Oculomotor nerve palsy limits the specific direction eyeball movement, and represents diplopia, mydriasis, and ptosis. The vascular-associated etiologies of oculomotor nerve palsy are the microvascular ischemia due to hypertension or diabetes, or compression of the nerve by the aneurysm. For the aneurysm, if not treated properly, it may result in mortality or severe neurological impairment. Thorough history taking, physical examinations, and proper imaging modality are needed to make an accurate diagnosis. A 76-year-old female with decreased mentality and anisocoria presented at our emergency department. An 83-year-old female presented with right ptosis and lateral-side deviated of the right eyeball. No definite lesion was noted on the initial non-contrast brain computed tomography (CT) and magnetic resonance imaging diffusion. An aneurysm was detected on CT angiography taken several hours later in the former patient. For the latter patient, a giant aneurysm was detected on magnetic resonance angiography that had been performed at another hospital 4 days earlier. These two patients underwent transfemoral cerebral angiography with coiling. They were discharged with no neurological sequelae.
Aged ; Aged, 80 and over ; Aneurysm ; Angiography ; Anisocoria ; Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Diagnosis ; Diffusion ; Diplopia ; Emergency Service, Hospital ; Female ; Humans ; Hypertension ; Ischemia ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Mortality ; Mydriasis ; Oculomotor Nerve Diseases ; Oculomotor Nerve ; Physical Examination

PURPOSE: To report a case of isolated abducens nerve palsy caused by the ophthalmic segment of an internal carotid artery (ICA) aneurysm which improved after endovascular coil trapping. CASE SUMMARY: A 59-year-old female visited the ophthalmology department for a sudden onset of horizontal diplopia for 10 days. The best corrected visual acuity was 20/20 in both eyes. The pupils showed normal response to light and near stimulation in both eyes. The extraocular examination showed 35 prism diopters left esotropia at primary gaze and −4 abduction limitation of the left eye. The patient suffered intermittent headaches in the left temporal area and left retrobulbar pain for 1 month. Magnetic resonance imaging with magnetic resonance angiography of the brain was performed. A focal protruding lesion of the left ICA suggested an aneurysm. The patient consulted with the neurosurgery department. The left ophthalmic segment of the ICA aneurysm was confirmed by transfemoral cerebral angiography and treated with coil placement and the patient showed gradual improvement after the procedure. Three months after the procedure there was no diplopia. The patient showed orthotropia at primary gaze without abduction limitation. CONCLUSIONS: Isolated abducens nerve palsy can be caused by the ophthalmic segment of an ICA aneurysm, which should be considered in the differential diagnosis of ocular motility disorders. The disorder improved with coil replacement treatment. Differential diagnosis as a cause of abducens nerve palsy is important for prompt and appropriate treatment. Neuroimaging should be considered in patients with isolated abducens nerve palsy with a non-ischemic origin.
Abducens Nerve Diseases ; Abducens Nerve ; Aneurysm ; Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Diagnosis, Differential ; Diplopia ; Esotropia ; Female ; Headache ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Aged ; Neuroimaging ; Neurosurgery ; Ocular Motility Disorders ; Ophthalmology ; Pupil ; Visual Acuity

An 81-year-old male patient presented with complaint of a pulsating neck mass. The patient had a previous history of cervical lymphadenopathy by non-tuberculous mycobacterium infection. Rapid growth of the mass on admission and contrast enhanced computed tomography of the neck resulted in a diagnosis of non-tuberculous mycobacterium induced pseudoaneurysm. The patient underwent emergency open repair of the pseudoaneurysm. Pseudoaneurysm of the common carotid artery is regularly reported, but here we report a rare case of non-tuberculous mycobacterium induced pseudoaneurysm of the common carotid artery.
Aged, 80 and over ; Aneurysm, False* ; Carotid Arteries ; Carotid Artery, Common* ; Diagnosis ; Emergencies ; Humans ; Lymphatic Diseases ; Male ; Mycobacterium Infections ; Mycobacterium* ; Neck ; Nontuberculous Mycobacteria ; Vascular Diseases

BACKGROUND/AIMS: The CHADS2 score, used to predict the risk of ischemic stroke in atrial fibrillation (AF) patients, has been reported recently to predict ischemic stroke in patients with coronary heart disease, regardless of the presence of AF. However, little data are available regarding the relationship between the CHADS2 score and cardiovascular outcomes. METHODS: This was a retrospective study on 104 patients admitted for acute coronary syndrome (ACS) who underwent coronary angiography, carotid ultrasound, and transthoracic echocardiography. RESULTS: The mean age of the subjects was 60.1 +/- 12.6 years. The CHADS2 score was as follows: 0 in 46 patients (44.2%), 1 in 31 (29.8%), 2 in 18 (17.3%), and > or = 3 in 9 patients (8.7%). The left atrial volume index (LAVi) showed a positive correlation with the CHADS2 score (20.8 +/- 5.9 for 0; 23.2 +/- 6.7 for 1; 26.6 +/- 10.8 for 2; and 30.3 +/- 8.3 mL/m2 for > or =3; p = 0.001). The average carotid total plaque area was significantly increased with CHADS2 scores > or = 2 (4.97 +/- 7.17 mm2 vs. 15.52 +/- 14.61 mm2; p = 0.002). Eight patients experienced cardiovascular or cerebrovascular (CCV) events during a mean evaluation period of 662 days. A CHADS2 score > or = 3 was related to an increase in the risk of CCV events (hazard ratio, 14.31; 95% confidence interval, 3.53 to 58.06). Furthermore, LAVi and the severity of coronary artery obstructive disease were also associated with an increased risk of CCV events. CONCLUSIONS: The CHADS2 score may be a useful prognostic tool for predicting CCV events in ACS patients with documented coronary artery disease.
Acute Coronary Syndrome/complications/*diagnostic imaging ; Aged ; Carotid Arteries/*diagnostic imaging ; Carotid Artery Diseases/complications/*diagnostic imaging ; Cerebrovascular Disorders/diagnosis/*etiology ; *Coronary Angiography ; Coronary Artery Disease/complications/*diagnostic imaging ; *Decision Support Techniques ; *Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic ; Predictive Value of Tests ; Prognosis ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors

Angiography, Digital Subtraction ; Arterial Occlusive Diseases ; diagnosis ; Carotid Artery Diseases ; diagnosis ; Carotid Artery, Internal ; pathology ; Carotid Artery, Internal, Dissection ; diagnosis ; Humans ; Male ; Middle Aged

The use of ultrasonography and especially of contrast-enhanced ultrasonography (CEUS) in the diagnosis of vascular pathologies before and after interventions has significantly increased over the past years due to the broader availability of modern ultrasound systems with CEUS capabilities and more trained user experience in this imaging modality. For the preinterventional and postinterventional work-up of carotid diseases, duplex ultrasound as well as CEUS have been established as the standard-of-care examination procedures for diagnosis, evaluation, and follow-up. In addition to its use for carotid arterial diseases, ultrasonography has also become the primary modality for the screening of vascular pathologies. This review describes the most common pathologies found in ultrasonography of the carotid arteries, the abdominal aorta, and the femoral arteries.
Aorta, Abdominal ; Arteriovenous Fistula ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis ; Contrast Media ; Diagnosis ; Femoral Artery ; Follow-Up Studies ; Mass Screening ; Pathology ; Plaque, Atherosclerotic ; Ultrasonography*

No abstract available.
Aged ; Anti-Inflammatory Agents/therapeutic use ; Carotid Artery Diseases/*complications/diagnosis/therapy ; Cerebral Angiography/methods ; Diagnosis, Differential ; Female ; Glucocorticoids/therapeutic use ; Humans ; Hydrocortisone/therapeutic use ; Hypopituitarism/diagnosis/*etiology/therapy ; Intracranial Aneurysm/*complications/diagnosis/therapy ; Magnetic Resonance Imaging ; Plasma Substitutes/administration & dosage ; Predictive Value of Tests ; Prednisolone/therapeutic use ; Sella Turcica ; Thyroid Hormones/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

The purpose of this study was to evaluate the effects of rheumatoid arthritis (RA) and antirheumatic drugs on atherosclerosis by comparing carotid intima-media thickness (CIMT) as an indicator for cardiovascular diseases (CVD). This study included 44 female RA patients who met the 2010 ACR/EULAR criteria and age-matched 22 healthy females. CIMT was measured on both carotid arteries using a B-mode ultrasound scan. The mean value of both sides was taken as the CIMT of the subject. The CIMT was evaluated according to the use of drugs, disease activity and CVD risk factors in RA patients as a case-control study. Higher CIMT was observed in RA patients as compared with healthy subjects (0.705 +/- 0.198 mm, 0.611 +/- 0.093 mm, respectively, P < 0.05). With adjustment for the CVD risk factors, disease activity and the use of anti-rheumatic drugs, methotrexate (MTX) only showed a favorable effect on CIMT in RA. A significantly lower CIMT was observed in RA with MTX as compared with RA without MTX (0.644 +/- 0.136 mm, 0.767 +/- 0.233 mm, respectively, P < 0.05). The effects were correlated with MTX dosage (beta = -0.029, P < 0.01). The use of MTX should be considered in high priority not only to control arthritis but also to reduce the RA-related CVD risk to mortality.
Adult ; Aged ; Aged, 80 and over ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/diagnosis/*drug therapy/*epidemiology ; Carotid Artery Diseases/*drug therapy/*epidemiology/ultrasonography ; *Carotid Intima-Media Thickness ; Causality ; Comorbidity ; Female ; Humans ; Incidence ; Male ; Methotrexate/*therapeutic use ; Middle Aged ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Sensitivity and Specificity

BACKGROUNDAbout 50% of the cerebral ischemia events are induced by intracranial and extracranial atherosclerosis. This study aimed to evaluate the feasibility and accuracy for displaying atherosclerotic plaques in carotid arteries and analyzing their ingredients by using high-resolution new magnetic resonance imaging (MRI) techniques.

METHODSTotally, 49 patients suspected of extracranial carotid artery stenosis were subjected to cranial MRI scan and magnetic resonance angiography (MRA) examination on carotid arteries, and high-resolution bright-blood and black-blood MRI analysis was carried out within 1 week. Digital subtraction angiography (DSA) examination was carried out for 16 patients within 1 month.

RESULTSTotally, 103 plaques were detected in the 49 patients, which were characterized by localized or diffusive thickening of the vessel wall, with the intrusion of crescent-shaped abnormal signal into lumens. Fibrous cap was displayed as isointensity in T1-weighted image (T1WI) and hyperintensities in proton density weighted image (PDWI) and T2-weighted image (T2WI), lipid core was displayed as isointensity or slight hyperintensities in T1WI, isointensity, hyperintensities or hypointensity in PDWI, and hypointensity in T2WI. Calcification in plaques was detected in 11 patients. Eight patients were detected with irregular plaque surface or ulcerative plaques, which were characterized by irregular intravascular space surface in the black-blood sequences, black hypointensity band was not detected in three-dimensional time-of-flight, or the hypointensity band was not continuous, and intrusion of hyperintensities into plaques can be detected. Bright-blood and black-blood techniques were highly correlated with the diagnosis of contrast-enhanced MRA in angiostenosis degree, Rs = 0.97, P < 0.001. In comparison to DSA, the sensitivity, specificity, and accuracy of MRI diagnosis of stenosis for ≥50% were 88.9%, 100%, and 97.9%, respectively.

CONCLUSIONSHigh-resolution bright-blood and black-blood sequential MRI analysis can accurately analyze ingredients in atherosclerotic plaques. Determined by DSA, MRI diagnosis of stenosis can correctly evaluate the serious degree of arteriostenosis.

Adult ; Aged ; Angiography, Digital Subtraction ; Carotid Artery Diseases ; diagnosis ; Carotid Stenosis ; Female ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Plaque, Atherosclerotic ; diagnosis ; Sensitivity and Specificity

Carotid Artery, Internal ; pathology ; Humans ; Oropharynx ; pathology ; Pharyngeal Diseases ; diagnosis