internal carotid artery

Parálisis Del III Par Craneal Con Disfunción Externa Completa y Preservación Pupilar Como Manifestación de Aneurisma. Reporte de Caso. Third Nerve Palsy With Complete External Dysfunction And Pupillary Preservation, As A Manifestation Of Aneurysm. Case Report.

Acquired paralysis of the oculomotor nerve in the adult population includes various etiologies and frequently those that produce compressive lesions, such as intracranial aneurysms, generate pupillary involvement.

Increasing reports have shown atypical clinical presentations in intracranial aneurysms and this report presents the case of a patient without internal dysfunction or with pupillary preservation in addition to complete external dysfunction, that is, paralysis of all extraocular muscles innervated by the third cranial nerve, due to an intracranial aneurysm, which has not been published in the literature so far. Considering the mortality that is implied by an aneurysmal rupture and the novel clinical presentations reported to date, it is of great importance to request diagnostic means quickly to all patients with third cranial nerve palsy, regardless of their clinical expression.

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Palabras clave: Aneurisma, Arteria Carótida interna, Blefaroptosis, Enfermedades del Nervio Oculomotor, Oftalmoplejía, Trastornos de la pupila,

Keywords: Aneurysm, Blepharoptosis, internal carotid artery, Oculomotor Nerve Diseases, Ophthalmoplegia, Pupil Disorders,

Trombo Flotante en Arteria Carótida. Carotid Free-Floating Thrombus.

Carotid free-floating thrombus (FFT) is a rare cause of ischemic stroke, usually detected during etiologic vascular studies. There is no consensus regarding the management of carotid free-floating thrombi in those patients.

A 83-year-old male presented to the emergency department with right hemiparesis and dysarthria, consistent with finding of multiple left hemispheric brain infarcts on neuroimaging. Contrast CT showed a free-floating thrombus fixed to an atheroma plaque in left internal carotid artery (ICA). Holter monitorization registered a not previously noticed paroxystic atrial fibrillation. Due to findings, sodic heparinization was started and serial ecosonographic monitoring of the thrombus was performed. He was discharged home with a clot reduction >50% with oral anticoagulant therapy (rivaroxaban 20mg daily). At 2 months, ecographic control was realized without residual clot in left ICA.

Oral anticoagulation is currently the first therapeutic option that should be considered when a FFT is detected. In some reported case series, simple antiplatelet therapy was associated. Deferred surgical endarterectomy has a limited therapeutic gap in these patients when an ulcerated atheroma plaque or a significant stenosis carotid stenosis are detected. Surgical thrombectomy is reported only in few cases series. Endovascular therapies are steadily growing as an effective option when a FFT is detected, usually associated with distal protection devices to avoid distal embolization.

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Palabras clave: Arteria Carótida interna, Fibrilación auricular, Heparina sódica, Trombo flotante,

Keywords: atrial fibrillation, Free-floating thrombus, internal carotid artery, Sodic heparinization,

Hipoplasia-agenesia de la arteria carótida interna.

Hypoplasia of the internal carotid artery is an infrequent congenital anomaly, rarely reported by medical literature. We report a case of stroke in the left medium cerebral artery territory, in which an agenesia-hypoplasia of the right carotid artery was diagnosed. After performing a doppler echography, the following findings led to suspect it: a significant difference between the flow speeds of the internal carotid arteries through continuous doppler study on the hypoplastic side through the submandibular window; an early disappearance of the spectrum; and the persistence of an invariable blood flow in the medium cerebral artery on the hypoplastic side when compressing the common carotid artery. With the study of the multi-slice helicoidal computerized tomography, the diagnosis was confirmed corroborating the existence of hypoplasia of the carotid hole in the skull base. Agenesia was also found in the distal portion of the internal carotid artery. The left medium cerebral artery was supplied by the basilar artery through the posterior communicating artery. The relationship with the stroke seems to be casual as shown by the characteristics of neuroimaging.