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Tarsia J, Vidal G, Zweifler RM. Arterial Dissection, Fibromuscular Dysplasia, and Carotid Webs. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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2
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Premi E, Pilotto A, Benussi A, Prandini F, Magoni M, Padovani A. Aberrant origin of the occipital artery from the internal carotid artery: utility of the occipital tap maneuver. J Vasc Surg Cases Innov Tech 2021; 7:743-745. [PMID: 34786528 PMCID: PMC8579073 DOI: 10.1016/j.jvscit.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022] Open
Abstract
We have described a case of a suspected transient ischemic attack with a double lumen potentially resembling a dissection of the internal carotid artery on Doppler ultrasound. The identification of an arterial branch from the internal carotid artery and flowing near it using magnetic resonance imaging suggested an aberrant origin of an ascending pharyngeal artery or occipital artery. Performance of the occipital tap maneuver in the occipital artery perfusion territory demonstrated a reflected flow in the double lumen, supporting the aberrant origin of the occipital artery from the internal carotid artery. The occipital tap maneuver can represent an easy-to-do procedure to distinguish anatomic variants and study double-lumen findings.
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Psychogios K, Magoufis G, Kargiotis O, Safouris A, Bakola E, Chondrogianni M, Zis P, Stamboulis E, Tsivgoulis G. Ultrasound Assessment of Extracranial Carotids and Vertebral Arteries in Acute Cerebral Ischemia. ACTA ACUST UNITED AC 2020; 56:medicina56120711. [PMID: 33353035 PMCID: PMC7765801 DOI: 10.3390/medicina56120711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/25/2022]
Abstract
Assessing ischemic etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis. Cervical Duplex Ultrasound (CDU) has evolved since many years as an excellent screening tool for the evaluation of extracranial vasculature. CDU has the advantages of a low cost, easily applicable, bed side examination with high temporal and spatial resolution and without exposing the patients to any significant complications. It represents an easily repeatable test that can be performed in the emergency room as a first-line examination of cervical artery pathology. CDU provides well validated estimates of the type of the atherosclerotic plaque, the degree of stenosis, as well as structural and hemodynamic information directly about extracranial vessels (e.g., subclavian steal syndrome) and indirectly about intracranial circulation. CDU may also aid the diagnosis of non-atherosclerotic lesions of vessel walls including dissections, arteritis, carotid-jugular fistulas and fibromuscular dysplasias. The present narrative review outlines all potential applications of CDU in acute stroke management and also highlights its potential therapeutic implications.
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Affiliation(s)
- Klearchos Psychogios
- Acute Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (K.P.); (O.K.); (A.S.); (E.S.)
- Second Department of Neurology, Attikon University Hospital, 15772 Athens, Greece; (E.B.); (M.C.)
- School of Medicine, University of Athens, 15772 Athens, Greece
| | - Georgios Magoufis
- Department of Interventional Neuroradiology, Metropolitan Hospital, 18547 Piraeus, Greece;
| | - Odysseas Kargiotis
- Acute Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (K.P.); (O.K.); (A.S.); (E.S.)
| | - Apostolos Safouris
- Acute Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (K.P.); (O.K.); (A.S.); (E.S.)
| | - Eleni Bakola
- Acute Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (K.P.); (O.K.); (A.S.); (E.S.)
| | - Maria Chondrogianni
- Acute Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (K.P.); (O.K.); (A.S.); (E.S.)
| | - Panagiotis Zis
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus;
| | - Elefterios Stamboulis
- Acute Stroke Unit, Metropolitan Hospital, 18547 Piraeus, Greece; (K.P.); (O.K.); (A.S.); (E.S.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, 15772 Athens, Greece; (E.B.); (M.C.)
- Correspondence:
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Wada S, Koga M, Makita N, Nakamura Y, Miwa K, Ide T, Yi K, Mizoguchi T, Yamaguchi Y, Ihara M, Toyoda K. Detection of Stenosis Progression in Intracranial Vertebral Artery Dissection Using Carotid Ultrasonography. J Stroke Cerebrovasc Dis 2019; 28:2201-2206. [PMID: 31122713 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess whether carotid ultrasonography indices detect arterial stenosis progression in patients with vertebral artery (VA) dissection. METHODS This was a retrospective, single-center, observational study that enrolled patients with intracranial VA dissection who were admitted from January 2011 to June 2017. Magnetic resonance angiography (MRA) was done on admission and followed up at a median 20 days after onset (interquartile range [IQR] 9-58 days), and ultrasonography was performed at a median of 22 (interquartile range 7-56) days. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), and pulsatility index (PI) were measured by ultrasonography, and the ratio of each follow-up value to the baseline (follow-up/baseline) value was calculated. Two stroke neurologists categorized into 3 groups by morphological changes of the dissected vessel: patients with stenosis progression (progression group: P-group); those with no remarkable change or dilatation improved (stable group: S-group); and those with stenosis regression or dilatation enlargement (enlargement group: E-group). Ultrasonography indices were compared among the groups. RESULTS Of the 42 patients who were enrolled to this study, 39 patients underwent ultrasonography and MRA on both admission and follow-up. The PI ratio was significantly higher in the P-group than in the S-group (1.96 ± .80 versus .98 ± .44, P = .02) and in the E-group (versus .65 ± .35, P < .01). There were no significant differences in the PSV ratio, EDV ratio, and MV ratio. CONCLUSIONS In patients with VA dissection, the PI ratio on ultrasonography is a promising index to detect stenosis progression.
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Affiliation(s)
- Shinichi Wada
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoki Makita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Nakamura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshihiro Ide
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichiro Yi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Xu K, Sun W, Dong Z, Xing H, Huang Y. Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:243-246. [PMID: 30673141 DOI: 10.1002/jcu.22685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/21/2018] [Accepted: 12/16/2018] [Indexed: 06/09/2023]
Abstract
We report the case of a patient with chronic type A aortic dissection (AD), who had been admitted, 18 months ago, to another hospital with acute chest-tearing pain accompanied with transient loss of consciousness. His symptoms resolved but he reported after discharge a toothache and fluctuating right mandibular pain. He presented to our outpatient clinic because his facial pain aggravated. Physical examination demonstrated a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection extending into the extracranial right internal carotid artery (ICA), which was tortuous. The patient refused surgery. This case reminds us that AD can involve the extracranial ICA, and that long-term survival is possible with type A acute AD without treatment. Carotid ultrasonography is noninvasive, inexpensive, easily performed, and can lead to the detection of chronic type A AD extending to the extracranial ICA.
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Affiliation(s)
- Ke Xu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhenya Dong
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Haiying Xing
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
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Adkins AL, Zelenock GB, Bendick PJ, Shanley CJ. Duplex Ultrasound Recognition of Spontaneous Carotid Dissection. Vasc Endovascular Surg 2016; 38:455-60. [PMID: 15490044 DOI: 10.1177/153857440403800510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spontaneous dissection of the internal carotid artery is an uncommon entity with a variable clinical presentation. A high index of suspicion is required to make the diagnosis, and prompt diagnosis and treatment with anticoagulation are essential for improved patient outcomes. Duplex ultrasound provides a safe and reliable imaging modality for early diagnosis and followup. The authors present a case of spontaneous internal carotid artery dissection with duplex ultrasound findings and a review of the literature.
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Affiliation(s)
- Amy L Adkins
- Division of Vascular Surgery, Department of Surgery, William Beaumont Hospital, Royal Oak, Michigan 48073, USA
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8
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Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA, Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129:1048-78. [PMID: 24548843 DOI: 10.1161/01.cir.0000442577.96802.8c] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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9
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Dittrich R, Ritter MA, Ringelstein EB. Ultrasound in spontaneous cervical artery dissection. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.permed.2012.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Suzuki R, Koga M, Toyoda K, Uemura M, Nagasawa H, Yakushiji Y, Moriwaki H, Yamada N, Minematsu K. Identification of internal carotid artery dissection by transoral carotid ultrasonography. Cerebrovasc Dis 2012; 33:369-77. [PMID: 22433224 DOI: 10.1159/000336121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 12/21/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Conventional transsurface carotid ultrasonography (TSCU) via the cervical surface often fails to detect dissection of the extracranial internal carotid artery (ICA). The role of transoral carotid ultrasonography (TOCU) in the detection of ICA dissection was examined. METHOD Patients with unilateral extracranial ICA dissection identified by digital subtraction angiography (DSA) from our database of patients with ischemic stroke or transient ischemic attack (TIA) were reviewed. Findings of dissection were compared between TSCU and TOCU. RESULTS Eight patients (7 men, 37-69 years old), including 7 with ischemic stroke and 1 with TIA, had ICA dissection. By DSA, dissection was identified between the first and third vertebrae in 4 patients and from the third cervical vertebra to the intracranial level in the remaining 4. TOCU images revealed an intimal flap as definite evidence of dissection in all patients. In 7 patients, color flow signals were not seen in false lumens, indicating thrombosed lumens. Four patients showed morphological changes of dissection on follow-up TOCU, including a patient with recovery of color flow signals in false lumens. The diameter of the dissected ICA was 7.3 ± 0.7 mm and that of the contralateral ICA was 4.9 ± 0.6 mm (p = 0.008). In contrast, TSCU did not enable any conclusive findings of ICA dissection to be made in any patient. Six patients had intramural hematoma on T(1)-weighted MRI, and 2 had an intimal flap with a double lumen on magnetic resonance angiography. CONCLUSION TOCU has advantages over TSCU in achieving an accurate diagnosis and follow-up evaluation of ICA dissection.
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Affiliation(s)
- Rieko Suzuki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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11
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Babic S, Mitrasinovic A, Gajin P, Ilijevski N, Radak D. Missed dissection as a result of the ascending pharyngeal artery arising from the internal carotid artery. Ann Vasc Surg 2011; 25:701.e5-8. [PMID: 21546212 DOI: 10.1016/j.avsg.2011.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 11/30/2010] [Accepted: 02/08/2011] [Indexed: 11/29/2022]
Abstract
Unlike high-grade stenosis, dissections of craniocervical arteries are a rare cause of cerebrovascular infarction. If the internal carotid artery (ICA) dissection is verified by duplex scanning or computed tomography angiography (CTA), the therapies of choice are antiplatelet and anticoagulation drugs, and surgical treatment is rarely performed. However, despite distinct clinical and radiological manifestation, carotid dissections are still under-recognized. In this study, we demonstrate the case of a 66-year-old man with dissection of ICA verified by duplex scanning and computed tomography angiography. The cause of missed diagnosis was an ascending pharyngeal artery originating from the ICA that runs parallel to it. Other than being a rare variation, this case may be interesting as a cause of misdiagnosis.
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Affiliation(s)
- Srdjan Babic
- Department of Vascular Surgery, Institute for Cardiovascular Disease Dedinje, Belgrade, Republic of Serbia.
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12
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Kaniecki RG, Taylor FR, Landy SH. Abstracts and Citations. Headache 2011. [DOI: 10.1111/j.1526-4610.2011.01897.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Zweifler RM, Silverboard G. Arterial Dissections and Fibromuscular Dysplasia. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fusco MR, Harrigan MR. Cerebrovascular Dissections—A Review Part I: Spontaneous Dissections. Neurosurgery 2011; 68:242-57; discussion 257. [DOI: 10.1227/neu.0b013e3182012323] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
abstract
Spontaneous cerebrovascular dissections are subintimal or subadventitial cervical carotid and vertebral artery wall injuries and are the cause of as many as 2% of all ischemic strokes. Spontaneous dissections are the leading cause of stroke in patients younger than 45 years of age, accounting for almost one fourth of strokes in this population. A history of some degree of trivial trauma is present in nearly one fourth of cases. Subsequent mortality or neurological morbidity is usually the result of distal ischemia produced by emboli released from the injury site, although local mass effect produced by arterial dilation or aneurysm formation also can occur. The gold standard for diagnosis remains digital subtraction angiography. Computed tomography angiography, magnetic resonance angiography, and ultrasonography are complementary means o evaluation, particularly for injury screening or treatment follow-up. The annual rate of stroke after injury is approximately 1% or less per year. The currently accepted method of therapy remains antithrombotic medication, either in the form of anticoagulation or antiplatelet agents; however, no class I medical evidence exists to guide therapy. Other options for treatment include thrombolysis and endovascular therapy, although the efficacy and indications for these methods remain unclear.
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Affiliation(s)
- Matthew R. Fusco
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark R. Harrigan
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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Bonati LH, Wetzel SG, Kessel-Schaefer A, Buser P, Lyrer PA, Engelter ST. Diffusion-weighted imaging findings differ between stroke attributable to spontaneous cervical artery dissection and patent foramen ovale. Eur J Neurol 2009; 17:307-13. [DOI: 10.1111/j.1468-1331.2009.02805.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chamoun RB, Mawad ME, Whitehead WE, Luerssen TG, Jea A. Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options. J Neurosurg Pediatr 2008; 2:101-8. [PMID: 18671613 DOI: 10.3171/ped/2008/2/8/101] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Currently, no diagnostic or treatment standards exist for extracranial carotid artery dissection (CAD) in children after trauma. The purpose of this study was to review and describe the characteristics, diagnosis, and treatment of this rather uncommon sequelae of pediatric trauma. METHODS A systematic review of the literature was performed to examine the pertinent studies of traumatic extracranial carotid artery (CA) injuries in children. RESULTS No randomized trials were identified; however, 19 case reports or small case series consisting of 34 pediatric patients were found in the literature. The diagnosis of CAD was made in 33 of 34 patients only after the onset of ischemic symptomatology. Twenty-four of 34 patients underwent cerebral angiography to confirm diagnosis; MR angiography affirmed the diagnosis in 6 of 34 patients. There was little published experience with CA ultrasonography or CT angiography for diagnosis. Thirty of 34 patients were treated with medical therapy or observation; 2 of 4 patients treated with observation alone died. There was little experience with open surgical treatment of CAD in the pediatric population, and there were no studies on the endovascular treatment of traumatic CAD in children. The literature does not support anticoagulation therapy over antiplatelet therapy. CONCLUSIONS As a result of this review of the literature, the authors propose the algorithms for the evaluation and treatment of traumatic extracranial CADs in children. These recommendations include utilizing MR angiography as a screening tool in cases in which the clinical suspicion of CAD is high, using conventional cerebral angiography to confirm the diagnosis, implementing antiplatelet therapy as initial medical management, and reserving endovascular stenting in cases of failed medical treatment.
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Affiliation(s)
- Roukoz B Chamoun
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Arnold M, Baumgartner RW, Stapf C, Nedeltchev K, Buffon F, Benninger D, Georgiadis D, Sturzenegger M, Mattle HP, Bousser MG. Ultrasound Diagnosis of Spontaneous Carotid Dissection With Isolated Horner Syndrome. Stroke 2008; 39:82-6. [PMID: 18006862 DOI: 10.1161/strokeaha.107.492652] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Isolated Horner syndrome without associated cranial nerve palsies or ischemic symptoms is an important presentation of spontaneous internal carotid artery dissection (sICAD). Ultrasound is often used as a screening method in these patients because cervical MRI is not always available on an emergency basis. Current knowledge on ultrasound findings in patients with sICAD presenting with isolated Horner syndrome is limited.
Methods—
Patients were recruited from prospective cervical artery dissection databases of 3 tertiary care centers. Diagnosis of sICAD was confirmed by cervical MRI and MR angiography or digital subtraction angiography in all patients. Data on Doppler sonography and color duplex sonography examinations performed within 30 days of symptom onset were analyzed.
Results—
We identified 88 patients with Horner syndrome as the only sign of sICAD. Initial ultrasound examination was performed in 72 patients after a mean time interval from symptom onset to examination of 11 (SD 8) days. The overall frequency of false-negative ultrasound findings was 31% (22 of 72 patients). It showed stenosis ≥80% or occlusion in 34 (47%) patients, and stenosis ≤80% in 16 (22%). It visualized mural hematoma in 7 patients and intimal flap in one. Patients with normal ultrasound were less frequently smokers (9% versus 28%,
P
=0.034), and had less frequently migraine without aura (9% versus 43%,
P
=0.012) or neck pain (18% versus 62%,
P
=0.003) than those with pathological ultrasound findings.
Conclusions—
Nearly one third of patients with Horner syndrome as the only sign of sICAD presented with normal ultrasound findings. These results indicate that ultrasound is not a reliable method to diagnose sICAD in patients with isolated Horner syndrome.
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Affiliation(s)
- Marcel Arnold
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Ralf W. Baumgartner
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Christian Stapf
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Krassen Nedeltchev
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Frédérique Buffon
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - David Benninger
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Dimitrios Georgiadis
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Matthias Sturzenegger
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Heinrich P. Mattle
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
| | - Marie-Germaine Bousser
- From the Assistance Publique (M.A., C.S., F.B., M.-G.B.), Hôpitaux de Paris, Department of Neurology, University Hospitals Lariboisière, Paris; the Department of Neurology (M.A., K.N., M.S., H.P.M.), University Hospital Berne, Switzerland; and the Department of Neurology (R.W.B., D.B., D.G.), University Hospital Zurich, Switzerland
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Pieri A, Spitz M, Valiente RA, Avelar WM, Silva GS, Massaro AR. Dissecção espontânea das artérias carótidas e vertebrais em uma população multiétnica. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:1050-5. [DOI: 10.1590/s0004-282x2007000600029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 08/10/2007] [Indexed: 11/22/2022]
Abstract
A dissecção espontânea das artérias carótidas e vertebrais (DEACV) é considerada uma causa rara de acidente vascular cerebral, particularmente em países com população multiétnica. O objetivo desse estudo foi avaliar características clínicas e de neuroimagem dos pacientes com DEACV em uma população multiétnica. Foram estudados 66 pacientes com diagnóstico de DEACV em dois hospitais terciários de São Paulo. Aplicou-se um questionário inicial e os pacientes foram seguidos prospectivamente. Dos pacientes estudados, 82% eram brancos, 53% eram homens e a média de idade foi 41,7 anos. Os fatores de risco cardiovasculares mais freqüentes foram hipertensão arterial e tabagismo. Outros aspectos avaliados foram história prévia de enxaqueca, tratamento inicial e prognóstico. Concluiu-se que apesar da população estudada ser multiétnica, houve um marcante predomínio de brancos. A análise das características clínicas e de neuroimagem dos pacientes com DEACV possibilita um melhor conhecimento da doença, levando a um diagnóstico precoce e tratamento mais adequado.
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Alecu C, Fortrat JO, Ducrocq X, Vespignani H, de Bray JM. Duplex Scanning Diagnosis of Internal Carotid Artery Dissections. Cerebrovasc Dis 2007; 23:441-7. [PMID: 17406115 DOI: 10.1159/000101469] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 12/08/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The reliability of duplex scanning (DS) for the diagnosis of internal carotid artery dissections (ICAD) is not clear. METHODS Nine DS signs known to be suggestive for the diagnosis of ICAD were compared between 70 patients with ICAD and 70 matched patients without dissection. RESULTS Visible internal tapering occlusion, regular eccentric narrowing channel, ectasia beyond the carotid bulb, resistive index asymmetry, blood flow slowdown, ophthalmic artery blood flow inversion, and biphasic flow are more frequent in cases than in controls (p < 0.001). Atheroma plaques were absent in 80% of ICAD. When DS direct signs and hemodynamic signs were studied, sensitivity was 90% and specificity 60%. CONCLUSION Diagnosis of ICAD by DS could be improved if direct signs were combined with hemodynamic signs, giving a high sensitivity and a rather good specificity.
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MESH Headings
- Adult
- Blood Flow Velocity
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/physiopathology
- Carotid Artery, Internal, Dissection/complications
- Carotid Artery, Internal, Dissection/diagnosis
- Carotid Artery, Internal, Dissection/diagnostic imaging
- Carotid Artery, Internal, Dissection/physiopathology
- Case-Control Studies
- Databases as Topic
- Female
- France
- Humans
- Laser-Doppler Flowmetry
- Logistic Models
- Male
- Middle Aged
- Ophthalmic Artery/diagnostic imaging
- Predictive Value of Tests
- Reproducibility of Results
- Retrospective Studies
- Sensitivity and Specificity
- Stroke/diagnostic imaging
- Stroke/etiology
- Stroke/physiopathology
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Duplex/methods
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Affiliation(s)
- C Alecu
- Neurology Department, University Hospital, Nancy, France.
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21
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Masdeu JC, Irimia P, Asenbaum S, Bogousslavsky J, Brainin M, Chabriat H, Herholz K, Markus HS, Martínez-Vila E, Niederkorn K, Schellinger PD, Seitz RJ. EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force. Eur J Neurol 2006; 13:1271-83. [PMID: 17116208 DOI: 10.1111/j.1468-1331.2006.01507.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neuroimaging techniques are necessary for the evaluation of stroke, one of the leading causes of death and neurological impairment in developed countries. The multiplicity of techniques available has increased the complexity of decision making for physicians. We performed a comprehensive review of the literature in English for the period 1965-2005 and critically assessed the relevant publications. The members of the panel reviewed and corrected an initial draft, until a consensus was reached on recommendations stratified according to the European Federation of Neurological Societies (EFNS) criteria. Non-contrast computed tomography (CT) scan is the established imaging procedure for the initial evaluation of stroke patients. However, magnetic resonance imaging (MRI) has a higher sensitivity than CT for the demonstration of infarcted or ischemic areas and depicts well acute and chronic intracerebral hemorrhage. Perfusion and diffusion MRI together with MR angiography (MRA) are very helpful for the acute evaluation of patients with ischemic stroke. MRI and MRA are the recommended techniques for screening cerebral aneurysms and for the diagnosis of cerebral venous thrombosis and arterial dissection. For the non-invasive study of extracranial vessels, MRA is less portable and more expensive than ultrasonography but it has higher sensitivity and specificity for carotid stenosis. Transcranial Doppler is very useful for monitoring arterial reperfusion after thrombolysis, for the diagnosis of intracranial stenosis and of right-to-left shunts, and for monitoring vasospasm after subarachnoid hemorrhage. Currently, single photon emission computed tomography and positron emission tomography have a more limited role in the evaluation of the acute stroke patient.
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Affiliation(s)
- J C Masdeu
- Department of Neurology and Neurosurgery, University of Navarra, Pamplona, Spain.
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22
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Gobin-Metteil MP, Oppenheim C, Domigo V, Trystram D, Brami-Zylberberg F, Naggara O, Meder JF. [Cervical arteries dissection: diagnostic Color Doppler US criteria at the acute phase]. ACTA ACUST UNITED AC 2006; 87:367-73. [PMID: 16691164 DOI: 10.1016/s0221-0363(06)74015-x] [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: 10/22/2022]
Abstract
PURPOSE To estimate the value of duplex color-coded ultrasonography in the initial diagnosis of acute cervical artery dissection. MATERIAL AND METHOD Retrospective study of 31 patients, mean age 45, sex ratio=1, referred for clinical suspicion of cervical artery dissection, confirmed by MRI. 46 dissected arteries were imaged. Ten patients presented multiple dissections. The evaluated sonographic diagnostic criteria were the direct signs of intra-mural hematoma: localized increased diameter of the artery, narrowed lumen, hypo and/or isoechoic intra-mural hematoma, intimal flap. The associated criteria studied were: the location of intra-mural hematoma and in case of an occlusion, the dissection of an other artery. RESULTS We analyzed separately the arterial segments visualized in B-mode ultrasound (supra-bulbar internal carotid artery, vertebral artery from V0 to V3) and the arterial segments evaluated only by pulsed Doppler (intrapetrosal carotid artery, V3-V4 of the vertebral artery). With the above criteria, on arterial segments visualized in B-mode ultrasound, the diagnosis of dissection was done in 83% of cases during the initial examination but in only 30% of the arterial segments non visualized on ultrasonography. CONCLUSION The direct signs of intra-mural hematoma on internal carotid and vertebral segments imaged by B-mode ultrasonography have a good sensitivity. Because results were compared to MRI, the specificity could not be assessed. In case of occlusion of an artery, multiple dissections are a strong argument for the diagnosis.
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Affiliation(s)
- M P Gobin-Metteil
- Département d'Imagerie Morphologique et Fonctionnelle, Centre Hospitalier Sainte-Anne, 1 rue Cabanis 74674 Paris cedex 14.
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Benninger DH, Georgiadis D, Gandjour J, Baumgartner RW. Accuracy of Color Duplex Ultrasound Diagnosis of Spontaneous Carotid Dissection Causing Ischemia. Stroke 2006; 37:377-81. [PMID: 16373650 DOI: 10.1161/01.str.0000198811.65068.16] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Spontaneous dissection of the cervical internal carotid artery (sICAD) is mainly assessed with MRI and magnetic resonance angiography (MRA), which are not always at hand. In contrast, color duplex sonography (CDS) is readily available. We undertook this prospective study to examine the accuracy of CDS to diagnose sICAD in patients with first carotid territory ischemia.
Methods—
Consecutive patients with first carotid territory stroke or transient ischemic attack or retinal ischemia underwent clinical and laboratory examinations, ECG, CDS of the cerebral arteries, cranial computed tomography in case of stroke or transient ischemic attack, and echocardiography and 24-hour ECG in selected cases. Patients were included, if they were <65 years of age, CDS showed a probable sICAD (cervical internal carotid artery stenosed or occluded), or had no determined etiology of ischemia. All of the included patients underwent cervical MRI and MRA±cerebral catheter angiography. The sonographer was blinded to the results of MRI and angiography studies.
Results—
We included 177 of 1652 screened patients. Excluded patients (n=1475) were ≥65 years old (n=818), had another determined cause of ischemia (n=1475), and had intracranial hemorrhage (n=58). CDS diagnosed sICAD in 77 of 177 patients, and the etiology of ischemia was undetermined in the remaining 100 patients. Cervical MRI and angiography showed 74 sICAD; there were 6 falsely positive and 3 falsely negative CDS findings. Thus, sensitivity, specificity, and positive and negative predictive values for CDS diagnosis of patients with sICAD causing carotid territory ischemia was 96%, 94%, 92%, and 97%, respectively.
Conclusions—
Color duplex ultrasound allows the reliable exclusion of sICAD in patients with carotid territory ischemia, whereas diagnosis of CDS of sICAD must be confirmed with cervical MRI and MRA.
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Affiliation(s)
- David H Benninger
- Department of Neurology, University Hospital of Zürich, CH-8091 Zürich, Switzerland
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24
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Dittrich R, Dziewas R, Ritter MA, Kloska SP, Bachmann R, Nassenstein I, Kuhlenbaumer G, Heindel W, Ringelstein EB, Nabavi DG. Negative ultrasound findings in patients with cervical artery dissection. J Neurol 2005; 253:424-33. [PMID: 16307203 DOI: 10.1007/s00415-005-0051-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 09/12/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cervical artery dissection (CAD) is a common cause of ischemic stroke in the younger age group. Modern imaging techniques allow the depiction of the mural hematoma, even in CADs with only subtle vessel alterations. The aim of this retrospective study was (1) to characterize the angiological features in CAD and (2) to determine the frequency of initially normal ultrasonography (US) findings. METHODS 86 patients aged 44 +/- 11 years with CAD of the internal carotid (ICA), (n = 55) or the vertebral artery (VA), (n = 31), admitted to our hospital within 8 days (mean 1.6 days) of symptom onset, were included. CAD was confirmed either by CT-angiography, MRI of the neck, MR-angiography or digital substraction angiography (DSA) and was compared with the results of the initial as well as repeated US examinations of the arteries supplying the brain. RESULTS In 75 patients (81.2 %) signs of vessel stenosis or occlusion were found while 11 patients (12.8%) with CAD of the ICA (n = 9) and the VA (n = 2) had normal US findings. The site of dissection in the US negative patients was highly variable without a predilection site. In 2 of 7 patients with repeated US examinations, complete vessel occlusion was found on follow-up, while in 5 patients again normal results were found. In four patients, there were changing findings in two alternative confirming imaging methods (MRI/DSA, CT/MRI) and in one patient conflicting findings (CT/MRI). Brain infarctions had occurred in 7 of the initially sonographically normal patients while the other 4 had suffered from transient (n = 2) or local (n = 2) symptoms only. CONCLUSION Approximately 1 out of 8 patients with subsequently proven CAD has negative initial neurovascular US findings despite comprehensive examination. In patients with suspected CAD and negative US examination, repeated US examinations and further diagnostic imaging, especially MRI is necessary.
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MESH Headings
- Adult
- Angiography, Digital Subtraction
- Blood Pressure/physiology
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/pathology
- Cerebral Angiography
- Cerebral Arterial Diseases/diagnostic imaging
- Cerebral Arterial Diseases/epidemiology
- Cerebral Arterial Diseases/pathology
- Cerebral Arteries/diagnostic imaging
- Cerebral Arteries/pathology
- Cohort Studies
- Constriction, Pathologic/diagnostic imaging
- Constriction, Pathologic/pathology
- False Negative Reactions
- Female
- Follow-Up Studies
- Heart Rate/physiology
- Humans
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Retrospective Studies
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Duplex
- Ultrasonography, Doppler, Transcranial
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Affiliation(s)
- R Dittrich
- Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48129, Münster, Germany.
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Tola M, Yurdakul M, Cumhur T. B-flow imaging in low cervical internal carotid artery dissection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1497-502. [PMID: 16239652 DOI: 10.7863/jum.2005.24.11.1497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Generally, the vascular ultrasonographic examination is the first method in evaluation of internal carotid artery (ICA) dissection. B-flow imaging (BFI), conversely, is a newer method of vascular ultrasonography. The objective of this study was to assess the accuracy and efficacy of BFI for the diagnosis of low cervical ICA dissection. METHODS Seventeen consecutive patients with 18 angiographically confirmed low cervical ICA dissections and 16 nondissected ICAs were studied with BFI and color Doppler ultrasonography (CDU). The results were compared with those of digital subtraction angiography. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of BFI in diagnosis of low ICA dissection were 94%, 94%, 94%, 94%, and 95%, respectively. Corresponding results for CDU were 83%, 94%, 94%, 83%, and 88%. B-flow imaging more precisely showed the intimal flap and the visualization of flow within the true and false lumens. In dissected carotid arteries, 6 intimal flaps were diagnosed with CDU, and 15 intimal flaps were diagnosed with BFI. The agreement between the observers in determining low cervical ICA dissection by BFI was found to be excellent (kappa = 0.80 for intramural hematoma; kappa = 0.93 for intimal flap). CONCLUSIONS B-flow imaging seems to be a new reliable vascular ultrasonographic technique for evaluation of low cervical ICA dissection.
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Affiliation(s)
- Muharrem Tola
- Department of Radiology, Türkiye Yüksek Ihtisas Hospital, Kizilay Sokak 4, 06100 Sihhiye, Ankara, Turkey
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de Bray JM, Baumgartner R, Guillon B, Pautot V, Dziewas R, Ringelstein EB, Sturzenegger M, Garnier P, Ducrocq X, Saudeau D, Neau JP, Larrue V, Vuillier F, Boulliat J, Verret JM, Verny C, Dubas F. Isolated Horner’s Syndrome May Herald Stroke. Cerebrovasc Dis 2005; 19:274-5. [PMID: 15761221 DOI: 10.1159/000084370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Baqué J, Azarine A, Beyssen B, Bonneville JF, Cattin F, Long A. Quand, comment et pourquoi réaliser une imagerie des carotides extracrâniennes ? ACTA ACUST UNITED AC 2004; 85:825-44. [PMID: 15243358 DOI: 10.1016/s0221-0363(04)97689-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The indications for treating carotid artery stenosis are related to the symptomatic nature of the lesion and the degree of stenosis. Duplex sonography is adequate for screening. While some groups believe that Duplex US alone or in combination with transcranial Doppler imaging may be sufficient for presurgical evaluation, it often is recommended to complete the evaluation with either MRA or CTA. Both techniques are advantageous since they allow evaluation of the cervical and intracranial arteries as well as cerebral parenchyma hence providing valuable information prior to definitive management. Catheter angiography remains indicated in patients with multi-vessel disease and ischemic cardiomyopathy, when results at non-invasive evaluation are discordant or in an emergency setting. Duplex US is used for routine follow-up of non-surgical lesions and after endarterectomy. Transcranial Doppler as well as advances in MRA and CTA techniques will be reviewed. Even though the treatment of atherosclerotic carotid artery stenoses remains primarily surgical, specific considerations related to angioplasty will be reviewed. Finally, diseases of the intracranial carotid artery and non-atherosclerotic diseases (dissection...) will also be discussed.
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Affiliation(s)
- J Baqué
- Service de Radiologie Cardio-Vasculaire, HEGP, 20, rue Leblanc, 75675 Paris cedex
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Campos CR, Evaristo EF, Yamamoto FI, Puglia P, Lucato LT, Scaff M. Dissecção espontânea cervical carotídea e verbal: estudo de 48 pacientes. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:492-8. [PMID: 15273850 DOI: 10.1590/s0004-282x2004000300021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Dada a ausência de estudos de séries brasileiras de pacientes com dissecção arterial cervical espontânea, com o objetivo de descrever os fatores de risco, sintomas precedentes, manifestações clínicas, resultados da investigação, tratamento e evolução. MÉTODO: realizamos a análise retrospectiva dos prontuários e laudos radiológicos [angiografia digital(AD), ressonância magnética(RM) e ângio-ressonância(ARM)] dos pacientes com esse diagnóstico atendidos no Serviço de Neurologia do HC/USP entre 1997 e 2003. RESULTADOS: 48 pacientes (24 homens), média de idade 37,9 anos; 26 pacientes com dissecção carotídea (DC) unilateral, 15 com vertebral (DV) unilateral e 7 com multiarterial, todos com déficits neurológicos. Os principais fatores de risco para doença vascular foram hipertensão arterial, tabagismo e dislipidemia. Mais de 80% apresentaram pelo menos um sintoma precedente, na maioria cefaléia têmporo-parietal. Cervicalgia foi referida por 44% dos pacientes com DV e por 3,4% dos com DC. O tempo médio entre o primeiro sintoma e o déficit foi 5,4 dias para as DC e 13,5 para as DV. AD foi o principal método diagnóstico (93%), associado a RM e ARM em 42% dos casos. Em 3 pacientes a RM cervical com supressão de gordura foi isoladamente suficiente. 75% dos pacientes receberam anticoagulação. Dois pacientes fizeram trombólise endovenosa sem complicações. A evolução foi boa, exceto por dois óbitos (DC bilateral). CONCLUSÃO: Os resultados são semelhantes aos da literatura, exceto pela baixa freqüência de cervicalgia nos casos de DC e pelo predomínio de cefaléia têmporo-parietal nas dissecções arteriais cervicais. Fatores de risco para doença vascular isquêmica foram frequentes.
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Affiliation(s)
- Cynthia Resende Campos
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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30
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Affiliation(s)
- Sherry D Scovell
- Department of Vascular Surgery, The Cleveland Clinic Foundation, OH 44195, USA
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Gonzales-Portillo F, Bruno A, Biller J. Outcome of extracranial cervicocephalic arterial dissections: a follow-up study. Neurol Res 2002; 24:395-8. [PMID: 12069289 DOI: 10.1179/016164102101200087] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cervicocephalic arterial dissections (CCAD) are an increasingly recognized cause of ischemic stroke in young adults. Various treatments have been suggested but no controlled trial has ever been performed. Medical treatment has included anticoagulant or platelet antiaggregant therapy. Surgical correction has been proposed for selected patients who have failed medical therapy. Percutaneous balloon angioplasty and stenting have been increasingly used in some patients, although long-term results are unknown. The objective of the study was to review our recent experience with the management and outcome of extracranial CCAD. We identified 27 patients with extracranial CCAD who were evaluated, treated and/or followed by our Stroke Service from September 1995 to August 2001. Clinical presentation, diagnostic evaluation, management, and outcome were reviewed. There were 15 men (56%) and 12 women (44%) with mean ages of 38 and 43 years respectively. Diagnosis was made by cerebral angiography in 15 (56%) patients and by MRI/MRA only in 12 (44%) patients. Twenty-two patients had spontaneous and five had traumatic extracranial CCAD. Most common associated disorders were arterial hypertension (37%) and migraine (26%). One patient presented only with a painful post-ganglionic Horner syndrome, another patient with neck pain and post-ganglionic Horner syndrome, another patient solely with protracted unilateral headaches, three with transient ischemic attacks (TIA), and 21 with ischemic strokes. The internal carotid artery (ICA) was the most frequently involved vessel (63%), followed by the vertebral artery (30%, and multivessel involvement in two patients (7%). Eighteen patients received anticoagulant therapy and nine platelet anti-aggregants. Follow-up extended from 2 to 115 months, with a mean of 58 months. At the end of follow-up, 23 (85%) patients had either no disability or only minor sequelae (modified Rankin score: 0 to 1), and four (15%) patients had moderate limitations (modified Rankin score: 2 to 3). Two patients had a recurrent ischemic stroke, one unrelated to recurrent CCAD, and the other following percutaneous balloon angioplasty/stenting for treatment of a persistent vertebral artery pseudoaneurysm. Most CCAD involved the extracranial ICA. The clinical presentation is variable, most patients having an ischemic stroke or TIAs. The short- and long-term outcome are usually favorable with either anticoagulant or platelet antiaggregant therapy. A medical initial approach to the management of extracranial CCAD is recommended for most patients.
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Affiliation(s)
- W I Schievink
- Cedars-Sinai Neurosurgical Institute, Los Angeles, CA 90048, USA.
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Abstract
Among the large variety of cerebrovascular syndromes, carotid artery dissections remain often under-recognized. Many patients present with minor or transient symptoms, some with local pain only, and some are asymptomatic. A useful rule is that the coincidence of any local pain in neck or face with an ipsilateral Horner's syndrome preceding transient or persistent retinal or cerebral ischemic symptoms should alert physicians--notably those treating emergencies--to rule out an underlying dissection of the ipsilateral carotid artery. In most cases the extracranial part of the carotid artery is affected; therefore, this review will focus on this main subgroup of patients. We review the pathological anatomy, as well as possible underlying causes, clinical features, diagnostic tools, differential diagnosis, treatment options, and outcome data.
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Affiliation(s)
- C Stapf
- Stroke Center/Neurological Institute, Columbia-Presbyterian Medical Center, New York, New York 10032, USA
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34
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Abstract
Carotid artery dissection is a major cause of cerebral infarction in the young. The extracranial portion of the internal carotid artery is much more frequently involved than the intracranial portion. In up to 20% of cases it is bilateral or associated with vertebral artery dissection. It is mainly characterised by local signs such as headache or facial pain, Horner's syndrome, lower cranial nerve palsies and pulsatile tinnitus, followed a few hours or days later by signs of cerebral or retinal ischemia. Ultrasound investigations show signs of distal stenosis or occlusion, highly suggestive of dissection, but the best diagnostic tool is presently the association of magnetic resonance imaging (MRI) and MR angiography which tend to replace intra-arterial angiography. The prognosis is highly variable: excellent in cases limited to local signs, but very poor leading to death or major sequelae in about 15% of cases. Various treatments have been suggested but no controlled trial has ever been performed in this condition. Heparin in the acute stage followed by warfarin or aspirin for 3 to 6 months is most commonly used.
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Affiliation(s)
- B Guillon
- Service de Neurologie, Hôpital Lariboisiere, Paris, France
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