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... studies have shown that 17% of patients with pure cortical PCA strokes have face-arm-leg motor defi cits and 23% have sensory defi cits in the same distribution. [8] This patient's imaging demonstrates a right CAD absent right PCA [ Figure 2] and an infarct in the right PCA territory [ Figure 1]. Such an occurrence is possible when a persistent fetal PCA, which takes direct origin from the internal carotid artery, acts as a conduit for embolism from the anterior circulation. ...
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![Fig. 1. [A-E] Case one with right ICA dissection and elongated styloid...](profile/Yahia-Imam/publication/375854990/figure/fig1/AS:11431281206777845@1700891530232/A-E-Case-one-with-right-ICA-dissection-and-elongated-styloid-processes-A-Axial_Q320.jpg)
![Fig. 2. [A-E] MRI /MRA head -Case one with right ICA dissection and...](profile/Yahia-Imam/publication/375854990/figure/fig2/AS:11431281206812076@1700891530403/A-E-MRI-MRA-head-Case-one-with-right-ICA-dissection-and-elongated-styloid-processes_Q320.jpg)
![Fig. 3. [A-C] CT head-Case two bilateral elongated styloid processes....](profile/Yahia-Imam/publication/375854990/figure/fig3/AS:11431281206777846@1700891530584/A-C-CT-head-Case-two-bilateral-elongated-styloid-processes-A-and-B-Axial-and-Coronal_Q320.jpg)
Citations
... It has been estimated to occur in 2.5-3 cases per 100,000 population. 4 A internal carotid artery dissection usually affects a unilateral side. Only 2%-10% of internal carotid arteries dissection are bilateral. ...
Introduction
Aortic dissection is a clinical chameleon that can have variable presenting features that require a careful history and physical examination. A non-specific presentation of this life-threatening condition causes a diagnostic dilemma among clinicians especially in the emergency department leading to grave consequences.
Case Presentation
We present a case of aortic dissection that presented as an acute bilateral blindness that was associated with a sudden onset of loss of consciousness and central chest pain. Bedside carotid ultrasound showed a double lumen carotid artery suggesting an intraluminal flap. Computed tomography angiography revealed extensive dissection of the entire length of the aorta.
Discussion
This case illustrated the need for a high index of suspicion to diagnose patients with aortic dissection especially as the patient presented with an acute binocular visual loss and chest pain.
Conclusion
A bedside carotid artery ultrasound in the emergency department was found useful in screening and diagnosing a carotid artery–related pathology.
... After 12 days, she was discharged to a skilled nursing facility. Emboli can move up the ICA, enter and occlude the FPCA or its branches, and result in a paradoxical PCA territory infarction-with [12][13][14][15] or without [16][17][18][19][20] attendant occlusion of other ICA branches. A left FPCA was clearly the reason for the left-sided paradoxical infarction in Patient 2. On the other hand, the reason for the right-sided paradoxical infarction in Patient 1 was not obvious. ...
Fetal-type or fetal posterior cerebral artery (FPCA) is a variant of cerebrovascular anatomy in which the distal posterior cerebral artery (PCA) territory is perfused by a branch of the internal carotid artery (ICA). In the presence of FPCA, thromboembolism in the anterior circulation may result in paradoxical PCA territory infarction with or without concomitant infarction in the territories of the middle (MCA) or the anterior (ACA) cerebral artery. We describe 2 cases of FPCA and concurrent acute infarction in the PCA and ICA territories—right PCA and MCA in Patient 1 and left PCA, MCA, and ACA in Patient 2. Noninvasive angiography detected a left FPCA in both patients. While FPCA was clearly the mechanism of paradoxical infarction in Patient 2, it turned out to be an incidental finding in Patient 1 when evidence of a classic right PCA was uncovered from an old computed tomography scan image. Differences in anatomical details of the FPCA in each patient suggest that the 2 FPCAs are developmentally different. The FPCA of Patient 1 appeared to be an extension of the embryonic left posterior communicating artery (PcomA). Patient 2 had 2 PCAs on the left (PCA duplication), classic bilateral PCAs, and PcomAs, and absent left anterior choroidal artery (AchoA), suggesting developmental AchoA-to-FPCA transformation on the left. These 2 cases underscore the variable anatomy, clinical significance, and embryological origins of FPCA variants.
... En contraste, raramente se presenta un compromiso de la arteria cerebral posterior (4)(5)(6). En el pasado se publicaron casos en los que el compromiso de la arteria carótida con infarto de la arteria cerebral posterior fue referido como una presentación inusual (7,8). El propósito de éste reporte es ilustrar el daño de la arteria cerebral posterior, así como de la arteria coroidea anterior con la explicación anatómica. ...
... La primera pregunta es cómo se explica que haya daño de la arteria cerebral posterior debido a una lesión carotídea. De acuerdo con la literatura, el primer reporte se tituló: "Infarto occipital con hemianopsia desde la enfermedad carotídea oclusiva" (7), los otros informes existentes son de pacientes con disección carotídea con presencia de infarto occipital (8,(17)(18)(19). La mayoría de las veces en que se compromete la arteria cerebral posterior la causa es una isquemia de la circulación posterior; sin embargo, la unión de la circulación anterior con la posterior en el polígono de Willis se da por la arteria comunicante posterior (20). ...
... Desde luego, para que suceda un infarto occipital por compromiso de la circulación anterior se deben dar algunas variantes anatómicas: la primera es la hipoplasia del segmento P1 o segmento precomunicante de la arteria cerebral posterior ipsilateral a la carótida ocluída (17,21), en la que la arteria comunicante posterior lleva la circulación al segmento postcomunicante (P2). La segunda variante se presenta cuando la arteria cerebral posterior se origina directamente de la arteria carótida interna; esto es lo que se llama el "origen fetal" de la arteria cerebral posterior (7,8,19). Con la oclusión de las arterias aferentes (carótida, vertebral) se sabe, desde Sir Thomas Willis, de la presencia de puentes colaterales para suplir las fallas de la circulación a través del polígono (21). ...
Bases: los principales sintomas del compromiso de la arteria carotida interna son la amaurosis fugax y aquellos que se deben a un compromiso de las arterias cerebral media y anterior. Metodos: se trata de un hombre de 79 anos diabetico e hipertenso que se presento con un cuadro que sugeria un compromiso de la arteria cerebral media izquierda. Se documento una obstruccion aguda de la arteria carotida interna izquierda, con infartos del territorio de la arteria coroidea anterior y la cerebral posterior del mismo lado; en el estudio se hallo una fuente cardioembolica. Conclusion: si bien la obstruccion aguda de la arteria carotida interna se asocia sobre todo a sintomas visuales y de compromiso de la circulacion anterior, se puede relacionar tambien con infartos de la arteria cerebral posterior.(AU) Background: the main symptoms of a compromise to the internal carotid artery are monocular blindness and those which are secondary to the lesion of the medial cerebral and anterior cerebral arteries. Methods: a 79 year old male patient, with past medical history of diabetes and high blood pressure and clinical symptoms of compromise to the left medial cerebral artery. The patient shows an acute occlusion of the left internal carotid artery with arterial infarcts in the choroidal anterior and cerebral posterior territories in the same side of the carotid lesion. The cardioembolic source of the infarct was documented. Conclusion: Although acute obstruction of the internal carotid artery is mostly associated with visual symptoms and engagement of the anterior circulation, it may also be associated with infarcts of the posterior cerebral artery.(AU)
Multidrug-resistant enterococcal nosocomial invasive infections are a rising concern faced by the medical community. Not many options are available to treat these highly virulent organisms. Risk factors for developing these highly resistant organisms include prolonged hospital stay, previous antibiotic use, and immunosuppression. In this article, we report a case of daptomycin-resistant enterococcal native infective endocarditis treated with off-label use of quinupristin-dalfopristin.
