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Thrombosis and Haemostasis Feb 2022
Topics: Ad26COVS1; Amaurosis Fugax; Anticoagulants; Carotid Artery Thrombosis; Humans; Ischemic Stroke; Male; Middle Aged; Recurrence; Syndrome; Thrombocytopenia; Thrombosis; Vaccination
PubMed: 34670287
DOI: 10.1055/a-1674-0341 -
Journal of Vascular Surgery Cases and... Jun 2021Aberrant vertebral artery (VA) origins are uncommon, and those arising from the carotid bulb are exceedingly rare. We report a 79-year-old man with a right thalamic...
Aberrant vertebral artery (VA) origins are uncommon, and those arising from the carotid bulb are exceedingly rare. We report a 79-year-old man with a right thalamic stroke and subsequent amaurosis fugax that was found to have severe right carotid bulb and internal carotid artery stenoses, as well as an aberrant VA arising from the bulb. He underwent carotid endarterectomy including eversion endarterectomy of the VA and had no recurrence of amaurosis fugax or posterior circulation symptoms at the 1-year follow-up. We also present a comprehensive review of the literature, focusing on symptomatic cases and those arising from the carotid bulb.
PubMed: 33997553
DOI: 10.1016/j.jvscit.2021.01.001 -
American Journal of Translational... 2024Spontaneous dissections in multiple arteries are a rare condition with clinical presentation varying from asymptomatic conditions to sudden death. We present a rare case...
Spontaneous dissections in multiple arteries are a rare condition with clinical presentation varying from asymptomatic conditions to sudden death. We present a rare case where a routine thoracic computed tomography (CT) scan showed a type B aortic dissection. Medical records showed that the patient previously had been diagnosed with bilateral spontaneous isolated internal carotid artery dissections, which caused an attack of amaurosis fugax a few months earlier. The patient was asymptomatic during the admission with type B aortic dissection. However, the patient had a high blood pressure which was medically treated. A new CT scan confirmed earlier findings and revealed a spontaneous isolated dissection in the superior mesenteric artery. No progression was seen when the scan was compared to a new CT scan performed 10 days later. The type B aortic dissection was considered to be chronic and stable with no need for vascular intervention. This case report illustrates a rare condition of four isolated arterial dissections. The present case demonstrates the necessity of further examinations, which should be considered carefully when a patient presents with several independent arterial dissections.
PubMed: 38322547
DOI: 10.62347/LGRD3495 -
International Journal of Ophthalmology 2024To describe the clinical, electrophysiological, and genetic features of an unusual case with an homozygous pathogenic variant and reviewed the characteristics of the...
AIM
To describe the clinical, electrophysiological, and genetic features of an unusual case with an homozygous pathogenic variant and reviewed the characteristics of the patients reported with the same variant.
METHODS
The patient underwent a complete ophthalmologic examination including best-corrected visual acuity, anterior segment and dilated fundus, visual field, spectral-domain optical coherence tomography (OCT) and electroretinogram (ERG). The retinal disease panel genes were sequenced through chip capture high-throughput sequencing and Sanger sequencing was used to confirm the result. Then we reviewed the characteristics of the patients reported with the same variant.
RESULTS
A 30-year male presented with severe early retinal degeneration who complained night blindness, decreased visual acuity, vitreous floaters and amaurosis fugax. The best corrected vision was 0.04 OD and 0.12 OS, respectively. The fundus photo and OCT showed bilateral macular atrophy but larger areas of macular atrophy in the left eye. Autofluorescence shows bilateral symmetrical hypo-autofluorescence. ERG revealed that the amplitudes of a- and b-wave were severely decreased. Multifocal ERG showed decreased amplitudes in the local macular area. A homozygous missense variant c.146C>T (chr14:68191267) was found. The clinical characteristics of a total of 13 patients reported with the same pathologic variant varied.
CONCLUSION
An unusual patient with a homozygous pathogenic variant in the c.146C>T of which causes late-onset and asymmetric retinal degeneration are reported. The clinical manifestations of the patient with multimodal retinal imaging and functional examinations have enriched our understanding of this disease.
PubMed: 38371258
DOI: 10.18240/ijo.2024.02.13 -
Neurologia Medico-chirurgica Jan 2020With recent advances in medical treatments for carotid artery stenosis (CS), indications for carotid surgery should be more carefully considered for asymptomatic CS...
With recent advances in medical treatments for carotid artery stenosis (CS), indications for carotid surgery should be more carefully considered for asymptomatic CS (ACS). Accurate stratification of ACS should be based on the risk of cerebral infarction, and subgroups of patients more likely to benefit from surgical treatment should be differentiated. Magnetic resonance imaging (MRI) offers a non-invasive, accurate modality for characterizing carotid plaque. Intraplaque hemorrhage (IPH) seems the most promising feature of vulnerable plaque detectable by MRI. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is a type II membrane protein of the C-type lectin family with an extracellular domain that can be proteolytically cleaved and released as a soluble form (sLOX-1). This sLOX-1 plays a key role in the pathogenesis of atherosclerosis, and elevated sLOX-1 concentrations correlate with thin or ruptured fibrous caps in patients with acute coronary syndrome. This ongoing study aims to clarify the incidence of ischemic stroke in patients with ACS and IPH confirmed by MRI, and to assess whether sLOX-1 could provide a biomarker for risk of future ischemic events. The study population comprises patients with ACS (>60% area stenosis) associated with MRI-diagnosed IPH receiving follow-up under medical treatment. Primary endpoints comprise transient ischemic attack, stroke or amaurosis resulting from concerned CS. Secondary endpoints comprise any stroke or surgical treatment for progressive luminal stenosis. The target number of patients is 120 and the observational period is 36 months. The study results could help identify individuals with ACS who are refractory to medical therapy.
Topics: Amaurosis Fugax; Asymptomatic Diseases; Biomarkers; Carotid Stenosis; Cerebral Infarction; Clinical Protocols; Disease Progression; Drug Resistance; Hemorrhage; Humans; Ischemic Attack, Transient; Japan; Magnetic Resonance Imaging; Multicenter Studies as Topic; Patient Selection; Plaque, Atherosclerotic; Prospective Studies; Rupture, Spontaneous; Scavenger Receptors, Class E; Ultrasonography
PubMed: 31708514
DOI: 10.2176/nmc.st.2019-0188 -
Journal of Medical Case Reports Jan 2022Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis...
BACKGROUND
Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis range from dissections leading to the fenestration to the more common interpretation as a developmental vascular variant. However, most reported cases were symptomatic and presented with dissections, where even endovascular treatment of the fenestration of the cervical segment of the internal carotid artery became necessary. Here we report a case of a fenestration of the cervical segment of the internal carotid artery suffering a transitory ischemic attack and local pain in absence of any sign of dissection.
CASE PRESENTATION
A 62-year-old Caucasian male patient was admitted to our institution because of an episode of amaurosis fugax, initially accompanied with headache. Magnetic resonance imaging revealed an intact fenestration of the cervical segment of the internal carotid artery on the symptomatic side. With antiplatelet therapy, all symptoms vanished within 2 months of the initial event.
CONCLUSIONS
Our findings support the interpretation of a fenestration of the cervical segment of the internal carotid artery as a developmental vascular variant, but also suggest a substantial risk for dissection and ischemic stroke. Even in case of an accidental finding, clinicians should be aware of this. At least in this case, antiplatelet therapy seemed beneficial.
Topics: Carotid Artery, Internal; Carotid Artery, Internal, Dissection; Humans; Ischemic Attack, Transient; Magnetic Resonance Imaging; Male; Middle Aged; Stroke
PubMed: 35031059
DOI: 10.1186/s13256-021-03227-0 -
American Journal of Ophthalmology Case... Jun 2020To describe two cases of retinal artery occlusion followed by contralateral amaurosis fugax associated with eosinophilic granulomatosis with polyangiitis (EGPA, formerly...
PURPOSE
To describe two cases of retinal artery occlusion followed by contralateral amaurosis fugax associated with eosinophilic granulomatosis with polyangiitis (EGPA, formerly known as Churg-Strauss syndrome).
OBSERVATIONS
Case 1 is a 57 year-old male who presented with transient vision loss in the right eye two weeks after a cilioretinal artery occlusion in the left eye. Evaluation eventually led to a diagnosis of EGPA. The patient was treated with high-dose steroids followed by systemic immunomodulatory therapy. Vision in the right eye recovered to 20/20 with no further episodes of vision loss. Case 2 is a 55 year-old male with a known diagnosis of EGPA who presented with transient vision loss in the right eye four weeks after a central retinal artery occlusion of the left eye. This patient also successfully recovered vision in the right eye after treatment with high-dose steroids following a change in his systemic immunomodulatory therapy.
CONCLUSIONS AND IMPORTANCE
While ANCA-vasculitides are an uncommon cause of retinal artery occlusion and amaurosis fugax, it is important that they remain in the differential diagnosis, as good visual outcomes can be achieved with prompt initiation of appropriate therapies.
PubMed: 32309675
DOI: 10.1016/j.ajoc.2020.100683 -
BMJ Case Reports Oct 2019A 72-year-old man presented with a short history of headache, jaw claudication, double vision, amaurosis fugax and distended temporal arteries. A diagnosis of giant cell...
A 72-year-old man presented with a short history of headache, jaw claudication, double vision, amaurosis fugax and distended temporal arteries. A diagnosis of giant cell arteritis (GCA) was confirmed on temporal artery ultrasound and temporal artery biopsy. Despite treatment with high-dose oral glucocorticoid (GC) and multiple pulses of intravenous methylprednisolone, his vision deteriorated to hand movements in one eye. 8 mg/kg intravenous tocilizumab, a humanised, recombinant anti-IL-6 receptor antibody, was administered within 48 hours of vision loss and continued monthly, resulting in marked visual improvement within days, as well as sustained remission of GCA. This case suggests a possible role for tocilizumab as a rescue therapy to prevent or recover visual loss in patients with GCA resistant to GC treatment, termed refractory GCA. Further research is required to elucidate the role of intravenous administration of tocilizumab in this setting.
Topics: Administration, Intravenous; Aged; Antibodies, Monoclonal, Humanized; Diagnosis, Differential; Diplopia; Drug Administration Schedule; Drug Resistance; Giant Cell Arteritis; Glucocorticoids; Headache; Humans; Male; Temporal Arteries
PubMed: 31586951
DOI: 10.1136/bcr-2019-229236 -
EJVES Vascular Forum 2021A carotid endarterectomy (CEA) has certain risks, of which peri-operative cardiovascular risk is one. Peri-operative neurological monitoring can be done with...
INTRODUCTION
A carotid endarterectomy (CEA) has certain risks, of which peri-operative cardiovascular risk is one. Peri-operative neurological monitoring can be done with electroencephalography (EEG) and transcranial Doppler (TCD). No previous reports have been published demonstrating the actual changes in cerebral and cardiac activity during a peri-operative asystole.
REPORT
The case of a 70 year old man with a symptomatic (bilateral) carotid stenosis is described. The patient complained of amaurosis fugax in both eyes. Duplex ultrasound showed a stenosis of >70% in both carotid arteries. The most severe symptoms were on the right side, so a staged approach was chosen, starting with a right sided eversion CEA (eCEA). Peri-operatively, the patient experienced an asystolic cardiac arrest after external carotid artery revascularisation, requiring brief cardiopulmonary resuscitation, which was recorded on the EEG. Post-operatively, the patient recovered fully, with no post-operative neurological or cardiac sequelae. The (symptomatic) contralateral stenosis was treated conservatively with best medical therapy (BMT; dual antiplatelets and statin). The patient is currently in good clinical condition, 1.5 years later.
CONCLUSION
This case shows the unique EEG recording of a cardiological event during eCEA. The cause of asystole was most likely a vasovagal syncope as a result of the surgical procedure by iatrogenic damage to the carotid sinus fibres, causing impairment of the baroreflex and chemoreflex mechanisms, which is greater during eCEA. The unilateral eCEA and contralateral BMT in this symptomatic (bilateral) stenosis seemed appropriate when cardiological risk was increased but follow up ruled out any cardiological cause.
PubMed: 34041506
DOI: 10.1016/j.ejvsvf.2021.04.001 -
Medicine Aug 2019Giant cell arteritis (GCA) is known to present with typical manifestations like temporal headache and visual abnormalities. However, several cases with atypical...
RATIONALE
Giant cell arteritis (GCA) is known to present with typical manifestations like temporal headache and visual abnormalities. However, several cases with atypical manifestations were reported. Stroke occurs in 3% to 7% of patients with GCA.
PATIENT CONCERNS
A 67-year-old male patient with known hypertension presented with somnolence, disorientation and mild bilateral limb ataxia. The magnetic resonance imaging showed multiple acute infarctions in the territory of the vertebrobasilar system with occlusion of the left vertebral artery.
DIAGNOSIS
Ten months later, during a routine neurovascular follow-up, recanalization of the left vertebral artery was observed and a hypoechoic concentric "halo" sign around both vertebral arteries, mainly on the left side was evident. On further examination of the superficial temporal artery, a hypoechoic concentric "halo" sign was also found, which-along with increased inflammatory markers-raised suspicion about GCA. Classical GCA features like headache, temporal tenderness or amaurosis fugax were not present. Repeated in-depth diagnostic work-up including 48 hours Holter-ECG did not reveal another stroke etiology.
INTERVENTIONS
Intravenous Methylprednisolone 250 mg/d was immediately started and after 6 days the dose was tapered to 80 mg/d. The patient was discharged on a tapering scheme with the recommendation to start azathioprine. Additionally, we placed the patient on acetylsalicylic acid 100 mg/d and clopidogrel 75 mg/d. However, the patient was not compliant to treatment; he stopped prednisolone early and did not start azathioprine.
OUTCOMES
The inflammatory markers were markedly reduced at the beginning of the treatment. After stopping the immunosuppressive medications, the inflammatory markers were once again increased. Three months later, the patient developed bilateral middle cerebral artery and right occipital lobe infarctions.
LESSONS
In patients with cryptogenic vertebrobasilar strokes, GCA may be considered in the differential diagnosis, especially if the inflammatory markers are increased.
Topics: Aged; Biomarkers; Giant Cell Arteritis; Humans; Inflammation Mediators; Magnetic Resonance Imaging; Male; Methylprednisolone; Stroke; Vertebral Artery
PubMed: 31393385
DOI: 10.1097/MD.0000000000016737