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CT angiography versus colour-Doppler US in acute dissection of the vertebral artery
No full textEpub 2007 Apr 20
Stroke related to carotid artery dissection in a young patient with Takayasu arteritis, systemic lupus erythematosus and antiphospholipid antibody syndrome
No full textAutoimmune diseases are rarely the cause of stroke even in the young age group in association with cervical artery dissection and collagen vascular diseases. Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. Takayasu arteritis rarely coexists with systemic lupus erythematosus, and only few cases have been reported in association with the presence of antiphospholipid antibodies. We describe a young patient with right internal carotid artery dissection and subsequent stroke who presented with all three syndromes. Although this patient met the diagnostic criteria for each syndrome, systemic lupus erythematosus, Takayasu arteritis and the antiphospholipid antibody syndrome, it remains unlikely that the three disorders are not related. We suggest a single disimmune disorder may have led to carotid artery dissection.Autoimmune diseases are rarely the cause of stroke even in the young age group in association with cervical artery dissection and collagen vascular diseases. Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. Takayasu arteritis rarely coexists with systemic lupus erythematosus, and only few cases have been reported in association with the presence of antiphospholipid antibodies. We describe a young patient with right internal carotid artery dissection and subsequent stroke who presented with all three syndromes. Although this patient met the diagnostic criteria for each syndrome, systemic lupus erythematosus, Takayasu arteritis and the antiphospholipid antibody syndrome, it remains unlikely that the three disorders are not related. We suggest a single disimmune disorder may have led to carotid artery dissection. Copyright (C) 2002 S. Karger AG, Basel
CT angiography versus colour-Doppler US in acute dissection ofthe vertebral artery.
No full textPurpose. Conventional digital subtraction angiography (DSA) still
represents the criterion standard for the diagnosis of vertebral
artery dissection (VAD), but the main drawbacks of this technique
include invasiveness, patient discomfort and risk of complications.
We evaluated the potential of multidetector computed tomography
angiography (CTA) as a noninvasive tool providing highresolution
images of the arterial lumen and wall by comparing the
diagnostic accuracy of CTA and colour-Doppler ultrasonography
(CDUS) in detecting acute VAD.
Materials and methods. We retrospectively reviewed 15 cases of
VAD in 15 patients (five men and ten women, age range 28–58
years) who came to our attention between August 2001 and
September 2005. The diagnosis was made on the basis of
appropriate clinical presentation, absence of atherosclerotic
disease in the cerebrovascular circulation and evidence of
distinctive CT features, which were subsequently confirmed by
conventional angiography used as reference standard. All patients
with a clinical suspicion of VAD underwent CDUS of the neck
vessels prior to CTA. Accuracy, sensitivity and specificity of
CDUS and CTA were expressed as percentages of agreement with
the reference angiographic procedure. Interreader concordance for
detection of VAD by CTA was calculated with the Cohen K value.
Results. The CDUS examinations revealed ten out of 15 VAD,
with a sensitivity of 66%, a specificity of 60%, a positive
predictive value of 55.5% and a negative predictive value of
70.5%. In five cases, CDUS revealed nonspecific wall and flow
alterations; in eight patients, high resistance obstructive flow;
and in two patients, intimal flap with demonstration of the true and
false lumen. CTA enabled the correct identification of all 15
VAD. The reported sensitivity, specificity, positive predictive
value and negative predictive value were 100%, 95%, 93.7%
and 100%, respectively. With regard to localisation of VAD,
CTA showed 100% correlation with DSA. The differences in CTA
and CDUS sensitivity (100% vs 66%), specificity (95% vs 60%),
and overall diagnostic accuracy (97% vs 62.8%), assessed by
cross tabulations and compared by using the McNemar’s
two-sided test, were significant (p<0.05).
Conclusions. Multidetector CTA is a sensitive technique for the
diagnosis of VAD. Used as a complement to unenhanced brain
CT, it has the advantage of being readily available and easy to
perform
Mild hyperhomocyst(e)inemia: A possible risk factor for cervical artery dissection
No full textBackground and Purpose—The pathogenesis of cervical artery dissection (CAD) remains unknown in most cases.
Hyperhomocyst(e)inemia [hyperH(e)], an independent risk factor for cerebrovascular disease, induces damage in
endothelial cells in animal cell culture. Consecutive patients with CAD and age-matched control subjects have been
studied by serum levels of homocyst(e)ine and the genotype of 5,10-methylenetetrahydrofolate reductase (MTHFR).
Methods—Twenty-six patients with CAD, admitted to our Stroke Unit (15 men and 11 women; 16 vertebral arteries, 10
internal carotid arteries), were compared with age-matched control subjects. All patients underwent duplex ultrasound,
MR angiography, and/or conventional angiography.
Results—Mean plasma homocyst(e)ine level was 17.88 mmol/L (range 5.95 to 40.0 mmol/L) for patients with CAD and
6.060.99 mmol/L for controls (P,0.001). The genetic analysis for the thermolabile form of MTHFR in CAD patients
showed heterozygosity in 54% and homozygosity in 27%; comparable figures for controls were 40% (P50.4) and 10%
(P50.1), respectively.
Conclusions—Mild hyperH(e) might represent a risk factor for cervical artery dissection. The MTHFR mutation is not
significantly associated with CAD. An interaction between different genetic and environmental factors probably takes
place in the cascade of pathogenetic events leading to arterial wall damage.Background and Purpose - The pathogenesis of cervical artery dissection (CAD) remains unknown in most cases. Hyperhomocyst(e)inemia [hyperH(e)], an independent risk factor for cerebrovascular disease, induces damage in endothelial cells in animal cell culture. Consecutive patients with CAD and age-matched control subjects have been studied by serum levels of homocyst(e)ine and the genotype of 5,10-methylenetetrahydrofolate reductase (MTHFR). Methods - Twenty-six patients with CAD, admitted to our Stroke Unit (15 men and 11 women; 16 vertebral arteries, 10 internal carotid arteries), were compared with age-matched control subjects. All patients underwent duplex ultrasound, MR angiography, and/or conventional angiography. Results - Mean plasma homocyst(e)ine level was 17.88 μmol/L (range 5.95 to 40.0 μmol/L) for patients with CAD and 6.0±0.99 μmol/L for controls (P<0.001). The genetic analysis for the thermolabile form of MTHFR in CAD patients showed heterozygosity in 54% and homozygosit..
Stroke related to carotid artery dissection in a young patient with Takayasu arteritis, systemic lupus erythematosus and antiphospholipid antibody syndrome.
No full textIs ultrasound examination sufficient in the evaluation of patients with internal carotid artery severe stenosis or occlusion?
No full textBACKGROUND AND PURPOSE: Carotid endarterectomy (CE) has been shown to be beneficial in patients with symptomatic high-grade internal carotid artery (ICA) stenosis. Some authors have suggested that when ultrasound shows a stenosis 70-99%, CE can be performed without further imaging study. However, ultrasound findings that suggest an ICA occlusion, not confirmed by angiography but which instead show a near-occlusion usually benefit from CE. The objectives of this study are: (1). to evaluate how angiography-obtained information on intracranial arteries affects the treatment decision in patients with 70-99% ICA stenosis, and (2). to evaluate when a symptomatic ICA occlusion shown by ultrasound could actually be a patent artery and therefore benefit from CE.
MATERIALS AND METHODS: We prospectively collected the cerebral angiograms of 133 consecutive patients with TIA or non-disabling stroke due to large artery disease where ultrasound suggested a stenosis >or=70% or occlusion of symptomatic ICA; we calculated the frequency of intracranial vascular malformations and intracranial artery disease (IAD) located in the infraclinoid or supraclinoid portion of the ICA, and in the anterior or middle cerebral artery.
RESULTS: Ultrasound showed 31 ICA occlusions and 102 ICA with 70-99% stenosis. All the patients with an ICA stenosis 70-99% on ultrasound examination had the degree of stenosis confirmed by angiography. Two out of 31 patients did not have a complete occlusion but angiography showed a near-occlusion and consequently they underwent CE. Sixty-five (62.5%) out of 104 patients with patent ICA had IAD (mild 26.9%, moderate 21.2%, and severe 14.4%). Five patients (4.8%) had intracranial vascular malformations (4 aneurysms and 1 arteriovenous malformation). One patient had disabling stroke during angiography. Seven patients (6.7%) did not undergo CE after angiography (1 patient had an aneurysm >10 mm, 1 patient had a very tight stenosis of the basilar artery, 5 patients had intracranial stenosis more severe than the extracranial stenosis).
CONCLUSIONS: In patients that on the basis of ultrasound examination can benefit from CE, information on intracranial arteries is necessary. Moreover, complete occlusion cannot be detected with certainty only by ultrasound examination.Background and Purpose: Carotid endarterectomy (CE) has been shown to be beneficial in patients with symptomatic high-grade internal carotid artery (ICA) stenosis. Some authors have suggested that when ultrasound shows a stenosis 70-99%, CE can be performed without further imaging study. However, ultrasound findings that suggest an ICA occlusion, not confirmed by angiography but which instead show a near-occlusion usually benefit from CE. The objectives of this study are: (1) to evaluate how angiography-obtained information on intracranial arteries affects the treatment decision in patients with 70-99% ICA stenosis, and (2) to evaluate when a symptomatic ICA occlusion shown by ultrasound could actually be a patent artery and therefore benefit from CE. Materials and Methods: We prospectively collected the cerebral angiograms of 133 consecutive patients with TIA or non-disabling stroke due to large artery disease where ultrasound suggested a stenosis ≥70% or occlusion of symptomatic ICA;..
Extracranial Venous Drainage Pattern in Multiple Sclerosis and Healthy Controls: Application of the 2011 Diagnostic Criteria for Chronic Cerebrospinal Venous Insufficiency
No full text
Is ultrasound examination sufficient in the evaluation of patients with internal carotid artery severe stenosis or occlusion?
No full textBACKGROUND AND PURPOSE: Carotid endarterectomy (CE) has been shown to be beneficial in patients with symptomatic high-grade internal carotid artery (ICA) stenosis. Some authors have suggested that when ultrasound shows a stenosis 70-99%, CE can be performed without further imaging study. However, ultrasound findings that suggest an ICA occlusion, not confirmed by angiography but which instead show a near-occlusion usually benefit from CE. The objectives of this study are: (1). to evaluate how angiography-obtained information on intracranial arteries affects the treatment decision in patients with 70-99% ICA stenosis, and (2). to evaluate when a symptomatic ICA occlusion shown by ultrasound could actually be a patent artery and therefore benefit from CE.
MATERIALS AND METHODS: We prospectively collected the cerebral angiograms of 133 consecutive patients with TIA or non-disabling stroke due to large artery disease where ultrasound suggested a stenosis >or=70% or occlusion of symptomatic ICA; we calculated the frequency of intracranial vascular malformations and intracranial artery disease (IAD) located in the infraclinoid or supraclinoid portion of the ICA, and in the anterior or middle cerebral artery.
RESULTS: Ultrasound showed 31 ICA occlusions and 102 ICA with 70-99% stenosis. All the patients with an ICA stenosis 70-99% on ultrasound examination had the degree of stenosis confirmed by angiography. Two out of 31 patients did not have a complete occlusion but angiography showed a near-occlusion and consequently they underwent CE. Sixty-five (62.5%) out of 104 patients with patent ICA had IAD (mild 26.9%, moderate 21.2%, and severe 14.4%). Five patients (4.8%) had intracranial vascular malformations (4 aneurysms and 1 arteriovenous malformation). One patient had disabling stroke during angiography. Seven patients (6.7%) did not undergo CE after angiography (1 patient had an aneurysm >10 mm, 1 patient had a very tight stenosis of the basilar artery, 5 patients had intracranial stenosis more severe than the extracranial stenosis).
CONCLUSIONS: In patients that on the basis of ultrasound examination can benefit from CE, information on intracranial arteries is necessary. Moreover, complete occlusion cannot be detected with certainty only by ultrasound examination
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