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.     

Percutaneous laser disc decompression: clinical experience at SCTIMST and long term follow up

BACKGROUND: Low backache (LBA) is now increasing in younger population due to misdirected spinal kinetics secondary to improper posture, heavy load lifting and motorbike driving. Hence minimally invasive procedures are increasingly sought after. Among these, PLDD is currently popular and in use. We present our long term follow-up in the use of Nd:YAG laser for PLDD. AIM: To evaluate the efficacy of PLDD in treatment of contained herniation of lumbar discs & long term follow up results. MATERIALS AND METHODS: Forty patients with contained lumbar disc herniation on MRI and who did not respond to 6 weeks conservative treatment were subjected to PLDD. L4-5 disc was treated in 31, L5-S1 in 12 and L1-2 and L3-4 in one each. Nd:YAG laser at 1064 nm was used for the procedure. Total laser energy of 1500-2000 Joules was delivered at the disc space depending upon the size. RESULTS: There was immediate pain relief in 32/40 (80%). According to MacNab criteria good to fair response was seen in 37/40 (92%) and 3 patients (7.5%) responded poorly to this treatment. On follow up which ranged from 1 to 7 years, 34/40 (85%) had pain relief with no need for further treatment. COMPLICATIONS: Significant pain at local puncture site was experienced by 8 (20%), pain during lasing was experienced by one. One patient developed muscular spasm. CONCLUSION: Percutaneous laser disc decompression is a safe, relatively noninvasive and effective treatment modality for contained, nonsequestered, herniated lumbar disc disease in carefully selected patients.     

Reversible periictal MRI abnormalities: clinical correlates and long-term outcome in 12 patients

Although a wide spectrum of reversible periictal magnetic resonance imaging (MRI) abnormalities (RPMA) are being increasingly identified, the clinicians are often in a dilemma about their localization significance. This prompted us to analyze the clinical, MRI, electroencephalographic (EEG) and follow-up data of 12 patients with RPMA seen in a tertiary referral epilepsy center. RPMA occurred after a single or a cluster of focal seizures with or without secondary generalization. The interictal and ictal EEG abnormalities were localized to the site of RPMA in nine patients. RPMA involved areas remote from the site of EEG abnormalities in four patients. We have developed a comprehensive classification to account for the wide spectrum of RPMA involving gray matter, white matter and leptomeninges with or without contrast enhancement or mass effect. Follow-up MRIs showed complete resolution of RPMA in all, except in four patients, who developed residual focal atrophy. During median follow-up period of 3 years, recurrence of RPMA was observed in two patients. Diffusion weighted MRI in two patients and histopathological finding in one patient favored causal role of hypoxia in the pathogenesis of RPMA. Our observations help to understand the electroclinical profile, radiological spectrum, localization significance and natural history of RPMA better.