Spontaneous bilateral internal carotid artery dissection with hypoglossal nerve palsy.

Spontaneous dissection of the extracranial internal carotid artery (ICA) is increasingly being recognized as a common vascular disease. We report on a 52-year-old-male presented with bilateral extracranial internal artery dissection and twelfth nerve palsy and review the previous literature.     

Spontaneous dissection of the cervical internal carotid artery. Diagnosis by MRI

A case of spontaneous dissection of the cervical internal carotid artery documented by angiography and MRI is reported. Angiography showed an irregular stenosis of the upper part of the cervical internal carotid artery extending up to the base of the skull, suggestive of spontaneous dissection. The diagnosis was confirmed beyond doubt by MRI which showed a sub-intimal collection of blood with a typical hyperintense appearance.     

Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature

Single-vessel cervical arterial dissections typically occur in young adults and are a common cause of cerebral ischemia and stroke. Although the pathogenesis of multivessel dissection is unclear, it is thought to be a consequence of underlying collagen vascular disease. We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation.     

Subarachnoid hemorrhage following spontaneous intracranial carotid artery dissection

Summary Subarachnoid hemorrhage due to spontaneous dissection of intracranial vessels is uncommon. Most such cases are confined to the posterior circulation. Dissection of an intracranial carotid artery producing subarachnoid hemorrhage without a focal ischemic event is rarely documented. We report a case and review the subject.     

Spontaneous dissection of the cervical internal carotid artery: correlation of arteriography, CT, and pathology

Spontaneous dissection of the internal carotid artery is being recognized as a more frequent cause of acute neurologic deficit, particularly in young persons. Saccular pseudoaneurysm formation may be an associated finding, especially in the presence of tortuosity (coiling) of the cervical internal carotid artery. Of eight patients with nine vessels demonstrating internal carotid artery dissection on arteriography, pseudoaneurysms were found in five arteries. Four of the five pseudoaneurysms occurred in tortuous (coiled) arterial segments. Thin-section contrast-enhanced dynamic incremental CT showed close agreement with the findings on selective arteriography and provided additional information on the presence and configuration of arterial wall thickening as well as the extent of the pseudoaneurysm. Our experience indicates that CT may play an important role in the diagnosis, management, and follow-up of this lesion.     

Spontaneous dissection of the internal carotid artery during magnetic resonance imaging

Spontaneous dissection of the internal carotid artery is an increasingly recognized condition that is readily identifiable with magnetic resonance imaging and -angiography. Early recognition of this entity is essential for optimizing medical management and avoiding potential cerebral infarction. We present a case of dissection of the internal carotid artery that occurred during magnetic resonance imaging and describe the immediate imaging characteristics.     

Implicating the long styloid process in cervical carotid artery dissection

Introduction

To look for the presence and strength of association of cervical carotid artery dissection (CCAD) with a long styloid process.

Methods

This case–control analysis included 35 patients with 37 affected carotid arteries. CT angiograms of these patients were analyzed by two raters blinded to clinical and radiological diagnosis. Parameters assessed were styloid process length, its proximity to the cervical internal carotid artery, and its medial and anterior angulations. The same parameters were assessed in 70 CT angiograms in age and sex matched controls.

Results

Interrater correlations were 0.87, 0.40, 0.71, and 0.79 for styloid process length, contact distance, medial angulation, and anterior angulation, respectively. The mean styloid process length on the affected side was significantly more than on the contralateral side (37.8 vs. 34.6 mm, p?=?0.006). There were also significant length and contact distance differences between the styloid processes ipsilateral to dissection and ipsilateral styloid processes of controls (38.9 vs. 36.2 mm, p?=?0.05 and 3.1 vs. 5.0 mm, p?=?0.05, respectively). There were increasing odds ratios (OR) for dissection with increasing styloid process length, with OR of 4.36 (95 % CI?=?1.04 to 18.4, p?=?0.04) for length more than 50 mm. ORs for dissection increased with decreasing contact distance, with OR for distances less than 5 mm being 7.58 (95 % CI?=?0.93 to 62.1, p?=?0.06). There was no significant association of CCAD with angulation of the styloid process.

Conclusion

Length and contact distance of the styloid process are risk factors for CCAD, suggesting mechanical impingement.     

Spontaneous coeliac artery dissection

A patient with spontaneous coeliac artery dissection that presented as upper abdominal pain is reported. This was diagnosed on contrast-enhanced multislice helical CT. The patient was treated conservatively and follow-up CT showed mild aneurysmal change of the splenic artery and a small splenic infarct. Isolated dissection of the visceral arteries (and, in particular, the coeliac artery) is extremely rare. With such limited evidence, decisions over best management are difficult, but depend on initial severity and progression at follow up.     

Endovascular therapeutic occlusion following bilateral carotid artery bypass for radiation-induced carotid artery blowout: case report

A patient with breast cancer received radiation therapy to the upper chest wall. Twenty-two years later, she presented with repeated severe bleeding through a left lower neck ulcer. She was taken to surgery for hemostasis, which was not successful because the carotid artery was surgically inaccessible. To manage for explosive carotid blowout, we performed common carotid artery ligation and endovascular coil embolization after contralateral-external-carotid to ipsilateral-common-carotid artery bypass with a polytetrafluoroethylene (PTFE) graft. The patient has experienced no ischemic events or bleeding since this treatment.     

Spontaneous healing of cervical pseudoaneurysm in vertebral artery dissection under anticoagulant therapy

We report a 41-year-old woman with embolic stroke of the mid-pons attributed to embolism from vertebral artery dissection. Angiography revealed an occluded artery on one side and an incidental pseudoaneurysm of the midcervical portion of the vertebral artery on the other. After 3 months of warfarin therapy control angiography showed complete occlusion of the pseudoaneurysm. We discuss therapeutic choices and review the literature. Received: 3 January 1997 Accepted: 26 January 1997     

Basilar and bilateral carotid dolichoectasia with spontaneous dissection of C2 segment of the internal carotid artery

We describe a previously unreported case of cranial arterial dolichoectasia associated with spontaneous dissection of the petrous (C2) segment of the internal carotid artery (ICA) with 2 patent lumena. Dolichoectasia of the cranial arteries and different types of double lumen of ICA are discussed. A review of previously reported cases is included.     

Triple spontaneous cervical artery dissection

A 39-year-old healthy man had several transient ischaemic attacks suggesting left internal carotid artery (ICA) occlusion. There were no vascular risk factors and no preceding trauma. Colour-coded duplex sonography suggested a pseudo-occlusion of the left ICA, and cerebral angiography demonstrated dissection of the left ICA and both vertebral arteries. Angiography 6 months later was completely normal. This underlines the importance of four vessel angiography in young patients with dissections of cervical arteries. Received: 27 August 1998 Accepted: 13 November 1998     

Spontaneous dissection of both extracranial internal carotid arteries

Summary Neurological examination and Doppler sonography of a 50-year-old patient were suggestive of a spontaneous dissection of the left internal carotid artery (left-sided headaches, amaurosis fugax, Horner's syndrome and hemispheric stroke). Four-vessel angiogram performed several days after the onset of the symptoms showed dissection of both extracranial carotid arteries, more pronounced on right side where the dissection was clinically asymptomatic. Angiogram follow-up demonstrated a recanalization of both carotid arteries. A review of 15 other documented reports indicates that bilateral internal carotid dissection is usually associated with fibromuscular dysplasia. A large majority of cases does not clinically differ from unilateral carotid artery dissection.