Brainstem infarction in a patient with internal carotid dissection and persistent trigeminal artery: a case report

Background  

The primitive trigeminal artery (PTA) is the most commonly described fetal anastomosis between the carotid and vertebrobasilar circulations.     

Efforts to support special-needs soldiers serving in the Israeli defense forces

Providing treatment and support to special-needs populations can decrease psychopathology and suicide rates. Because service in the military is an important socializing force in Israeli society and most Israelis serve, the Israeli Defense Forces (IDF) makes special efforts to identify, treat, and support soldiers with emotional, behavioral, and cognitive problems. This column describes the IDF's efforts for three groups of soldiers with special needs, with a focus on those with the most severe problems who receive support throughout their service to address psychopathology and suicidality. Suicide rates for the IDF population and for the three groups are reported.     

Carotid artery in-stent restenosis in a patient with contralateral total occlusion, resolved with drug-eluting stenting

A 70-year-old male patient with 90% stenosis of the right carotid artery and total occlusion of the left carotid artery underwent right carotid stenting. Two weeks after the procedure, the patient experienced grand mal seizures, and had angioplasty after 6 and 11 months, respectively, for recurrent in-stent restenosis. During drug-eluting stent deployment, the patient developed acute stent thrombosis, but he recovered quickly and completely after local thrombolysis and balloon angioplasty. For the 1 year of follow up to date, the patient has been symptom-free and without restenosis. At 6 months from the last-mentioned study, the patient was admitted for intermittent claudication, fatigability and severe hypertension. A Doppler study of the carotid stent showed normal velocities, and the the neurological exam was similar to the previous one. Angiography confirmed bilateral ostial stenosis of the renal arteries and we performed bilateral renal stenting at that time.