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Micieli E, Voci D, Mumoli N, Mastroiacovo D, Grigorean A, Obadia M, de Champfleur NM, Naggara O, Carsin B, Amor-Sahli M, Cottier JP, Bensoussan J, Auffray-Calvier E, Varoquaux A, Bonneville F, Sadik JC, Kucher N, Lecler A, Barco S. Transient perivascular inflammation of the carotid artery (TIPIC) syndrome. VASA 2022; 51:71-77. [PMID: 35130715 DOI: 10.1024/0301-1526/a000989] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The Transient Perivascular Inflammation of the Carotid artery (TIPIC) syndrome is presumably a very rare disease characterized by a local transient inflammation of the tissue around the carotid artery. Its pathophysiology remains unknown. We performed an updated study of TIPIC syndrome cases in the setting of a multinational collaborative study. Methods: This study was conducted as an observational multinational retrospective individual patient level cohort study. Information from all known cases diagnosed with TIPIC syndrome in the literature (2005-2020) was collected after a semi-structured literature search of PubMed and Web of Science. We also collected unpublished information of patients from French, Swiss, and Italian vascular medicine or radiology departments. Results: A total of 72 patients were included and served for data analysis: 42 (58.3%) were women; the mean age was 47.9 (SD=11.4) years. Symptoms were unilateral in 92% of patients and 81.4% required pain killers. At baseline, irrespective of the imaging method used, the median thickness of the carotid lesions was 5 (Q1-Q3: 4-7; range: 2-11) mm and the median length of the lesion was 20 (Q1-Q3: 10-30; range: 3-50) mm. We found a positive linear correlation between thickness and length. At follow-up, the thickness of the carotid lesions decreased to a median of 2 (Q1-Q3: 1-3; range: 0-6) mm; the length decreased to a median 10 (Q1-Q3: 5-15; range: 0-41) mm. A linear correlation between baseline and follow-up values was observed for both thickness and length measurements. Symptoms disappeared after a median of 14 (Q1-Q3: 10-15) days. Thirteen patients experienced a recurrence after a median follow-up of 6 (Q1-Q3: 2-12) months. Conclusions: The present analysis elucidates clinical and sonographic characteristics of TIPIC syndrome, indicating the benign nature of this condition. A future international registry will study the long-term course of the disease.
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Affiliation(s)
- Evy Micieli
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Nicola Mumoli
- Department of Internal Medicine, Magenta Hospital, Magenta (MI), Italy
| | | | | | - Michael Obadia
- Department of Neurology, A.Rothschild Foundation Hospital, Paris, France
| | | | - Olivier Naggara
- Department of Neuroradiology, CHU Sainte Anne, Paris, France
| | | | - Malika Amor-Sahli
- Department of Neuroradiology, CHU La Pitié-Salpêtrière, Paris, France
| | | | | | | | | | | | - Jean Claude Sadik
- Department of Neuroradiology, A.Rothschild Foundation Hospital, Paris, France
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Augustin Lecler
- Department of Neuroradiology, A.Rothschild Foundation Hospital, Paris, France
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland.,Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
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Modi T, Verma M, Ahuja G, Kamat N, Patkar DP. TIPIC-A Newly Recognized Syndrome: Multimodality Imaging of a Rare Clinicoradiological Entity. Indian J Radiol Imaging 2021; 31:488-491. [PMID: 34556937 PMCID: PMC8448226 DOI: 10.1055/s-0041-1734353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Carotidynia is a controversial clinicopathological entity vastly described in Western literature as neck pain in the region of carotid bifurcation secondary to an underlying inflammatory etiology. Radiologically, this appears as perivascular inflammation and has recently been designated as transient perivascular inflammation of the carotid artery (TIPIC) syndrome. The authors of this report discuss the multimodality imaging features of a rare case of this disease in our country to familiarize radiologists with the imaging findings and to encourage the inclusion of TIPIC syndrome as a differential diagnosis for focal neck pain.
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Affiliation(s)
- Tanvi Modi
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
| | - Mitusha Verma
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
| | - Gauri Ahuja
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
| | - Neemish Kamat
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
| | - Deepak P Patkar
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
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Rafailidis V, Chryssogonidis I, Tegos T, Partovi S, Charitanti-Kouridou A, Staub D. Role of multi-parametric ultrasound in transient perivascular inflammation of the carotid artery syndrome. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2019; 27:77-84. [PMID: 31037091 DOI: 10.1177/1742271x18822658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/06/2018] [Indexed: 01/25/2023]
Abstract
Introduction The term "carotidynia" has been used to describe a symptom or a nosologic entity characterized by pain in the lateral neck region and over the carotid bifurcation. Recent advances in diagnostic imaging and the introduction of diagnostic criteria have led to the adoption of term "Transient perivascular inflammation of the carotid artery" (TIPIC) syndrome. Method A retrospective analysis of the Radiology Department's database was performed to identify cases with the diagnosis of TIPIC syndrome. The purpose was to identify ultrasound images including B-mode technique, colour, power Doppler technique and contrast-enhanced ultrasound (CEUS). Findings In total, five patients with the diagnosis of TIPIC syndrome are presented in this review. TIPIC syndrome is a clinic-radiologic entity characterized by pain over the carotid area, a symptom referring to a wide differential diagnosis where imaging plays a crucial role for proper diagnosis and treatment. Characteristic imaging findings on conventional ultrasound and CEUS are presented in this review. Discussion TIPIC syndrome can be investigated with virtually any imaging modality. Ultrasound typically reveals perivascular infiltration and a hypoechoic intimal plaque, while no significant luminal narrowing is appreciated. Computed tomography angiography and magnetic resonance angiography also demonstrate these vascular wall changes primarily affecting the distal common carotid artery, the carotid bulb and possibly the internal carotid artery proximal part. Contrast enhancement is a very characteristic and constant finding of TIPIC lesions, suggestive of the inflammatory nature of the disease and can be appreciated on computed tomography angiography and magnetic resonance angiography. CEUS has been recently used and successfully observed contrast enhancement of the lesions, similar to computed tomography angiography and magnetic resonance angiography. Conclusion Ultrasound remains the first-line modality for the evaluation of TIPIC syndrome, capable of providing all the information needed, especially if supplemented with the administration of microbubbles so that the enhancement of lesions can be evaluated.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Neurology Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Sasan Partovi
- Department of Radiology, Section of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Afroditi Charitanti-Kouridou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Staub
- Department of Vascular Medicine/Angiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Imaging Spectrum of TIPIC Syndrome : Validation of a new Entity with Vessel Wall Imaging. Clin Neuroradiol 2018; 30:145-157. [PMID: 30470848 DOI: 10.1007/s00062-018-0746-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Acute neck pain can have non-vascular and vascular causes. Some patients present with distinct vascular and perivascular changes on imaging at the site of tenderness. This study aimed to evaluate the imaging findings of transient perivascular inflammation of the carotid artery (TIPIC) syndrome with an emphasis on vessel wall imaging using 3‑Tesla (3-T) high-resolution (HR) magnetic resonance imaging (MRI). METHODS Clinical data along with diagnostic and follow-up imaging of patients presenting to these hospitals with acute neck pain/tenderness and at least 1 imaging study using color Doppler ultrasound (CDU) and/or MRI including vessel wall imaging from September 2013 through September 2017 were retrospectively evaluated. A total of 15 patients with no other underlying cause of pain, findings meeting the imaging criteria for TIPIC syndrome and clinical recovery (spontaneous or with treatment) were included in the study. RESULTS The mean patient age was 43.2 years. With CDU and precontrast MRI, perivascular inflammation (PVI) of the involved artery segment was evident in all patients. Contrast enhancement of the adventitia and PVI were noted on postcontrast HR vessel wall MRI in all patients. Of the patients five had co-existing plaques at the site of tenderness. Follow-up imaging demonstrated pronounced regression or complete resolution of the findings. CONCLUSION Imaging is useful for the establishment of TIPIC syndrome diagnosis and to rule out other conditions. The use of CDU is usually sufficient for diagnosis and follow-up but in clinically doubtful and complicated cases, vessel wall imaging with HR-MRI is very valuable. Thorough knowledge of this entity among radiologists enables a prompt diagnosis, which accelerates the clinical management.
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Lecler A, Obadia M, Savatovsky J, Picard H, Charbonneau F, Menjot de Champfleur N, Naggara O, Carsin B, Amor-Sahli M, Cottier JP, Bensoussan J, Auffray-Calvier E, Varoquaux A, De Gaalon S, Calazel C, Nasr N, Volle G, Jianu DC, Gout O, Bonneville F, Sadik JC. TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity. AJNR Am J Neuroradiol 2017; 38:1391-1398. [PMID: 28495942 DOI: 10.3174/ajnr.a5214] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity. MATERIALS AND METHODS From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets. RESULTS The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others. CONCLUSIONS Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.
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Affiliation(s)
- A Lecler
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | | | - J Savatovsky
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - H Picard
- Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Charbonneau
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - N Menjot de Champfleur
- Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - O Naggara
- Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - B Carsin
- Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France
| | - M Amor-Sahli
- Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France.,Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France
| | - J P Cottier
- Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France.,Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France
| | - J Bensoussan
- Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France
| | | | - A Varoquaux
- Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France
| | - S De Gaalon
- Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France
| | - C Calazel
- Departments of Neuroradiology (C.C., F.B.)
| | - N Nasr
- Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - G Volle
- Neurology (M.O., G.V., O.G.)
| | - D C Jianu
- Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - O Gout
- Neurology (M.O., G.V., O.G.)
| | | | - J C Sadik
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
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A pain in the throat: a 19-year history of symptoms relating to the carotid artery. Wien Klin Wochenschr 2014; 127:143-5. [PMID: 25398291 DOI: 10.1007/s00508-014-0633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
A 38-year-old man presented with a 19-year history of sore throat and an ache radiating from the centre of the anterior neck to the both ears and the occiput. Computed tomography angiography revealed a tortuous submucosal right internal carotid artery, which was causing tonsillar displacement. The diagnosis of carotidynia has a controversial history within the literature and is currently not accepted as a distinct pathological entity by the International Headache Society. In this patient, the clinical and imaging features, in addition to the absence of any other pathology confers support to the diagnosis of carotidynia.
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8
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Inatomi Y, Nakajima M, Yonehara T, Hirano T. Contralateral recurrence of carotidynia during steroid therapy. J Stroke Cerebrovasc Dis 2012; 23:184-6. [PMID: 23253536 DOI: 10.1016/j.jstrokecerebrovasdis.2012.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/13/2012] [Accepted: 10/20/2012] [Indexed: 11/20/2022] Open
Abstract
A 44-year-old woman presented with contralateral recurrence of carotidynia during steroid therapy at 1 month after onset. Carotidynia can present with a multiphasic clinical course and can affect the neck bilaterally. Therefore, patients with carotidynia should be observed even after remission.
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Affiliation(s)
- Yuichiro Inatomi
- Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
| | - Makoto Nakajima
- Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan; Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Toshiro Yonehara
- Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Teruyuki Hirano
- Department of Internal Medicine III, Faculty of Medicine, Oita University, Oita, Japan
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COMACCHIO F, BOTTIN R, BRESCIA G, TSILIKAS K, VOLO T, TREGNAGHI A, MARTINI A. Carotidynia: new aspects of a controversial entity. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2012; 32:266-9. [PMID: 23093819 PMCID: PMC3468931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/24/2011] [Indexed: 10/24/2022]
Abstract
Idiopathic carotidynia or Fay syndrome is a little known pathology, which in the past was the subject of much controversy. Even though carotydinia was removed as a pathological entity from the second International Headache Society classification in 2004, recent reports seem to confirm that the disease demonstrates unusual radiological findings. The presence of a typical amorphous enhancing soft tissue surrounding the carotid artery by MRI, CT and ultrasonography in patients with carotidynia has reopened discussion on the hypothesis that carotidynia may represent a distinctive inflammatory process. The aetiology of carotidynia is unknown. We report a case of carotidynia that developed after an upper airway infection, wherein MR studies demonstrated typical enhanced tissue surrounding the common carotid artery in contiguity with pathological enhancement in laryngeal tissue.
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Affiliation(s)
- F. COMACCHIO
- Address for correspondence: Francesco Comacchio, via Polesine 40/D, 35142 Padua, Italy. Tel. +39 049 8808146. E-mail:
| | | | | | | | | | - A. TREGNAGHI
- Institute of Radiology, University Hospital of Padova
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Stanbro M, Gray BH, Kellicut DC. Carotidynia: revisiting an unfamiliar entity. Ann Vasc Surg 2012; 25:1144-53. [PMID: 22023945 DOI: 10.1016/j.avsg.2011.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/25/2011] [Accepted: 06/02/2011] [Indexed: 10/16/2022]
Abstract
Carotidynia (unilateral neck pain reproducible with light pressure on the carotid artery) is a controversial and poorly understood vascular condition. This review provides important historical information, several representative case reports, and a comprehensive summary of the literature. The authors also propose an algorithm for the care of these patients.
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Affiliation(s)
- Marcus Stanbro
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA
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Aydil U, Kizil Y, Köybaşioğlu A. Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders. Eur Arch Otorhinolaryngol 2011; 269:9-16. [PMID: 21842201 DOI: 10.1007/s00405-011-1746-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/01/2011] [Indexed: 11/26/2022]
Abstract
Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on head and neck area. As a result, most of the patients with these syndromes are either overlooked without having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face region or entities related to neuromusculoskeletal system may result in more appropriate and effective management of such conditions while avoiding unnecessary medical and surgical treatments. In this review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known craniofacial and neck pain entities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia, superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.
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Affiliation(s)
- Utku Aydil
- Department of Otorhinolaryngology, Gazi University School of Medicine, Gazi Ün Tıp Fak KBB AD, Beşevler, 06500 Ankara, Turkey.
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Symptomatic carotidynia: neck pain of vascular origin. Neurologia 2011; 26:310. [PMID: 21354669 DOI: 10.1016/j.nrl.2010.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 12/03/2010] [Accepted: 12/17/2010] [Indexed: 11/24/2022] Open
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Castrillo Sanz A, Mendoza Rodríguez A, Gil Polo C, Gutiérrez Ríos R. Symptomatic carotidynia: neck pain of vascular origin. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70065-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sato S, Yazawa Y, Itabashi R, Tsukika K, Furui E. [A case of carotidynia with carotid sinus hypersensitivity]. Rinsho Shinkeigaku 2010; 50:714-717. [PMID: 21061551 DOI: 10.5692/clinicalneurol.50.714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 71-year-old man presented with acute, right-sided neck pain and marked falls in blood pressure in response to cervical extension/rotation. Enhanced CT of the right carotid artery showed wall thickening and soft tissue enhancement surrounding the vessel. Ultrasonography demonstrated wall thickening and marked acceleration of the blood flow velocity. [18F] fluorodeoxyglucose (18F-FDG) positron-emission tomography (PET)-CT revealed increased FDG activity in the area of the right carotid bulb. The patient's symptoms resolved in 2 weeks with nonsteroidal anti-inflammatory drug; regression of wall thickening and decreased velocity were observed on follow-up ultrasonography. A carotid inflammatory process due to carotidynia in addition to atherosclerosis may increase carotid sinus baroreceptor stimulation, resulting in the onset of carotid sinus hypersensitivity.
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Holland NW, Patel BB. A pain in the neck. Am J Med 2010; 123:508-9. [PMID: 20569753 DOI: 10.1016/j.amjmed.2010.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 11/28/2022]
Affiliation(s)
- N Wilson Holland
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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