Dolichoectasia of the left internal carotid artery with unilateral agenesis of the right internal carotid artery

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
MansoorC Abdulla
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She had no addictions. Examination was normal except for high blood pressure. Biochemical parameters were normal. Electrocardiogram showed left ventricular hypertrophy. Computed tomography of the brain showed absent bony carotid canal on the right side. Magnetic resonance imaging of the brain with contrast showed scattered nonenhancing hyperintensities in bilateral frontoparietal white matter (small-vessel ischemic changes), DE of the left ICA and left vertebral arteries and absent flow voids of right ICA [Figures 1a and b].Figure 1: Magnetic resonance imaging of the brain with contrast showing dolichoectasia of the left internal carotid artery and left vertebral arteries (1 a marked with arrow) and absent flow voids of right ICA (1 b marked with arrow)DE is common in the vertebrobasilar system but can affect the vertebrobasilar system and anterior circulation simultaneously.[1] The prevalence of vertebrobasilar DE ranges from 7.6% to 18.8% in patients with stroke, and 1.3% to 4.4% in the general population.[2] DE is commonly seen in patients with advanced cerebral atherosclerosis and arterial hypertension. Besides atherosclerosis and hypertension, multiple pathophysiological processes, including inherited, inflammatory, and infectious, might contribute to its development.[2] Histological studies support the hypothesis of underlying degeneration of the internal elastic lamina and thinning of the media secondary to smooth muscle atrophy. Most cases are asymptomatic, but symptoms can occur as a result of compression on cranial nerves or brain stem, obstructive hydrocephalus, and ischemia. Emboli from the thrombi or fragments of plaques in the walls of the enlarged arterial segment causes ischemia. Rarely intracranial hemorrhages due to dissection of the ectatic artery, rupture of associated aneurysm, or rupture of stretched perforating arteries can be seen. However, this arteriopathy is frequently found in the absence of an apparent cause. Most patients with DE are asymptomatic but may have clinical manifestations secondary to compression, rupture, or ischemia. Agenesis of ICA is a rare anomaly with male predominance.[3] Absent ICA flow void on MRI and absence of bony carotid canal on routine CT should suggest the diagnosis.[3] Patients with agenesis of ICA are prone to developing cerebrovascular events (including ischemia, subarachnoid hemorrhage, and parenchymal hemorrhages) and have an increased risk of aneurysm formation.[4] Our patient was evaluated for headache and was found to have DE of the left ICA with agenesis of the right ICA. Hypertension might be the likely etiology for DE in our patient. Her blood pressure control was intensified, and on follow-up, she had normal blood pressure. She was counseled regarding the potential complications related to the abnormalities and the need for strict blood pressure control. To conclude, we present a patient with DE of the left ICA with agenesis of the right ICA, which was not reported previously to the best of our knowledge. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.2000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Medical Specialities","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/injms.injms_97_23","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Dear Editor, Intracranial dolichoectasia (DE) is a rare arteriopathy characterized by dilation and tortuosity of the intracranial arteries. DE could be detected incidentally or can be associated with neurological complications. Unilateral agenesis of the internal carotid artery (ICA) with intercavernous anastomosis is a rare congenital anomaly. We present a patient with DE of the left ICA with agenesis of the right ICA, which was not reported previously. A 53-year-old female presented to us with a holocranial headache for 1 month. The headache was insidious in onset, moderately severe and was not associated with other neurological symptoms. She had hypertension and diabetes for the past 6 years. She was also receiving thyroxine supplementation for hypothyroidism. She had no addictions. Examination was normal except for high blood pressure. Biochemical parameters were normal. Electrocardiogram showed left ventricular hypertrophy. Computed tomography of the brain showed absent bony carotid canal on the right side. Magnetic resonance imaging of the brain with contrast showed scattered nonenhancing hyperintensities in bilateral frontoparietal white matter (small-vessel ischemic changes), DE of the left ICA and left vertebral arteries and absent flow voids of right ICA [Figures 1a and b].Figure 1: Magnetic resonance imaging of the brain with contrast showing dolichoectasia of the left internal carotid artery and left vertebral arteries (1 a marked with arrow) and absent flow voids of right ICA (1 b marked with arrow)DE is common in the vertebrobasilar system but can affect the vertebrobasilar system and anterior circulation simultaneously.[1] The prevalence of vertebrobasilar DE ranges from 7.6% to 18.8% in patients with stroke, and 1.3% to 4.4% in the general population.[2] DE is commonly seen in patients with advanced cerebral atherosclerosis and arterial hypertension. Besides atherosclerosis and hypertension, multiple pathophysiological processes, including inherited, inflammatory, and infectious, might contribute to its development.[2] Histological studies support the hypothesis of underlying degeneration of the internal elastic lamina and thinning of the media secondary to smooth muscle atrophy. Most cases are asymptomatic, but symptoms can occur as a result of compression on cranial nerves or brain stem, obstructive hydrocephalus, and ischemia. Emboli from the thrombi or fragments of plaques in the walls of the enlarged arterial segment causes ischemia. Rarely intracranial hemorrhages due to dissection of the ectatic artery, rupture of associated aneurysm, or rupture of stretched perforating arteries can be seen. However, this arteriopathy is frequently found in the absence of an apparent cause. Most patients with DE are asymptomatic but may have clinical manifestations secondary to compression, rupture, or ischemia. Agenesis of ICA is a rare anomaly with male predominance.[3] Absent ICA flow void on MRI and absence of bony carotid canal on routine CT should suggest the diagnosis.[3] Patients with agenesis of ICA are prone to developing cerebrovascular events (including ischemia, subarachnoid hemorrhage, and parenchymal hemorrhages) and have an increased risk of aneurysm formation.[4] Our patient was evaluated for headache and was found to have DE of the left ICA with agenesis of the right ICA. Hypertension might be the likely etiology for DE in our patient. Her blood pressure control was intensified, and on follow-up, she had normal blood pressure. She was counseled regarding the potential complications related to the abnormalities and the need for strict blood pressure control. To conclude, we present a patient with DE of the left ICA with agenesis of the right ICA, which was not reported previously to the best of our knowledge. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.
左侧颈内动脉过度扩张伴右侧颈内动脉单侧发育不全
亲爱的编辑,颅内微缩扩张症(DE)是一种罕见的动脉疾病,其特征是颅内动脉的扩张和扭曲。DE可能是偶然发现的,也可能与神经系统并发症有关。单侧颈内动脉发育不全伴海绵间吻合是一种罕见的先天性异常。我们报告了一位左ICA DE合并右ICA发育不全的患者,这在以前没有报道过。一名53岁女性以颅脑头痛1个月就诊。头痛发病隐匿,中度严重,无其他神经系统症状。她在过去的6年里患有高血压和糖尿病。她还因甲状腺功能减退而接受甲状腺素补充治疗。她没有毒瘾。除高血压外,检查正常。生化指标正常。心电图显示左室肥厚。脑部电脑断层显示右侧骨颈动脉管缺失。脑磁共振造影显示双侧额顶叶白质散在性非强化高信号(小血管缺血改变),左侧ICA和左侧椎动脉DE,右侧ICA无血流空洞[图1a和b]。图1:脑磁共振造影术显示左侧颈内动脉和左侧椎动脉多壁扩张(1a用箭头标记),右侧ICA无血流空洞(1b用箭头标记)DE常见于椎基底动脉系统,但可同时影响椎基底动脉系统和前循环[1]。椎基底动脉DE在卒中患者中的患病率为7.6%至18.8%,在一般人群中为1.3%至4.4%。[2]DE常见于晚期脑动脉粥样硬化和动脉高血压患者。除了动脉粥样硬化和高血压,多种病理生理过程,包括遗传、炎症和感染,可能有助于其发展。[2]组织学研究支持平滑肌萎缩继发于内部弹性板变性和中膜变薄的假设。大多数病例无症状,但由于脑神经或脑干受压、梗阻性脑积水和缺血,也可能出现症状。血栓或斑块碎片在扩大的动脉段壁上形成的栓子引起缺血。由于扩张动脉剥离、相关动脉瘤破裂或拉伸穿动脉破裂引起的颅内出血是罕见的。然而,这种动脉病变经常在没有明显病因的情况下发现。大多数DE患者无症状,但可能有继发于压迫、破裂或缺血的临床表现。ICA发育不全是一种罕见的异常,男性占优势。[3]MRI未见ICA流腔,常规CT未见颈动脉骨管,应提示诊断。[3]ICA发育不全的患者容易发生脑血管事件(包括缺血、蛛网膜下腔出血和实质出血),动脉瘤形成的风险增加。[4]我们的病人被评估为头痛,并被发现有左ICA DE与右ICA发育不全。高血压可能是本例患者DE的病因。她的血压控制得到加强,在随访中,她的血压正常。她被告知与异常有关的潜在并发症和严格控制血压的必要性。综上所述,我们报告了一位左ICA DE伴右ICA发育不全的患者,据我们所知,这在以前没有报道过。患者同意声明作者证明他们已经获得了所有适当的患者同意表格。在此表格中,患者已同意她的图像和其他临床信息将在杂志上报道。患者明白姓名和首字母不会被公布,并将尽力隐藏身份,但不能保证匿名。财政支持和赞助利益冲突没有利益冲突。
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来源期刊
Indian Journal of Medical Specialities
Indian Journal of Medical Specialities MEDICINE, GENERAL & INTERNAL-
自引率
16.70%
发文量
51
期刊介绍: The Indian Journal of Medical Specialities is an all-encompassing peer-reviewed quarterly journal. The journal publishes scholarly articles, reviews, case reports and original research papers from medical specialities specially pertaining to clinical patterns and epidemiological profile of diseases. An important highlight is the emphasis on undergraduate and postgraduate medical education including various aspects of scientific paper-writing. The journal gives priority to research originating from the developing world, including from the tropical regions of the world. The journal also publishes special issues on health topics of current interest. The Indian Journal of Medical Specialities is one of the very few quality multispeciality scientific medical journals.
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