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Principles of Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
➢ Central TPN:■ Hickmann line (dedicated tunneled catheter).■ PICC line (Peripherally Inserted central venous catheter).■ Risks of central venous catheterization include: Haematoma / haemorrhage.Line superinfection / infection to surrounding soft tissues.Line obstruction / kinking / malplacement.Damage to surrounding structures from malplacement, including: Pneumothorax.Air embolism.Cardiac dysrhythmias.Carotid artery dissection.
Neck Holds
Published in Darrell L. Ross, Gary M. Vilke, Guidelines for Investigating Officer-Involved Shootings, Arrest-Related Deaths, and Deaths in Custody, 2018
There are several imaging modalities used to diagnose carotid artery dissection, including carotid ultrasound, computed tomography, magnetic resonance imaging/magnetic resonance angiography (MRI/MRA), and digital subtraction angiography (DSA). A literature review by Vilke and Chan (2011) revealed no case series or retrospective reviews on strangulation and carotid injury. They called for more studies to be done to better guide practitioners. The gold standard screening exam was traditionally digital subtraction angiography (DSA) of the cerebrovascular vessels. Recently, there has been a growing body of evidence showing that computed tomography angiography (CTA) had a sufficient negative predictive value to rule out carotid injury. This is likely due to the increasing sensitivity of new generation (64 channel) computed tomography (CT) scanners (Paulus et al., 2014). The non-inferiority of CTA was welcomed by many as DSA is relatively high in cost, invasiveness, resource demands, and complications.
Case 51: Headache and Thrombocytopenia
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
Vertebral or carotid artery dissection may develop spontaneously and presents with headaches and neurological symptoms. Vertebral artery dissection can cause cerebellar ischaemia and subsequent symptoms of impaired co-ordination. Other precipitants for an ischaemic stroke include cerebral vasculitis, which is associated with autoimmune pathology, or a pulmonary embolus with paradoxical emboli formation (cerebral arterial thrombosis due to a pulmonary embolus passing through a patent foramen ovale).
Depressed skull fracture compressing eloquent cortex causing focal neurologic deficits
Published in Brain Injury, 2023
Alexander In, Brittany M. Stopa, Joshua A. Cuoco, Adeolu L. Olasunkanmi, John J. Entwistle
Traumatic causes of focal neurologic deficits may include intraparenchymal hemorrhage, subdural hematoma, epidural hematoma, or internal carotid artery dissection. However, altered mentation would usually be observed in the presence of intra- or extra-axial hemorrhage that is large enough to cause focal deficits. Although an internal carotid artery dissection may lead to contralateral hemiplegia, it typically is associated with headache, neck pain, or Horner’s syndrome and tends not to disturb the frontal eye fields. In the absence of trauma, the differential diagnosis of the observed symptomatology may include ischemic stroke or seizure activity. Ischemic stroke and seizure activity can certainly present in a similar fashion; however, gaze preference should be a differentiating factor between these diagnoses. In the setting of ischemic stroke, inhibition of the frontal eye field would cause gaze deviation toward the lesion. Comparatively, seizure activity would stimulate the frontal eye field and cause gaze deviation away from the lesion.
Spontaneous extracranial arterial dissections in a case of patient with osteogenesis imperfecta
Published in International Journal of Neuroscience, 2021
XiaoJia Tang, Jing Jian, YuHan Luo, Hongyang Fan, PeiPei Liu, YingZhu Chen
Stroke is the second most common cause of death and leading cause of adult disability worldwide. Indeed, stroke represents the first cause of death in China [9]. Ischemic stroke of unusual etiology includes patients with rare cause of stroke, such as: (a) carotid artery dissection; (b) hematological disorders; (c) infections; (d) primary inflammatory arteritis; (e) cerebral infarction secondary to venous thrombosis; and (f) miscellaneous disorders [7]. Similarly, spontaneous internal carotid artery dissection (SICAD) is one of the main causes of ischemic stroke in young people, accounting for 20 to 25% of the cases [10]. The earliest symptoms of SICAD can manifest as headaches, neck pains, incomplete Horner syndrome, as well as brain and retinal ischemia symptoms (50 to 95% of patients). These symptoms often occur within 1 month from the start of the headache and may result in a transient ischemic attack, arterial-infarction, and hemodynamic cerebral infarction [11]. However, the pathogenesis of carotid dissection is not yet fully understood. In fact, although a history of neck trauma is common, it is not universal. Moreover, hematological disorders are uncommon causes of cerebrovascular disease. It has been estimated that 1% of cerebral infarctions in young adults are due to a hematological disorder [12].
Recurrent cerebral infarction in anterior and posterior circulation territories associated with persistent primitive hypoglossal artery and carotid artery dissection: a case report
Published in International Journal of Neuroscience, 2018
Jingzhe Han, Ye Ji, Guomei Ma, Zhilei Kang
Persistent carotid-vertebrobasilar artery anastomoses are persistent embryonic circulatory pathways, including the trigeminal, hypoglossal, otic (acoustic) and proatlantal intersegmental arteries [1]. Persistent primitive hypoglossal artery (PPHA) which arises from the cervical internal carotid artery (ICA), then passes through the hypoglossal canal to form the basilar artery is the second most common artery linking the anterior and posterior circulation [2]. Some cases about cerebral infarction associated with PPHA have been reported, and these patients all had atherosclerosis lesions in the ICA or cardioembolic stroke [3–5]. Carotid artery dissection (CAD) is a frequent and preventable cause of ischemic stroke in young patients. However, reports about PPHA with CAD are still lacking currently. We presented a case of acute cerebral infarction in both the anterior and posterior circulation territories which occurred three times in a short period of time, and associated with right PPHA and ipsilateral CAD for the first time.