(1/2869) Facial diplegia complicating a bilateral internal carotid artery dissection.
BACKGROUND AND PURPOSE: We report a case of facial diplegia complicating a bilateral internal carotid artery dissection. CASE DESCRIPTION: A 49-year-old patient presented with unilateral headache and oculosympathetic paresis. Cerebral angiography revealed a bilateral internal carotid artery dissection. A few days later, the patient developed a facial diplegia that regressed after arterial recanalization. An arterial anatomic variation may explain this ischemic complication of carotid dissection. CONCLUSIONS: Double carotid dissection should be included among the causes of bilateral seventh nerve palsy. (+info)
(2/2869) Bruits, ophthalmodynamometry and rectilinear scanning on transient ischemic attacks.
One hundred seventeen patients with clinical signs and symptoms of transient ischemic attacks (TIAs) were evaluated. All underwent clinical evaluation for bruit, ophthalmodynamometry, rapid sequence scintiphotography with rectilinear scanning and four-vessel cerebral angiography. The results of these tests were compared for reliability in predicting location of lesions causing transient ischemic attacks. Angiography remains the most accurate procedure in evaluating extracranial vascular lesions. When determination of bruits, ophthalmodynamometry and brain scanning are done together, accuracy is greater than when any one of the procedures is done alone. (+info)
(3/2869) A new sign of occlusion of the origin of the internal carotid artery.
When the origin of the internal carotid artery is occluded, the transmission of cardiac sounds along the carotid stops at the site of the occlusion. This is a new neurovascular sign which is being reported. (+info)
(4/2869) Ophthalmodynamometry in internal carotid artery occlusion.
Retinal artery pressure was measured by ophthalmodynamometry in 15 patients with occlusion of the internal carotid artery in its extracranial part. Nine of the patients had severe neurological deficit whereas the remaining six had slight or intermittent symptoms. Retinal artery pressure was reduced on the side of the internal carotid artery occlusion in all patients studied. Near-zero low diastolic retinal artery pressure on the affected side was a common finding among patients with severe deficit and was also seen in some patients with slight deficit. Its presence strongly suggests occlusion of the ipsilateral internal carotid artery. (+info)
(5/2869) Carotid endarterectomy and intracranial thrombolysis: simultaneous and staged procedures in ischemic stroke.
PURPOSE: The feasibility and safety of combining carotid surgery and thrombolysis for occlusions of the internal carotid artery (ICA) and the middle cerebral artery (MCA), either as a simultaneous or as a staged procedure in acute ischemic strokes, was studied. METHODS: A nonrandomized clinical pilot study, which included patients who had severe hemispheric carotid-related ischemic strokes and acute occlusions of the MCA, was performed between January 1994 and January 1998. Exclusion criteria were cerebral coma and major infarction established by means of cerebral computed tomography scan. Clinical outcome was assessed with the modified Rankin scale. RESULTS: Carotid reconstruction and thrombolysis was performed in 14 of 845 patients (1.7%). The ICA was occluded in 11 patients; occlusions of the MCA (mainstem/major branches/distal branch) or the anterior cerebral artery (ACA) were found in 14 patients. In three of the 14 patients, thrombolysis was performed first, followed by carotid enarterectomy (CEA) after clinical improvement (6 to 21 days). In 11 of 14 patients, 0.15 to 1 mIU urokinase was administered intraoperatively, ie, emergency CEA for acute ischemic stroke (n = 5) or surgical reexploration after elective CEA complicated by perioperative intracerebral embolism (n = 6). Thirteen of 14 intracranial embolic occlusions and 10 of 11 ICA occlusions were recanalized successfully (confirmed with angiography or transcranial Doppler studies). Four patients recovered completely (Rankin 0), six patients sustained a minor stroke (Rankin 2/3), two patients had a major stroke (Rankin 4/5), and two patients died. In one patient, hemorrhagic transformation of an ischemic infarction was detectable postoperatively. CONCLUSION: Combining carotid surgery with thrombolysis (simultaneous or staged procedure) offers a new therapeutic approach in the emergency management of an acute carotid-related stroke. Its efficacy should be evaluated in interdisciplinary studies. (+info)
(6/2869) Expression of interleukin-10 in advanced human atherosclerotic plaques: relation to inducible nitric oxide synthase expression and cell death.
Inflammation is a major feature of human atherosclerosis and is central to development and progression of the disease. A variety of proinflammatory cytokines are expressed in the atherosclerotic plaque and may modulate extracellular matrix remodeling, cell proliferation, and cell death. Little is known, however, about the expression and potential role of anti-inflammatory cytokines in human atherosclerosis. Interleukin-10 (IL-10) is a major anti-inflammatory cytokine whose expression and potential effects in advanced human atherosclerotic plaques have not been evaluated. We studied 21 advanced human atherosclerotic plaques. IL-10 expression was analyzed by use of reverse transcription-polymerase chain reaction and immunohistochemical techniques. Inducible nitric oxide synthase expression was assessed by using immunohistochemistry, and cell death was determined by use of the TUNEL method. Reverse transcription-polymerase chain reaction identified IL-10 mRNA in 12 of 17 atherosclerotic plaques. Immunohistochemical staining of serial sections and double staining identified immunoreactive IL-10 mainly in macrophages, as well as in smooth muscle cells. Consistent with its anti-inflammatory properties, high levels of IL-10 expression were associated with significant decrease in inducible nitric oxide synthase expression (P<0.0001) and cell death (P<0. 0001). Hence, IL-10, a potent anti-inflammatory cytokine, is expressed in a substantial number of advanced human atherosclerotic plaques and might contribute to the modulation of the local inflammatory response and protect from excessive cell death in the plaque. (+info)
(7/2869) Surgical treatment of internal carotid artery anterior wall aneurysm with extravasation during angiography--case report.
A 54-year-old female presented subarachnoid hemorrhage from an aneurysm arising from the anterior (dorsal) wall of the internal carotid artery (ICA). During four-vessel angiography, an extravasated saccular pooling of contrast medium emerged in the suprasellar area unrelated to any arterial branch. The saccular pooling was visualized in the arterial phase and cleared in the venophase during every contrast medium injection. We suspected that the extravasated pooling was surrounded by hard clot but communicated with the artery. Direct surgery was performed but major premature bleeding occurred during the microsurgical procedure. After temporary clipping, an opening of the anterior (dorsal) wall of the ICA was found without apparent aneurysm wall. The vessel wall was sutured with nylon thread. The total occlusion time of the ICA was about 50 minutes. Follow-up angiography demonstrated good patency of the ICA. About 2 years after the operation, the patient was able to walk with a stick and to communicate freely through speech, although left hemiparesis and left homonymous hemianopsia persisted. The outcome suggests our treatment strategy was not optimal, but suture of the ICA wall is one of the therapeutic choices when premature rupture occurs in the operation. (+info)
(8/2869) Vasa vasorum: another cause of the carotid string sign.
BACKGROUND AND PURPOSE: Our purpose was to describe a variant of the carotid string sign that may be associated with a completely occluded vessel and to consider possible pathophysiological mechanisms for this observation. METHODS: Carotid angiography was performed in three patients with suspected carotid stenosis and in a fourth with carotid dissection. Surgery was performed in one of the patients with carotid stenosis. RESULTS: On all angiograms, instead of a single linear or curvilinear contrast "string," either single or multiple serpiginous channels were seen. In one case, such a channel was seen emanating from below the origin of an occluded internal carotid stump, reconstituting the distal portion of the vessel. Surgery revealed a completely occluded lumen with a small intramural vessel bypassing the obstruction. CONCLUSION: We propose that these channels are either atherosclerotically induced neovessels connecting bridging vasa vasorum or recanalized luminal thrombus. We review the literature associated with this subject. (+info)