Facial nerve palsy secondary to internal carotid artery dissection

We report facial palsy as the sole cranial neuropathy complicating an ipsilateral internal carotid artery dissection. A previously healthy 44-year-old man developed retro-orbital and temporal headache with associated nausea while engaged in modest physical exercise. On the following morning he noticed a left ptosis and miotic pupil. One week later he woke with a left facial weakness. On the same day he had a 90-minute episode of expressive dysphasia. Magnetic resonance imaging and angiography demonstrated left internal carotid artery dissection. The temporal association between our patient's facial nerve palsy and typical features of spontaneous internal carotid artery dissection suggests a common aetiology. We suggest that involvement of the VII cranial nerve in isolation followed disruption of an anomalous nutrient artery. The delay in clinical manifestation may imply extension of the dissection.     

Traumatic and spontaneous extracranial internal carotid artery dissections

Summary Seventy patients with spontaneous and 21 with traumatic extracranial internal carotid artery dissections were studied clinically and angiographically with mean follow-ups of 64 (spontaneous group) and 40 months (traumatic group). Sixty percent of the patients in the spontaneous group and 71% in the traumatic group also had follow-up angiograms. In traumatic dissections aneurysms were common, significantly fewer aneurysms resolved or became smaller and fewer stenoses resolved or improved, whereas more stenoses progressed to occlusion. Traumatic dissections were more likely to leave the patients with neurological deficits. A significantly higher percentage of the patients with spontaneous dissections were asymptomatic at follow-up compared with the traumatic group. Although both spontaneous and traumatic dissections of extracranial internal carotid arteries mostly carry a good prognosis, the outcome may be somewhat less favorable for the traumatic group.Presented in part at the meeting of the European Neurological Society, Nice, France, 19–22 June 1988     

Minor trauma may lead to traumatic internal carotid artery dissection

A farmer’s wife was slapped by her cow’s tail during milking. There was no obvious injury, but afterward she first developed unusual headaches of unknown origin and then a severe stroke 7 days later. Further diagnostics, including magnetic resonance imaging techniques, revealed a dissection of the carotid artery to be the reason for the stroke, probably caused by being hit by the cow’s tail. This case demonstrates that persisting unusual headaches, even after minor trauma, should lead to further diagnostic procedures and then therapeutic intervention for stroke prevention if necessary.     

Hypoglossal nerve palsy as an isolated syndrome of internal carotid artery dissection: A review of the literature and a case report

A review of literature on the dissection of internal carotid artery was presented with a presentation of a rare case of patient with transient left hypoglossal nerve palsy caused by mechanic compression from intramural hematoma in higher extracranial portion of dissected carotid artery confirmed in MRI and CT scans. The clinical presentation and management are discussed.     

Cerebral arterial compliance in patients with internal carotid artery disease

Background: A decrease in arterial compliance of the internal carotid artery has been associated with an increased risk in ipsilateral ischaemic stroke. However, so far, no technique has been validated to monitor the compliance of intracerebral arteries (Ca) in patients with carotid artery disease. In this study, we sought to monitor Ca in patients with unilateral symptomatic disease and to determine its variations during changes in PaCO₂. Methods: We studied 18 patients with unilateral symptomatic internal carotid artery stenosis >50% or occlusion. Patients underwent monitoring of arterial blood pressure (ABP) and middle cerebral artery cerebral blood flow velocities (CBFV) during baseline, hyperventilation and 5%CO₂ inhalation. Ca was calculated from pulsatile amplitudes of ABP and Cerebral arterial blood volume, extracted from the CBFV waveform using a new mathematical model. Results: At baseline, the decrease in Ca on the diseased side was correlated with the degree of stenosis (r = −0.35; P = 0.01). During hypocapnia, Ca was lower compared to baseline on the normal side (P = 0.004) and on the diseased side (P = 0.04). Ca reactivity, reflecting the changes in Ca per changes in 1 mmHg PaCO₂, was lower on the diseased side between baseline and hypocapnia (3.4 vs. 2.6%; P = 0.04). During hypercapnia, no changes in Ca on the diseased (P = 0.8) nor on the normal sides (P = 0.2) were observed. Conclusions: The decrease in cerebral arterial compliance the side of stenosis/occlusion was correlated with the severity of the internal carotid artery disease. Further studies are needed to determine whether Ca may improve the prediction of ischaemic events in symptomatic and asymptomatic patients.     

Optic nerve MRI enhancement in posterior ischaemic optic neuropathy due to internal carotid artery dissection

Posterior ischaemic neuropathy (PION) is characterized by infarction in the retrobulbar optic nerve. A 73-year-old man suddenly experienced blurred vision in his left eye and intermittent weakness in his right hand. He had visual defects of superior lateral quarter and inferior medial quarter areas in the left eye. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed segmental enhancement in the left optic nerve. A cerebral angiogram showed a left internal carotid dissection (ICD). He did not have fever, and his laboratory and cerebrospinal fluid tests were normal. These findings were suggestive of PION associated with ICD. No reports of PION caused by ICD has been reported and his is the first case in which MRI showed optic nerve enhancement due to ICD.     

Left internal carotid artery dissection presenting with headache, Collet-Sicard syndrome and sustained hypertension

The baroreflex maintains blood pressure through the glossopharyngeal (IX) cranial nerve. We report a 54-year-old man who developed a left sided headache, hoarseness, dysarthria, dysphagia, and sustained hypertension from a left internal carotid artery dissection. We hypothesise that interruption of the left IX nerve caused hypertension in this patient.     

Basilar artery dissection in a young woman: a case report.

The case of a young woman with basilar artery dissection, possibly precipitated by trauma, is presented, and the literature is reviewed.     

运动相关颈内动脉夹层致脑梗死的临床及影像学特点(附1例报告)

目的 研究运动相关颈内动脉夹层致腩梗死的临床及影像学特点.方法 回顾性分析1例运动相关颈内动脉夹层致脑梗死患者的临床资料.结果 本例为青年男性,临床表现为快速进展的认知功能障碍(失算症、命名性失语)及偏盲.颅脑MRI显示左侧颞、枕交界区T1低信号、T2及弥散加权成像(DWI)高信号灶.全脑血管造影示颈内动脉C1段"双腔...     

Upper cranial nerve palsy resulting from spontaneous carotid dissection

Introduction Upper cranial nerve palsy has a variety of causes such as cerebral and nerve ischemia, diabetes, infectious and non–infectious meningitis, subarachnoid hemorrhage and intracranial aneurysm. Case 1 A 45–year–old man suffered from holocephalic headaches and a rightsided neck pain for two weeks. He presented to our emergency department because of a sudden ptosis of the right eye. On admission neurological examination revealed a right sided Horners syndrome and hypesthesia of the right side of the face. Magnetic resonance angiography identified a circumscribed dissection of the right extracranial internal carotid artery originating from the carotid bifurcation. Conventional angiography 2 weeks later showed a nearly recanalized artery. Case 2 A 55–year–old previously healthy man without cardiovascular risk factors developed right sided neck pain when loading a seeder with several sacks of crop. A few hours later he noticed a left–sided weakness. On admission a severe left sided hemiparesis and a mild neglect were present. Duplex sonography revealed a right–sided distal internal carotid artery (ICA) occlusion. The next morning the patient complained of double vision; he had a right–sided pupil–sparing oculomotor palsy. The diagnosis of ICA dissection was confirmed by conventional angiography, at that time showing a partially recanalized ICA without involvement of the cavernous region by the dissection. Conclusion ICA dissection must be included in the differential diagnosis of upper cranial nerve palsy and should be assessed by duplex ultrasound and magnetic resonance imaging. A possible explanation is nerve ischemia due to a transient or permanent interruption of the blood supply by compression of the vasa nervorum originating from the intracranial carotid artery.     

Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study

Because of the presumed non-atherosclerotic pathogenesis, the potential link between spontaneous cervical artery dissection (sCAD) and common risk factors for atherosclerosis has never been investigated systematically. Therefore, this prospective, multicentre, case-control study compared the frequency of tobacco use, hypertension, diabetes mellitus, and hypercholesterolaemia among a group of consecutive patients with sCAD (n = 153), a group of patients with ischaemic stroke, not related to CAD (non-CAD), and a group of controls. As opposed to the other variables, a trend towards a significant association was seen when the prevalence of hypertension was compared among patients with sCAD and controls (26.8% v 17.0%; odds ratio (OR) 1.79; 95% confidence interval (CI), 0.98 to 3.27; p = 0.058). Hypertension was also significantly associated with the subgroup of patients with sCAD and cerebral infarction (OR, 1.94; 95% CI, 1.01 to 3.70; p = 0.045), particularly when involving the vertebral arteries (OR, 2.69; 95% CI, 1.20 to 6.04; p = 0.017). These findings might help define the spectrum of pathogenic conditions predisposing to sCAD and provide information to help investigate the combined effect of such susceptibility factors in future studies.     

Recurrence of bilateral spontaneous cervical internal carotid artery dissection after a 12-year-interval: a case report]

Recurrence of spontaneous cervical internal carotid artery (ICA) dissection is not rare (1%/year) but bilateral recurrence affecting the same cervical ICA is rare, especially after a 12-year-interval. A 41-year-old man exhibited left hemiparesis and angiography revealed tapered stenosis of his right cervical ICA. Within 2 days, his hemiparesis improved. After 21 days, repeated angiography showed complete resolution of the once-stenosed right cervical ICA. He was discharged with slight left hemiparesis. The follow-up angiography performed after 18 months disclosed not only the recanalization of the right cervical ICA but also a new concentric stenosis of his left cervical ICA. Since he presented no new neurological deficit, he was treated with an antiplatelet agent. The angiography performed 14 months later revealed normalization of bilateral cervical ICA. After 12 years, at the age of 53, he presented with worsening of his left motor weakness. Also on this occasion, angiography revealed bilateral cervical ICA dissection and their spontaneous resolution. The anamnesis revealed that he had experienced the same ischemic symptoms, that is, hemiparesis, aphasia and their spontaneous resolution, when he was 24 and 37 years of age. These 4 episodes had some characteristics in common: occurrence in winter (from December to March), being preceded by moderate fever and upper respiratory tract infection. The pathogenesis of spontaneous cervical ICA dissection is unclear. From experience with this patient, we propose that the occurrence of spontaneous cervical ICA dissection might depend on a genetic predisposition and infection might play the role of a trigger.     

Giant aneurysms of bilateral internal carotid arteries in a child

Aneurysms in the petrous or cavernous portion of the internal carotid artery in childhood are extremely rare. Only two such cases have been previously reported. We present a case of bilateral giant intrapetrous aneurysms in a young female. CT was especially helpful in evaluating the absolute size of these aneurysms. This case is unique in that we demonstrated the temporal evolution of internal carotid aneurysms on follow-up angiography.     

Heart and carotid artery disease in stroke patients with intermittent claudication

Much has been published on the natural history of intermittent claudication (IC), but little is known about the clinical features of stroke patients with IC. The purpose of this study was to examine clinical features and risk factors in stroke patients with or without IC, including heart disease and carotid artery disease. A hospital-based study was conducted of 3901 stroke patients, who were prospectively coded and entered into a computerized databank. Of these patients, 219 had symptoms of IC. Patients were subdivided by age into 10-year categories. There were at least 12 times more non-IC than IC patients in each category. An age-matched random sample was obtained containing 12 non-IC cases for each IC case, resulting in 219 cases of IC and 2628 non-IC cases. The prevalence of IC in the total stroke population was 5.6%. IC prevalence increased sharply with age until about 70 years. Cardiac ischaemia and internal carotid artery (ICA) disease were significantly more frequent in stroke with IC than without IC. IC patients also exhibited a higher prevalence of atherosclerotic disease as well as other risk factors such as smoking, hypercholesterolaemia, elevated haematocrit, and family history of stroke. Ischaemic heart disease and ICA disease are especially common in stroke with IC. IC, large artery disease and stroke share similar risk factors. IC symptoms in stroke patients may indicate extensive generalized atherosclerosis.     

Seasonal variability in spontaneous cervical artery dissection

We examined the seasonal variability of spontaneous cervical artery dissection (sCAD) by analysing prospectively collected data from 352 patients with 380 sCAD (361 symptomatic sCAD; 305 carotid and 75 vertebral artery dissections) admitted to two university hospitals with a catchment area of 2,200,000 inhabitants between 1985 and 2004. Presenting symptoms and signs of the 380 sCAD were ischaemic stroke in 241 (63%), transient ischaemic attack in 40 (11%), retinal ischemia in seven (2%), and non-ischaemic in 73 (19%) cases; 19 (5%) were asymptomatic sCAD. A seasonal pattern, with higher frequency of sCAD in winter (31.3%; 95% confidence interval (CI): 26.5 to 36.4; p=0.021) compared to spring (25.5%; 95% CI: 21.1 to 30.3), summer (23.5%; 95% CI: 19.3 to 28.3), and autumn (19.7%; 95% CI: 15.7 to 24.1) was observed. Although the cause of seasonality in sCAD is unclear, the winter peaks of infection, hypertension, and aortic dissection suggest common underlying mechanisms.     

Cerebral cortical microinfarcts in patients with internal carotid artery occlusion

Cerebral cortical microinfarcts (CMI) are small ischemic lesions that are associated with cognitive impairment and probably have multiple etiologies. Cerebral hypoperfusion has been proposed as a causal factor. We studied CMI in patients with internal carotid artery (ICA) occlusion, as a model for cerebral hemodynamic compromise. We included 95 patients with a complete ICA occlusion (age 66.2 ± 8.3, 22% female) and 125 reference participants (age 65.5 ± 7.4, 47% female). Participants underwent clinical, neuropsychological, and 3 T brain MRI assessment. CMI were more common in patients with an ICA occlusion (54%, median 2, range 1–33) than in the reference group (6%, median 0; range 1–7; OR 14.3; 95% CI 6.2–33.1; p<.001). CMI were more common ipsilateral to the occlusion than in the contralateral hemisphere (median 2 and 0 respectively; p<.001). In patients with CMI compared to patients without CMI, the number of additional occluded or stenosed cervical arteries was higher (p=.038), and cerebral blood flow was lower (B −6.2 ml/min/100 ml; 95% CI −12.0:–0.41; p=.036). In conclusion, CMI are common in patients with an ICA occlusion, particularly in the hemisphere of the occluded ICA. CMI burden was related to the severity of cervical arterial compromise, supporting a role of hemodynamics in CMI etiology.     

Morphological changes of the internal carotid artery: prevalence and characteristics. A clinical and ultrasonographic study in a series of 19 804 patients over 25 years old

Background and purpose

Morphological changes of the internal carotid arteries (McICA) are frequently found during cervical ultrasound studies. However, the etiology of McICA remains controversial. During this study, the prevalence and demographic characteristics of McICA, such as kinking, coiling or looping identified by Doppler ultrasound, were analysed and its relationship with vascular risk factors and stroke was assessed.

Methods

A retrospective study was performed by analysing 19 804 patients who were subjected to cervical ultrasonographic study between January 2000 and June 2012. The data were statistically analysed with SPSS^® 20 and a multivariate logistic regression was performed. Statistical significance was accepted for P < 0.05 and 95% confidence intervals (CIs) were used.

Results

Morphological changes of the internal carotid arteries were present in 2678 patients (13.5%) and were unilateral in 61.6% of these cases. Carotid kinking was found in 80% of the patients, coiling in 16% and looping in 1%. In multivariate analysis, the presence of McICA was related to older groups (1.04; 95% CI, 1.04–1.05; P < 0.01), female gender (1.78; 95% CI, 1.64–1.94; P < 0.01), patients with hyperlipidemia (1.28; 95% CI, 1.17–1.40; P < 0.01), carotid thickness (1.22; 95% CI, 1.13–1.33; P < 0.01) and cardiac or cardioembolic disease (1.11; 95% CI, 1.01–1.21; P = 0.02). The results of this study indicate that kinking in the carotid artery was associated with ipsilateral cerebral ischemic events (1.43; 95% CI, 1.040–1.958; P < 0.05).

Conclusion

Morphological changes of the internal carotid arteries were associated with aging, female gender and patients with hyperlipidemia, hypertension, diabetes and heart disease. Kinking was associated with ipsilateral cerebral ischemia.