Bilateral extracranial aneurysm of the internal carotid artery--a case report.

The authors report a case study of a 78-year-old man with a bilateral extracranial atherosclerotic aneurysm of the internal carotid artery. The patient was treated surgically with resection of the aneurysm and restoration of the flow with a polytetrafluoroethylene (PTFE) graft. The postoperative period was uneventful. Histologic tests demonstrated almost complete destruction of the elastin fibers. The potential hazards of an aneurysm of the internal carotid artery indicate that surgical treatment is warranted.     

Mycotic aneurysm of internal carotid artery — A case report

Mycotic aneurysms are rare entities. Most of them occur in aorta or femoral artery. Mycotic aneurysm of extracranial carotid artery has been reported quite infrequently in the literature. Surgical intervention is mandatory. The ideal treatment is to excise the aneurysm and restore the circulation by interposition grafting by saphenous vein. However the limited access to extracranial internal carotid artery and the presence of infection at that site may not always allow the ideal management. Ligation of the aneurysm is a practical life-saving method in such cases. We are presenting our experience with one such patient who presented with a painful bleeding swelling in the throat and was successfully treated with ligation of internal carotid artery.     

Mycotic carotid aneurysm

Mycotic aneurysms of the extracranial internal carotid artery are rare; they usually appear as an enlarging pulsatile neck mass with associated pain, tenderness, and fever. This case report illustrates the need for prompt diagnosis and urgent surgical intervention. The most common organisms found with these aneurysms have been Staphylococcus aureus and Streptococcus pyogenes. We report a case of a mycotic internal carotid artery aneurysm resulting from Salmonella enteritidis. A 20-year review of both the foreign and English language literature revealed only one other case of a mycotic carotid aneurysm resulting from Salmonella infection. The cornerstone of therapy in the past had been proximal ligation. More recently, primary reconstructive procedures with either an end-to-end anastomosis or an interposition vein graft have been described. The present case was managed with an end-to-end technique with the use of a Pruitt-Inahara shunt.     

Mycotic carotid artery aneurysm

A painful, pulsatile neck mass with associated fever should suggest the presence of a mycotic carotid artery aneurysm. Diagnosis can be confirmed from angiograms. Broad spectrum antibiotics are indicated, and an operation should be performed promptly. The lack of tissue planes uninvolved by infection will almost always prevent vascular reconstruction. Carotid artery ligation with excision of the aneurysms is recommended.     

Dissecting aneurysm of the posterior inferior cerebellar artery--a case report

The authors present a case of dissecting aneurysm of the right posterior inferior cerebellar artery (PICA) in a 47-year-old female, who suffered from mild subarachnoid hemorrhage. Right vertebral angiogram showed typical "pearl and string" sign of the PICA, but we could not fully understand the condition until a surgical exposure revealed a purple sausage-like dissecting aneurysm of the PICA. The aneurysm was wrapped with muscle pieces. Postoperatively she developed Wallenberg's syndrome, but it subsided gradually. No specific disorder concerning the mural dissection was found in this patient, except for a history of mild hypertension. This case is unusual because it affected not an arterial trunk but a small branch and we could find only one other case reported in the literature. Other formerly reported cases were of arterial trunks. The intracranial dissecting aneurysm has been known as a rare cause of cerebral infarct in children and adolescents. Infants are also affected and referred to as "infantile hemiplegia". It mainly affects one of the trunk arteries and cause a severe ischemic stroke, and surgically treatable case is rare. But as the typical angiographic findings are commonly known the number of the reported cases is increasing at an accelerating rate, and some of them are being noted to need surgical treatment because they cause subarachnoid hemorrhage. We here emphasize that not only trunk arteries but also small branch arteries can develop mural dissection, leading to subarachnoid hemorrhage. Dissecting aneurysm of a smaller artery would be milder in symptom, and would give more chance for surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mycotic aneurysm of the extracranial carotid artery: a case report and review of the literature

Aneurysm of the extracranial carotid artery is a rare condition; mycotic aneurysms are even less common. They always need surgical treatment to prevent possible rupture, embolisation or death. The literature before 1980 mentions ligation as the only treatment for mycotic aneurysms of the carotid artery, obviously with a high morbidity and mortality rate. We describe an 85-year-old male with a left carotid artery mycotic aneurysm. He presented with a history of Transient Ischaemic Attack (TIA) four weeks after a gastrointestinal infection. Resection of the aneurysm and interposition with autologous vein was performed. Escherichia coli was isolated from the excised tissue. Primary resection of the aneurysm with autologous vein interposition, in association with prolonged antibiotic therapy, is the preferred strategy. Prompt diagnosis and aggressive treatment is essential to prevent serious complications.     

Mycotic aneurysm of the carotid bifurcation in the neck: case report and review of the literature

OBJECTIVE AND IMPORTANCE: Mycotic aneurysms of the extracranial carotid artery are rare and difficult to diagnose. A search of the world literature published since 1966 reveals at least six cases of mycotic carotid aneurysms due to a Salmonella septicemia. We present an exceptional case of mycotic pseudoaneurysm of the bifurcation of the carotid artery due to Salmonella septicemia and discuss the pathogenesis as well as various aspects of the diagnosis and surgical management. CLINICAL PRESENTATION: A 68-year-old man presented in Poland with Salmonella sepsis; 1 month later, he was admitted to the emergency department of the Sir Mortimer B. Davis-Jewish General Hospital in Montreal with a bulky and pulsatile right cervical mass. An angiogram and a computed tomographic scan revealed a voluminous and partially thrombosed aneurysm the size of a tangerine originating from the posterior aspect of the carotid junction. INTERVENTION: Balloon trapping was attempted at the Montreal Neurological Hospital. Subsequently, the patient developed a significant neurological deficit, which was quickly reversed by the administration of hypertensive, hypervolemic, and hemodilution therapy. Thereafter, the pseudoaneurysm was resected surgically, and the internal and external carotid arteries were sacrificed. Pathological examination of the excised specimen of the carotid junction revealed a pseudoaneurysm. Bacterial culture of the lesion showed growth of Salmonella. CONCLUSION: The postoperative course was satisfactory except for laryngeal paralysis due to involvement of the vagus nerve. Four months later, a computed tomographic scan showed only small lacunae in both centra semiovale.     

Mycotic aneurysm of the internal carotid artery presenting with multiple cerebral septic emboli

Mycotic aneurysms of the extracranial carotid artery are uncommon and always warrant surgical treatment to prevent eventual rupture and death. Septic embolization to the brain is an even rarer complication of these aneurysms. We present a case of a 79-year-old male with an extracranial internal carotid artery mycotic aneurysm during Staphylococcus aureus bacteremia. He presented with hemiparesis owing to brain embolism from multiple septic emboli originating from the aneurysm. Multidetector computed tomographic angiography contributed to the diagnosis. Resection of the aneurysm and restoration of arterial supply to the brain by vein graft interpositioning was the therapeutic procedure along with long-term antibiotic treatment. A high index of suspicion is required for the diagnosis of a mycotic carotid aneurysm and aggressive treatment is always needed to prevent lethal complications.     

Mycotic abdominal aortic aneurysm: a case report

A case of mycotic aneurysm of the abdominal aorta, arising as a complication of subacute bacterial endocarditis in a 75-year-old white woman, is presented. The dramatically expansile nature of this aneurysm is well documented. The history, clinical presentation, etiology, microbiology and surgical management of this rapidly progressive and often fatal condition are discussed through a review of the literature.     

Traumatic aneurysm of the supraclinoid internal carotid artery: report of a case

A case of traumatic aneurysm of the supraclinoid internal carotid artery is presented. Formation of the aneurysm was thought to be due to a direct injury to the wall of the internal carotid artery from a basal skull fracture of the anterior cranial fossa.     

Recurrent fusiform aneurysm of the internal carotid artery; a case report]

A 61-year-old woman was referred to our department on February 12, 1991, due to a fusiform aneurysm of her left internal carotid artery (ICA). She had received aneurysm surgery twice in other hospitals in the past. The first operation, in June, 1980, was for an unruptured, symptomatic left internal carotid-posterior communicating aneurysm and the aneurysm disappeared completely after the neck clipping procedure was carried out by one of the authors. In November, 1990, she suffered from subarachnoid hemorrhage with a hematoma in the left frontal lobe. A ruptured anterior communicating aneurysm was clipped in another hospital, where abnormal dilatation of the left ICA was pointed out. She was referred to our department after a ventricular peritoneal shunt operation. Though the postoperative angiogram performed in 1980 had shown complete disappearance of the left IC-PC aneurysm, it was presumed that the fusiform aneurysm which she presented at our department was recurrent because it existed in almost the same place as the aneurysm which had been clipped. It was also in contact with a clip applied in 1980. In accord with the patient's desire to receive surgery, the fusiform aneurysm was operated on directly, and it was remarkably reduced in size by dome clipping. During a clip, a Sugita booster clip was useful for preventing a slip-out of the clip applied on the aneurysmal dome. The patient was discharged about 20 days after the operation and returned to her usual life. A recurrent fusiform aneurysm of the ICA arising after the neck clipping of IC-PC aneurysm has rarely been encountered.(ABSTRACT TRUNCATED AT 250 WORDS)     

Villaret's syndrome due to extra-cranial internal carotid aneurysm: a case report

A 69 year-old male was admitted to our clinic with the chief complaint of hoarseness and difficulty in swallowing. These symptoms occurred about 5 months after penetrating neck injury. Neurological examination revealed right ninth to twelfth cranial nerves palsy and Horner's syndrome. Plain skull X-P demonstrated two broken pieces of glass below the right mastoid processus. The right carotid angiogram showed a 45 x 25 mm aneurysm originated from the right internal carotid artery just below the carotid canal. As the first operation, gradual occlusion of right internal carotid artery combined with the right STA-MCA anastomosis was performed. But two days after complete occlusion, left hemiparesis and pseudobulbar palsy appeared. Two months after such episode, aneurysm and the pieces of glass were removed. He discharged on foot with the improvement of the symptoms of lower cranial nerves. Villaret's syndrome caused by the traumatic aneurysm of extracranial internal carotid artery is rare. This case seems to be the first report in Japan.     

Gradual facial palsy and intrapetrous internal carotid aneurysm: a case report

A case of aneurysm of the horizontal intratemporal carotid artery with compression of the facial nerve is presented. Exclusion of the aneurysm with an intraluminal balloon did not relieve the facial nerve compression. Surgical resection of the aneurysm and repair of the facial nerve continuity was successfully performed through a combined transmastoid supralabyrinthine approach, after permanent balloon occlusion of the internal carotid artery.     

Extracranial internal carotid artery aneurysm associated with Marfan syndrome: case report

Marfan syndrome is a heritable disorder of connective tissue characterized by autosomal dominant inheritance. Cerebrovascular disorders associated with Marfan syndrome are known to be rare. In this report, we described a rare case of a 64-year-old woman with an extracranial internal carotid artery (ICA) aneurysm associated with Marfan syndrome. The extracranial ICA was very tortuous and a 3-cm-diameter aneurysm was observed at the distal portion of the carotid bifurcation. Through anterior neck incision, the aneurysm was dissected from the surrounding tissue. The carotid artery was clamped, and external shunting was performed using a 3-way shunt tube. The aneurysm was excised, and an end-to-end anastomosis of the ICA was made. Postoperative course was uneventful except for mild swallowing disturbance lasting for 2 weeks. The surgical indication and technique are discussed.     

Surgical intervention for isolated dissecting aneurysm of the superior mesenteric artery--a case report

A 44-year-old man with abdominal pain was diagnosed as having a spontaneous isolated dissection of the superior mesenteric artery. The patient was successfully treated with endoaneurysmorrhaphy 5 months after the onset and has been symptom free 15 months after surgery. In view of the excellent surgical outcome in the literature, surgical intervention for this rare pathology should be considered.     

Successful surgical management of extracranial high internal carotid aneurysm. A case report

A 76 year-old woman visited our university hospital with a complaints of dysphagia of 3 months duration and was discovered to have a right internal carotid aneurysm protruding to the right side of the larynx. A day prior to admission, dysarthria and left hemiparesis occurred with sudden onset. These ischemic attacks spontaneously remitted within 48 hours. A carotid arteriogram showed a saccular aneurysm located high in the right internal carotid artery. Four days after admission, aneurysmectomy with end-to-end anastomosis was carried out with the temporary internal shunt under the induced hypertension. There was no sign of ischemic brain damage after the operation. But she suffered from dysphagia due to the NO. 9, 10, and 12 cerebral nerve palsies, which took 5 months to recover completely. Despite several difficulties in the operation for a highly located internal carotid aneurysm, we emphasize in this report the necessity of aneurysmectomy and the establishment of vascular continuity with the aid of internal shunt to prevent the ischemic brain damage.     

Giant internal carotid artery aneurysm manifesting as difficulty in swallowing: case report

A 66-year-old man presented with a rare case of a giant aneurysm of the internal carotid artery manifesting as difficulty in swallowing, resulting in severe malnutrition. Initial examination found a pulsating mass protruding from the posterior wall of the pharynx in the oral cavity. The patient had left hemiplegia caused by cerebral infarction one year previously. The patient underwent surgical therapy consisting of superficial temporal artery-middle cerebral artery bypass and trapping of the internal carotid artery. The pulsation of the oral mass vanished just after surgery and his difficulty in swallowing gradually improved. The patient was discharged with no new neurological deficits. The previous cerebral infarction was probably caused by an embolus from this giant aneurysm.