Background: Vasospasm occurs commonly in the intracranial arteries as a complication of subarachnoid haemorrhage. On the other hand, extracranial Internal carotid artery (ICA) vasospasm is scarce, and it may occur due to mechanical manipulation during cerebral angiography. We report a case of cervical carotid artery vasospasm during diagnostic cerebral angiography, which caused anterior cerebral artery territory hypoperfusion, to discuss potential risk factors. Case description: For a 22-year-old female with a ten-year history of epilepsy on multiple drugs, brain magnetic resonance imaging (MRI) showed frontal periventricular developmental venous anomaly. Diagnostic catheter cerebral angiography was used to better identify the vascular abnormality. In the procedure, extra steps were performed, including instruments being sterilized with CIDEX® OPA Solution (phthalaldehyde as the active ingredient), the reuse of the set including the catheters more than twice or triple times, and cold temperature of normal saline that was used in the flushing procedure. Under conscious sedation, the procedure went uneventful until the catheterization of the left carotid artery was performed, where severe vasospasm was noticed in the extracranial ICA, followed by cessation of flow in the ipsilateral ACA. Pulling the catheter to a more proximal location in the extracranial ICA was performed to alleviate the vasospasm. It took twelve minutes for the circulation to be restored, and that was under continuous irrigation and flushing. The patient did not develop any symptoms throughout the procedure or post-procedural course. Conclusion: Chemical irritation from the sterilizing agent and reuse of the catheters could cause extracranial ICA vasospasm.
Background: Duplex ultrasound is inexpensive, non-invasive and can provide functional and anatomical information about vessel stenosis and plaque morphology. Color duplex flow ultrasonography has thus become the most widely used noninvasive method of assessing extra cranial cerebrovascular occlusive disease.
Objectives:To find the relation of the severity of carotid artery stenosis, intima media thickness, and atheromatous plaque morphology with the size of cerebral infarction.
Patients and Methods: A prospective study, conducted from September 2010 to May 2011, in Department of Radiology in Baghdad Teaching Hospital. A total of 62 Patients with clinical & radiological (brain CT) diagnosis of acute stroke, (42 males & 20 fe
Background: Imaging has a critical role in the diagnosis and evaluation of cardiac diseases, beginning with chest radiography and fluoro-scopy and progressing to coronary angio-graphy, echocardiography, nuclear medicine and recently multidetector computed tomo-graphy (MDCT) as well as magnetic resonance (MR) imaging
Objective: To highlight the role of Multi-detector CT in the evaluation of coronary artery disease and its importance of being noninvasive diagnostic technique.
Methods: A cross sectional study for 20 patients. Patients were asked to fast 6 hours prior to the examination and the patients with heart rates above 65 beats per minute were given cardio-
... Show MoreIn this paper, the effects of hematocrit of red blood cells on blood flow through a stenosed human carotid artery was considered by taking blood as a Newtonian fluid. The governing equations on blood flow were derived. The mathematical content involved in the equations are the variables of interest such as number of stenosis , percentage of hematocrit of red blood cells in the blood, flow rate, wall shear stress, and viscosity of the blood. Guided by medical data collected on the constraint of blood flow in stenosed human carotid arteries, the governing equations were used to check the effects of pressure gradient, wall shear stress, velocity, and volumetric flow rate of blood in the human carotid arteries. Also, the one-dimensiona
... Show MoreAims: The aim of this study was to evaluate the value and accuracy of longitudinal strain in detection of coronary artery disease compared to coronary angiography. Results: The left ventricular longitudinal strain-speckle tracking showed evidence of stenosis of left anterior descending artery, circumflex artery and right coronary artery in (86.1%), (76.4%), and (84.7%) respectively. For the stenosis in left anterior descending artery, the current study showed that the longitudinal strain was a good predictor for presence of significant stenosis with a sensitivity of (93.8%), specificity (75%) and accuracy (91.7%) compared with coronary angiography. For the stenosis in right coronary artery, the left ventricular longitudinal strain had
... Show MoreAneurysms of the cortical branches of the middle cerebral artery (MCA) are rare. They usually are secondary to traumatic or infectious etiologies and are rarely idiopathic. The specific characteristics of idiopathic aneurysms in such location are not well defined in the literature. The authors report a rare case of a ruptured giant idiopathic cortical MCA aneurysm with review of the available literature on this clinical entity.
A 24-year-old female presented with headache, disturbed level of consciousness, and right-sided weakness. Imaging studies showed a left frontoparietal intracer
Introduction: In recent decades, the endovascular treatment of cerebral arteriovenous malformations (AVMs) has advanced. However, it still carries risks of unanticipated complications. Coil migration is a reported complication of aneurysmal coiling procedures. Herein, we report a case of early intraprocedural coil migration during pressure cooker technique embolization of right thalamic AVM, discussing the management and potential explanations. The literature showed no report of coil migration after the pressure cooker technique in the form of coil-augmented Onyx injection technique (CAIT). Case description: An otherwise healthy 26-year-old female suddenly developed a severe headache with no loss of consciousness. Computed tomograp
... Show MoreAbsence or hypoplasia of the internal carotid artery (ICA) is a rare congenital anomaly that is mostly unilateral and highly associated with other intracranial vascular anomalies, of which saccular aneurysm is the most common. Blood flow to the circulation of the affected side is maintained by collateral pathways, some of which include the anterior communicating artery (Acom) as part of their anatomy. Therefore, temporary clipping during microsurgery on Acom aneurysms in patients with unilateral ICA anomalies could jeopardize these collaterals and place the patient at risk of ischemic damage. In this paper, we review the literature on cases with a unilaterally absent ICA associa
Background. Aneurysms of the distal anterior cerebral artery (DACA) are uncommon; they often form near the pericallosal-callosomarginal junction and are typically small. To our knowledge, giant DACA aneurysms developing from the more distant parts of the anterior cerebral artery (ACA), A4-5, have been described only once in the literature. Case description. A 66-year-old gentleman reported with a brief loss of consciousness followed by weakness in his right lower leg. The patient was admitted with a Glasgow Coma Score (GCS) of 15. A computed tomography (CT) scan of the head revealed a left hyperdense mass in the frontal parasagittal supracallosal region. Contrast MRI revealed a heterogeneously enhancing mass measuring 35x30x25 mm. C
... Show MoreBackground: Giant middle cerebral artery (MCA) aneurysms are surgically challenging lesions. Because of the complexity and variability of these aneurysms, a customized surgical technique is often needed for each case. In this article, we present a modified clip reconstruction technique of a ruptured complex giant partially thrombosed middle cerebral artery aneurysm.
Case description: The aneurysm was exposed using the pterional approach. Following proximal control, the aneurysm sac was decompressed. Then, we applied permanent clips to reconstruct the aneurysm neck. The configuration of the aneurysm mandated a tailored clipping pattern to account for resi
... Show MoreVascular injury is still common in countries such as Iraq where both military and urban violence are endemic.
This is a report of a thirty eight year old civilian patient who had been inflicted with shrapnel injury during the 3rd. Gulf war, which had caused two different types of vascular injury with minimal evidence of vascular injury with evidence of only two small wounds in the neck and upper chest at the time of injury but presented few months later with a pulsatile neck mass and palpable thrill across the right supraclavicular area and upper chest.
Preoperative investigations were done including Doppler study and angiography which confirmed the presence of right common carotid artery aneurysm and