Bilateral hypoplasia of the internal carotid arteries is a rare condition. The authors experienced two cases of bilateral hypoplasia of the internal carotid arteries. In one case, a 46-year-old female patient, presented with subarachnoid hemorrhage. Internal carotid angiograms showed right hypoplastic internal carotid artery and left agenetic internal carotid artery. An aneurysm, believed to be the source of the subarachnoid hemorrhage, took origin from the trunk of the basilar artery. In another case, a 48-year-old male, presented with semicomatous mentality. Brain CT demonstrated intracranial hemorrhage on the parasylvian area, and high density on the basal cistern, quadrigerminal cistern and temporal horn of left lateral ventricle. Initially, aortic arch injection did not visualized the origin of the common carotid arteries. It revealed only the vertebral arteries and both external carotid artery originating from each vertebral artery. A selective left vetebral artery study demonstrated a communication between the hypertrophied basilar artery and the posterior cerebral arteries. The anterior and middle cerebral vessels, in turn, were opacified through the circle of Willis, via the posterior communicating arteries. In addition, an aneurysm, believed to be the sourse of the subarachnoid hemorrhage, took origin from the posterior cerebral artery. The cases of the bilateral hypoplasia of internal carotid artery with intracranial aneurysm are reported as above, together with literature review.
Aneurysm ; Animals ; Aorta, Thoracic ; Arteries ; Basilar Artery ; Brain ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal* ; Circle of Willis ; Collateral Circulation ; Female ; Horns ; Humans ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Lateral Ventricles ; Male ; Middle Aged ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage ; Vertebral Artery

Intracranial angiolipoma is extremely rare. We report the radiologic findings of angiolipoma in the rightmiddle cranial fossa, extending medially into the suprasellar and cavernous sinus region, in a 63-year-old woman.The lesion was a relatively well marginated extra-axial tumor that showed low density on precontrast CT and markedenhancement after contrast infusion. MR imaging showed heterogeneous low signal on T1W1 mixed with hyperintensefoci on T2W1, and marked enhancement after gadolinium infusion. On cerebral angiography, displacement of the rightinternal carotid artery by the tumor was seen. On an arteriogram of the right external carotid artery, the massshowed persistent capillary blush.
Angiolipoma* ; Capillaries ; Carotid Arteries ; Carotid Artery, External ; Cavernous Sinus ; Cerebral Angiography ; Gadolinium ; Humans ; Magnetic Resonance Imaging ; Middle Aged

We report our experience using Onyx for embolization of dural arteriovenous fistula (DAVF) under dual lumen balloon catheter flow arrest. Transfemoral cerebral angiography revealed a superior sagittal sinus (SSS) DAVF that was supplied via multiple branches of the external carotid arteries, the right anterior cerebral arteries, and the meningeal branches of the internal carotid artery. There was no anterograde venous drainage through the SSS, and venous drainage was almost retrograde through the medullary and cortical veins. Under general anesthesia, a transvenous approach was utilized to place the microcatheter close to the fistula site. After intravenous embolization with various coils, DAVF was partially occluded; Balloon catheter gained access to the DAVF via the right middle meningeal artery. We injected Onyx through the Scepter C catheter, after which DAVF was nearly completely occluded. Balloon-assisted Onyx embolization is a feasible and effective approach for the management of DAVF.
Anesthesia, General ; Anterior Cerebral Artery ; Carotid Artery, External ; Carotid Artery, Internal ; Catheters ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Drainage ; Fistula ; Hypogonadism ; Meningeal Arteries ; Mitochondrial Diseases ; Ophthalmoplegia ; Superior Sagittal Sinus ; Veins

BACKGROUND: Agenesis of the common carotid artery (CCA) resulting in separation of the origin of the external carotid artery (ECA) and internal carotid artery (ICA) from the aortic arch is rare. Fewer than 25 cases have been reported, and correlative ultrasound data were available for only 1 of them. CASE REPORT: A 52-year-old woman visited the hospital with a 3-day history of vertigo and headache. Color-coded duplex ultrasonography performed to evaluate the carotid and vertebral arteries revealed a normal configuration on the left side. However, the right CCA could not be found; instead, there were two vessels of approximately equal size in close proximity to each other. The cerebral angiographic findings were consistent with the ultrasonographic findings. The ECA and ICA originated directly from the brachiocephalic trunk, and the ECA arose proximal to the ICA. CONCLUSIONS: The ultrasonographic findings revealed absence of the CCA, the ECA and ICA originating separately from the aortic arch. Color-coded duplex ultrasonography appears to be an effective and sensitive method for detecting absence of the CCA. These findings should help to further our understanding of the embryologic development of the carotid arteries.
Angiography ; Aorta, Thoracic ; Brachiocephalic Trunk ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Female ; Headache ; Humans ; Middle Aged ; Vertebral Artery ; Vertigo

In order to study the vascular manifestation of Behcet's disease, authors analized retrospectively the radiological and clinical features of 22 patients who were diagnosed as vasculo-Behcet's disease. The angiographic findings were aneurysm formation and occlusion of artery and vein, Aneurysm formations were found at common carotid artery (3 cases), abdominal aorta (2 cases), aortic arch (2 cases), innominate artery (2 cases) etc. Arterial occlusions were found at pulmonary artery (2 cases), subclavian artery (1 cases), brachial artery (1 case), common femoral artery (1 case) etc. Venous occlusions were found at the veins of the lower extremities including superficial femoral vein (18 cases), IVC (2 cases), SVC (1 case), and lateral sinus (1 case). The clinical features were similar to that of Behcet's disease without vascular involvement, but incidence of vascular involvement was more common in men and interval between the onset of the disease and vascular symptoms was 1-16 years(77%) and common associated symptoms were oral ulcers(59%) and skin lesions(55%). Angiographically the morphological featured of vasculo-Behcet's disease are not specific, but vascular radiologist must be aware of vascular involvement by Behcet's disease in differential diagnosis when occlusive changes in the venous or arterial tree, or aneurysm formation are seen in young patients.
Aneurysm ; Aorta, Abdominal ; Aorta, Thoracic ; Arteries ; Brachial Artery ; Brachiocephalic Trunk ; Carotid Artery, Common ; Diagnosis, Differential ; Femoral Artery ; Femoral Vein ; Humans ; Incidence ; Lower Extremity ; Male ; Pulmonary Artery ; Retrospective Studies ; Skin ; Subclavian Artery ; Transverse Sinuses ; Trees ; Veins

As the internal carotid artery(ICA) spans the cavernous sinus and supraclinoid segments, it assumes an S-shaped configuration on lateral view that is referred as the carotid siphon. The supraclinoid carotid artery begins where the artery emerges through the dural ring from the clinoidal segment, thereby forming the distal half of the siphon. The artery enters the subarachnoid space medial to the anterior clinoid process, just inferior to the optic nerve, and then pass posteriorly, and laterally to the side of the optic chiasm. The vessel then angles forward as it nears the anterior perforated substance at the medial end of Sylvian fissure, where it bifurcates into the anterior and middle cerebral arteries. The supraclinoid portion of the ICA can be divided into three segments: ophthalmic, communicating, and choroidal, based on the site of origin of the ophthalmic, posterior communicating, and anterior choroidal arteries, respectively.
Arteries ; Carotid Arteries ; Carotid Artery, Internal* ; Cavernous Sinus ; Choroid ; Middle Cerebral Artery ; Olfactory Pathways ; Optic Chiasm ; Optic Nerve ; Subarachnoid Space

As the internal carotid artery(ICA) spans the cavernous sinus and supraclinoid segments, it assumes an S-shaped configuration on lateral view that is referred as the carotid siphon. The supraclinoid carotid artery begins where the artery emerges through the dural ring from the clinoidal segment, thereby forming the distal half of the siphon. The artery enters the subarachnoid space medial to the anterior clinoid process, just inferior to the optic nerve, and then pass posteriorly, and laterally to the side of the optic chiasm. The vessel then angles forward as it nears the anterior perforated substance at the medial end of Sylvian fissure, where it bifurcates into the anterior and middle cerebral arteries. The supraclinoid portion of the ICA can be divided into three segments: ophthalmic, communicating, and choroidal, based on the site of origin of the ophthalmic, posterior communicating, and anterior choroidal arteries, respectively.
Arteries ; Carotid Arteries ; Carotid Artery, Internal* ; Cavernous Sinus ; Choroid ; Middle Cerebral Artery ; Olfactory Pathways ; Optic Chiasm ; Optic Nerve ; Subarachnoid Space

Two cases of massive epistaxis following nonpenetrating head injury are reported. A 23-year-old man was referred to us because of massive epistaxis and binocular blindness which developed about two months after a head injury. Carotid angiography demonstrated a intracavernous carotid aneurysm protruding into the ethmoid and sphenoid sinuses, and occlusion of the supraclinoid part of contralateral carotid artery. CT scan demonstrated a large hyperdense mass extending into the parasellar area, the ethmoid and sphenoid sinuses, and both orbits with destruction of bony structures. Treatment was delayed because the patient developed typhoid fever and sepsis, he died about six months after a head injury from a severe cerebral infarction due to internal carotid artery occlusion. A 34-year-old man, involved in a car accident, was admitted in semicomatose state. Over the next 72 hr he become more alert but he had massive epistaxis 11 day later which required blood transfusions. Carotid angiography revealed a false aneurysm of the distal part of the internal maxillary artery. About 30 days later, the false aneurysm occluded by embolization with Gelfoam. The patient recovered uneventfully from these procedures.
Adult ; Aneurysm ; Aneurysm, False ; Angiography ; Blindness ; Blood Transfusion ; Carotid Arteries* ; Carotid Artery Injuries* ; Carotid Artery, External ; Carotid Artery, Internal ; Cerebral Infarction ; Craniocerebral Trauma* ; Epistaxis* ; Gelatin Sponge, Absorbable ; Head Injuries, Closed ; Head* ; Humans ; Maxillary Artery ; Orbit ; Sepsis ; Sphenoid Sinus ; Telescopes ; Tomography, X-Ray Computed ; Typhoid Fever ; Young Adult

(K+)o can be increased under a variety of conditions including subarachnoid hemorrhage. The increase of (K+)o in the range of 5 ~ 15 mM may affect tensions of blood vessels and cause relaxation of agonist-induced precontracted vascular smooth muscle (K+-induced relaxation). In this study, effect of the increase in extracellular K+ concentration on the agonist-induced contractions of various arteries including resistant arteries of rabbit was examined, using home-made Mulvany-type myograph. Extracellular K+ was increased in three different ways, from initial 1 to 3 mM, from initial 3 to 6 mM, or from initial 6 to 12 mM. In superior mesenteric arteries, the relaxation induced by extracellular K+ elevation from initial 6 to 12 mM was the most prominent among the relaxations induced by the elevations in three different ways. In cerebral arteries, the most prominent relaxation was produced by the elevation of extracellular K+ from initial 1 to 3 mM and a slight relaxation wasp rovoked by the elevation from initial 6 to 12 mM. In superior mesenteric arteries, K+-induced relaxation by the elevation from initial 6 to 12 mM was blocked by Ba2+ (30 muM) and the relaxation by the elevation from 1 to 3 mM or from 3 to 6 mM was not blocked by Ba2+. In cerebral arteries, however, K+-induced relaxation by the elevation from initial 3 to 6 mM was blocked by Ba2+, whereas the relaxation by the elevation from 1 to 3 mM was not blocked by Ba2+. Ouabain inhibited all of the relaxations induced by the extracellular K+ elevations in three different ways. In cerebral arteries, when extracellular K+ was increased to 14 mM with 2 or 3 mM increments, almost complete relaxation was induced at 1 or 3 mM of initial K+ concentration and slight relaxation occurred at 6 mM. TEA did not inhibit Ba2+/-sensitive relaxation at all and NMMA or endothelial removal did not inhibit K+-induced relaxation. Most conduit arteries such as aorta, carotid artery, and renal artery were not relaxed by the elevation of extracellular K+. Among conduit arteries, trunk of superior mesenteric artery and basilar artery were relaxed by the elevations of (K+)o. These data suggest that K+-induced relaxation has two independent components, Ba2+-sensitive and Ba2+-insensitive one and there are different mechanisms for K+-induced relaxation in various arteries.
Aorta ; Arteries* ; Basilar Artery ; Blood Vessels ; Carotid Arteries ; Cerebral Arteries ; Mesenteric Artery, Superior ; Muscle, Smooth, Vascular ; Ouabain ; Relaxation* ; Renal Artery ; Subarachnoid Hemorrhage ; Tea ; Wasps

Spontaneous bilateral cerebellar infarction in the territory of the superior cerebellar arteries is extremely rare. Occasionally there have been reports of bilateral cerebellar infarction due to vertebrobasilar atherosclerotic occlusion or stenosis, whereas no report of bilateral cerebellar infarction due to complicated hemodynamic changes. In this report, we present a patient with bilateral cerebral infarctions related to stenoses of bilateral internal carotid arteries, in whom vertebrobasilar system was supplied by multiple collaterals from both posterior communicating arteries and right external carotid artery. We performed stent-angioplasty of bilateral internal cerebral arterial stenosis, and then acute infarction developed on bilateral superior cerebellar artery territories. The authors assumed that the infarction occurred due to hemodynamic change between internal carotid artery and external carotid artery after stent-angioplasty for stenosis of right internal carotid artery.
Arteries* ; Carotid Artery, External ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebral Infarction ; Constriction, Pathologic ; Hemodynamics ; Humans ; Infarction*