of the middle meningeal artery.     

Rare case of right accessory renal artery originating as a common trunk with the inferior mesenteric artery: a case report

Dissection of a male cadaver revealed several vascular abnormalities in the abdominal cavity, notably of the renal circulation. In particular, three renal arteries were observed on the right side and two on the left. On the right side, one accessory renal artery originated as a common trunk with the inferior mesenteric artery. Additional variations included a left inferior phrenic artery originating from the celiac trunk, bilateral testicular veins emptying into renal veins, and the left testicular artery arising from the left renal artery. The possible embryonic development of these branching patterns and their clinical significance are discussed briefly.     

Vascular anatomy for right colon lymphadenectomy

Since the superior mesenteric artery (SMA) mostly originates on the left side of the superior mesenteric vein (SMV), the ileocolic artery (ICA) and the right colic artery (RCA) cross the SMV. Understanding the three-dimensional relation of these vessels is important for dissecting these arteries to their origin. Hence, we conducted a study of the vascular anatomy of the right colon in 27 cadavers. The RCA was separate from the SMA in eight cases (30%). The RCA passed the SMV either anteriorly (5 cases, 63%) or posteriorly (3 cases, 38%). In seven (88%) of these eight cases, the ICA was posterior to the SMV. The ICA was identified in all 27 cases, and passed the SMV anteriorly in nine cases (33%) and posteriorly in 18 cases (67%). Thus, the ICA and the RCA may pass on either side of the SMV. The surgeon must dissect the arteries with the SMV, being aware of both possibilities.     

偏头痛患者脑动脉变异及脑血流动力学特征

目的:观察偏头痛患者脑动脉变异及脑血流动力学特征,探讨偏头痛的病因及可能的发病机制。方法:对68例偏头痛患者行全脑血管造影检查,观察其脑血管的发育、变异情况,并进行分类;经颅多谱勒检测双侧大脑前、中、后动脉血流速度。结果:大脑后动脉发育异常29例,大脑前动脉发育异常17例,颈内动脉发育异常2例;总变异率为70.59%。经颅多谱勒显示发育异常侧脑血流速度减慢。结论:脑动脉变异引起的脑血流动力学改变可能是导致偏头痛发生的主要机制。     

Migraine complicated by brachial plexopathy as displayed by MRI and MRA: aberrant subclavian artery and cervical ribs.

This article describes migraine without aura since childhood in a patient with bilateral cervical ribs. In addition to usual migraine triggers, symptoms were triggered by neck extension and by arm abduction and external rotation; paresthesias and pain preceded migraine triggered by arm and neck movement. Suspected thoracic outlet syndrome was confirmed by high-resolution bilateral magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brachial plexus. An unsuspected aberrant right subclavian artery was compressed within the scalene triangle. The aberrant subclavian artery splayed apart the recurrent laryngeal and vagus nerves, displaced the esophagus anteriorly, and effaced the right stellate ganglia and the C8-T1 nerve roots. Scarring and fibrosis of the left scalene triangle resulted in acute angulation of the neurovascular bundle and diminished blood flow in the subclavian artery and vein. A branch of the left sympathetic ganglia was displaced as it joined the C8-T1 nerve roots. Left scalenectomy and rib resection confirmed the MRI and MRA findings; the scalene triangle contents were decompressed, and migraine symptoms subsequently resolved.     

Aberrant branch of the superior laryngeal artery passing through the thyroid foramen

This study examines the microsurgical anatomy of the aberrant superior laryngeal artery (ASLA) which passes through the thyroid foramen. It defines the location of the ASLA and its main branches. The aberrant superior thyroid artery was looked for in 20 randomly selected Chinese adult cadavers, and when found, was dissected and measured under an operating microscope (7-30x magnification). The ASLA passed through the thyroid foramen, which only occurred in the presence of the artery. The foramen was observed in six of the 20 cadavers: one on the right, three on the left, and two on both sides. The study provides detailed information concerning the ASLA, which we hope will help explain the arterial bleeding that may occur during laryngeal surgery. The results might be helpful in improving surgery to the larynx and other neck operations. Incidental intraoperative injury of the aberrant artery could be avoided by understanding details of its course in relation to surrounding anatomic landmarks.     

An aberrant muscular nerve to the latissimus dorsi muscle from the posterior cutaneous nerve of the arm]

In the 1987 student course on gross anatomy dissection of cadavers at Iwate Medical University School of Medicine, an aberrant muscular nerve to the latissimus dorsi muscle arising from the posterior cutaneous nerve of the arm was found bilaterally in a 65-year-old female who had died of acute pneumonia. The case was investigated anatomically. The posterior cutaneous nerve of the arm arose from the radial nerve approximately at the lateral axial border as the first branch independently on the right, and by forming a trunk with the nerve to the long head of the triceps brachii muscle on the left. The aberrant muscular nerve originated from the posterior cutaneous nerve of the arm about 3 cm distally to the point of the branching of the cutaneous nerve from the radial nerve. This aberrant nerve entered the latissimus dorsi muscle near the transitional area from the muscular part to the tendinous part while dividing into three on the right, and without dividing on the left. The side into which the aberrant nerve entered was just the reverse of the side into which the thoracodorsal nerve and artery supplied. The muscular part innervated by the aberrant nerve was bounded by a tendinous intersection for the most part of the latissimus dorsi muscle innervated by the thoracodorsal nerve. The intramuscular nerve distribution of the aberrant nerve was investigated under a binocular dissecting microscope. It was revealed that there was no communication between the ramification of the aberrant nerve and that of the thoracodorsal nerve.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnetic resonance imaging based classification of anatomic relationship between the cochleovestibular nerve and anterior inferior cerebellar artery in patients with non-specific neuro-otologic symptoms

In this study, we aimed to assess anatomical relationship between the anterior inferior cerebellar artery (AICA) and cochleovestibular nerve (CNV) in patients with non-specific cochleovestibular symptoms using magnetic resonance imaging (MRI). One-hundred and forty patients with non-specific neuro-otologic symptoms were assessed using cranial and temporal MRI. Classification was performed according to four different types of anatomical relationship observed between the AICA and CVN. In type 1 (point compression), the AICA compresses only a limited portion of the CVN. In type 2 (longitudinal compression), the AICA approaches the CVN as both traverse parallel to each other. In type 3 (loop compression), the vascular loop of the AICA encircles the CVN. In type 4 (indentation), the AICA compresses the CVN so as to make an indentation in the nerve. The anatomical relationship between the CVN and AICA was encountered in 19 out of 140 (13.6%) patients (20 ears). The VCC was unilateral in 18 patients (94.7%) and bilateral in one patient (5.3%). There was no other vascular structure causing VCC to the CVN except for vertebral artery that was seen in 2 out of 140 patients (1.4%). These were unilateral cases. There were tinnitus, vertigo or dizziness, hearing loss, and both hearing loss and vertigo in 5 (25%), 13 (65%), 1 (5%) and 1 (5%) ears of 20 patients, respectively. There was no relationship between the cochleovestibular symptoms and type of compression (p>0.05). Neurovascular relationship between the CVN and AICA can be imaged properly using MR and MR based classification may help reporting this relationship in a standard way. Although, MR images can show the anatomical relationship accurately, diagnosis of vascular conflict should not be based on imaging findings alone.     

Anomalous artery directly connecting the external and internal carotid arteries

An anomalous artery directly connecting the external with the internal carotid artery was encountered on the right side of a 68-year-old Japanese female cadaver. This anomalous artery (5 mm in diameter, 12 mm in length) branched out from the posterior aspect of the external carotid at the level of the origin of the lingual artery, ran obliquely upward posteriorly along the course of the hypoglossal nerve, and was confluent with the anterior aspect of the internal carotid artery. No other variations were found in the morphological aspects of, or in the anatomical relationships between, the carotid arteries and their surrounding structures on either side. The carotid body-like structure was observed at the carotid bifurcation and was innervated by small branches of the glossopharyngeal, the vagus and the sympathetic trunk. Embryologically, it is conceivable that this anomalous artery may have derived from the right second branchial arch artery, although there is no abnormality in other derivative structures of the second pharyngeal arch. There may have been no effect from this anomaly on the functions of the arterial blood flow and blood supply under normal circumstances in the present case, but this report may be of embryological significance and contribute some insight into the mechanisms of the formation of the carotid circulation systems.     

Double renal arteries originating from the aorta

From a study of renal vascularization, we present 54 cases of double renal arteries supplying one kidney and originating from the aorta. Of the 54 cases, 42 were unilateral, showing a left predominance (25 cases), three of them with triple renal arteries on the opposite side. In six cases we encountered bilateral double renal arteries. Most often, the supplementary renal artery originated from the lateral side of the aorta (58%). Examination of the renal approach showed that in 28 cases the supplementary renal artery entered the kidney through the hilum (proper supplementary renal artery), in 16 cases it was inferior polar, in five cases it was superior polar and in five cases the supplementary renal artery terminated in two branches, equal in caliber, one polar and the other hilar, thus showing a combined character, identical with the manner of termination of the main renal artery. In most of the samples the supplementary renal artery ended with a bifurcation inside the kidney, either into the renal sinus (proper supplementary renal artery) or inside the renal parenchyma (polar supplementary renal artery). The course of the double renal arteries showed multiple variations: retro-ureteral passage of the supplementary renal artery (6 cases), right supplementary renal artery passing anterior to the inferior vena cava (5 cases), crossed course of the double renal arteries (5 cases). Double renal arteries may coexist with other uro-vascular variations, such as: double renal veins on the same side (4 cases) or on the opposite side (3 cases), double ureter on the same side (2 cases) or on the opposite side (1 case), persistence of the fetal renal lobulation on the adult kidney (3 cases) and genital artery originating from the supplementary renal artery (3 cases).     

Structural MRI of carotid artery atherosclerotic lesion burden and characterization of hemispheric cerebral blood flow before and after carotid endarterectomy

Collateral circulation plays a major role in maintaining cerebral blood flow (CBF) in patients with internal carotid artery (ICA) stenosis. CBF can remain normal despite severe ICA stenosis, making the benefit of carotid endarterectomy (CEA) or stenting difficult to assess. Before and after surgery, we assessed CBF supplied through the ipsilateral (stenotic) or contralateral ICA individually with a novel hemisphere-selective arterial spin-labeling (ASL) perfusion MR technique. We further explored the relationship between CBF and ICA obstruction ratio (OR) acquired with a multislice black-blood imaging sequence. For patients with unilateral ICA stenosis (n = 19), conventional bilateral labeling did not reveal interhemispheric differences. With unilateral labeling, CBF in the middle cerebral artery (MCA) territory on the surgical side from the ipsilateral supply (53.7 +/- 3.3 ml/100 g/min) was lower than CBF in the contralateral MCA territory from the contralateral supply (58.5 +/- 2.7 ml/100 g/min), although not statistically significant (p = 0.09). The ipsilateral MCA territory received significant (p = 0.02) contralateral supply (7.0 +/- 2.7 ml/100 g/min), while ipsilateral supply to the contralateral side was not reciprocated. After surgery (n = 11), ipsilateral supply to the MCA territory increased from 57.3 +/- 5.7 to 67.3 +/- 5.4 ml/100 g/min (p = 0.03), and contralateral supply to the ipsilateral MCA territory decreased. The best predictor of increased CBF on the side of surgery was normalized presurgical ipsilateral supply (r(2) = 0.62, p = 0.004). OR was less predictive of change, although the change in normalized contralateral supply was negatively correlated with OR(excess) (=OR(ipsilateral) - OR(contralateral)) (r(2) = 0.58, p = 0.006). The results demonstrate the effect of carotid artery stenosis on blood supply to the cerebral hemispheres, as well as the relative role of collateral pathways before surgery and redistribution of blood flow through these pathways after surgery. Unilateral ASL may better predict hemodynamic surgical outcome (measured by improved perfusion) than ICA OR.     

喉部动脉影像解剖学的应用研究

目的研究喉部动脉的影像解剖学为临床提供解剖学依据和资料。方法取36例喉部结构完整的尸体标本,8例尸体标本做动脉铸型,12例尸体标本用MR扫描仪进行水平面和矢状面的扫描,8例尸体标本进行1mm/片冰冻磨铣,8例尸体标本进行大体及显微解剖,并对5种不同的形态学研究方法关于喉部动脉的观测结果进行统计学分析和定性、定量研究。结果左、右甲状腺上动脉的长度分别为(42.30±0.20)mm和(40.50±0.20)mm,起点处的管径分别为(1.80±0.30)mm和(1.65±0.30)mm;左、右甲状腺下动脉的长度分别为(23.60±0.27)mm和(22.40±0.24)mm,起始点的管径为分别为(1.40±0.25)mm和(1.35±0.30)mm。喉上动脉起点处的管径(1.50±0.20)mm,入喉处管径为(1.32±0.15)mm,长度为(18.60±2.45)mm;其入喉处在甲状软骨的前下方,距甲状软骨上角尖的距离,左侧为(6.80～25.50)mm,平均(14.60±2.45)mm;右侧为(7.60～28.60)mm,平均(15.58±2.58)mm,两侧差异有统计学意义(<0.05)。喉下动脉起点处的管径(1.70±0.30)mm,长度为(15.50±1.80)mm。结论喉部动脉的影像解剖学研究,为耳鼻喉头颈科特别是喉部病变的临床诊断和治疗提供更为科学和全面的影像解剖学依据及血供形态学资料。     

The diameters of common carotid artery and its branches in newborns

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14±0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78±0.12, 0.71±0.13, and 0.93±0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.     

Systematization,description, and territory of arteries that promote vascularization of the midbrain and rhombencephalon in the ostrich (Struthio camelus)

Brain specimens from 30 ostriches were injected with red-dyed latex via the internal carotid arteries (Aa.). The ventral tectal mesencephalic artery (a.), invariably a medium-sized single vessel, was, on the right side, a collateral branch of the caudal branch of the carotid artery (53.4%), a direct branch of the carotid artery (43.3%) and a direct branch of the basilar artery (3.3%) and on the left side, a collateral branch of the caudal branch of the carotid artery (66.7%), a direct branch of the carotid artery (30%), and a direct branch of the basilar artery (3.3%). It vascularized only the ventral half of the optic lobe, with no involvement in cerebellar vascularization on the right (93.3%) and left (80%) sides, extending to the ventrorostral-most cerebellar lobules, which were vascularized on the right (6.7%) and left (20%) sides. The caudal ventral cerebellar arteries were a single vessel on the right (96.7%) and left (93.3%) sides. Its first branch was a common trunk: dorsal spinal—caudal cerebellar on the right (60%) and left (56.6%) sides. Its second branch was the caudal cerebellar artery on the right (76.7%) and left (86.7%) sides. Its third branch was the second component of the caudal cerebellar artery on the right (6.7%) and left (3.3%) sides. The midbrain was vascularized by dorsal and ventral tectal mesencephalic arteries. The cerebellum was vascularized by branches of the caudal ventral cerebellar artery and by the dorsal cerebellar artery.     

Femoral neuropathy in a patient with rheumatoid arthritis

Femoral mononeuropathy (FMN) as an extraarticular finding of rheumatoid arthritis (RA) is a phenomenon which has not been reported previously. We report a 53-year-old female patient with RA, presenting FMN findings during the course of the disease. On examination, right quadriceps and iliopsoas muscles showed grade 3 weakness on the Medical Research Council (MRC) scale. Sensory examination revealed sensory loss in the right medial leg and thigh. Patellar tendon reflex was absent in the right side. A diagnosis of a partial right femoral neuropathy was confirmed using nerve conduction study and electromyography. The probable mechanism of FMN was thought to be vasculitis.     

Abnormal extrapelvic course of the inferior gluteal artery

At its extrapelvic course the inferior gluteal a. is found to be strictly related to the sciatic n. This relationship has been described in a general way, emphasizing its medial localization in respect to the nerve. Clinicosurgical reports describe cases of aneurysms of the inferior gluteal a. on its extrapelvic course and subsequent compression at the nerve. In order to get further details on the relationship between these two structures, 80 gluteal regions from 40 cadavers of adult Brazilian individuals, 29 males and 11 females, were dissected. The inferior gluteal a. was found medial to the sciatic n. in 62 cases (77.5%); in the 18 remaining (22.5%) the trunk of the artery or one of its branches perforated the nerve. Of these, 14 (77.8%) were males and 4 (22.2%) females. This disposition was found 8 times (44.4%) on the right and 10 (55.6%) on the left side; was unilateral in 4 individuals (1 on the right and 3 on the left side) and bilateral in 7. The course of the inferior gluteal a. through the sciatic n. and/or the presence of aneurysms of this artery should be considered as a possible cause of nerve compression.     

浙西南地区中老年人群肾动脉影像解剖学特征

目的　探讨浙西南地区中老年人群的肾动脉影像特征,为临床肾动脉介入手术提供影像解剖学资料。 方法　抽取浙江省丽水市10个城镇社区常住人口中45~75岁者为研究对象,收集问卷资料,行肾动脉CTA检查,采用西门子FORCE CT行腹部CT增强扫描,观察肾动脉的起源、结构,入肾位置及变异等情况,按性别及侧别进行统计分析。 结果 共纳入3090例,男1447例,女1643例,男性和女性在吸烟、饮酒、身高、腰围、舒张压、脉压、服用高血压药物、服用糖尿病药物方面存在显著性差异（P＝0.00）。男性和女性双侧肾动脉的长度和外径无统计学差异（P>0.05）,肾动脉长度和平均外径左侧为（37.43±13.73）、（6.37±6.6）mm,右侧为（24.52±25.5）、（4.4±2.67）mm。肾动脉与腹主动脉夹角均以大于45 °为主,男性左72.3%,右70.9%;女性左74.8%,右71.8%。肾动脉开口位置集中在第2腰椎和第1腰椎（左L2 67.8%,L1 30.1%）;（右L2 75.9%,L1 20.4%）,肾动脉开口位置均为右侧较高（男56.7%,女56.6%）。肾动脉经肾门入肾为主（男48.5%,女47.6%）。肾血管走形左侧以上斜型为主,右侧以平直型为主,两侧有统计学差异（P＝0.00）。肾动脉变异的发生率男性24.5%（95% CI 22.3% ~26.8%）,女性22.3%（95% CI 20.3% ~ 24.4%）。男性副肾动脉检出率为15.4%（95% CI 13.5% ~ 17.3%）,女性为11.1%（95% CI 9.7%~12.7%）。单侧副肾动脉发生率为15.0%,双侧为3.9%。 结论 运用CT可直观、准确地显示肾动脉结构及其变异情况,男性和女性肾动脉的变异差异较大,术前行肾CTA检查可明确肾动脉结构和变异,有利于肾动脉介入术的顺利开展。     

A case report: the first successful cochlear implant in Uganda

Hearing impairment is a significant disability. According to the World Health Organization (WHO), more than 80% of the world''s approximately 120 million people with hearing impairment live in developing countries. Cochlear implant is the only therapeutic intervention for those with severe-profound sensorineural hearing loss. We are reporting an interesting case of the very first cochlear implant operation carried out in Uganda. The patient was a 23 year old male whose presenting complaint was inability to hear in the left ear for three and a half years and in the right ear for one year. He had been treated for TB(Tuberculosis) mastoiditis. After the 8 months of treatment, the otorrhea persisted and he underwent a tympanomastoidectomy on the same ear. He reported no familial history of hearing loss. On examination, ENT examination revealed a small pars flaccida retration pocket of the right tympanic membrane with cholesteatoma. The left ear had an intact tympanic membrane. Pure tone audiometry revealed profound sensorineural hearing loss in both ears (see attached PTA results), CT scan of the temporal bone showed normal inner ear anatomy bilaterally and mild sclerotic changes in both mastoid bones. He then had surgery on his right ear which included cochlear implantation. The cochlear implant (CI) was activated on the first postoperative day remotely via internet with the help of the cochlear implant team at New York University Cochlear Implant Center and the patient was immediately able to appreciate some sounds. He received a pneumococcal vaccine on the first postoperative day and was discharged the following day.