The carotid artery is divided into three segments: the common carotid artery and the internal and external carotid artery. The latter two, the internal and external are the two branches into which the common carotid artery is divided, at the level of the 4th cervical vertebra (carotid bifurcation). Anyone of these segments can be affected with an aneurysm; the internal carotid artery is the one most prone to aneurysms. Based on their location, CAAs are divided into intracranial and extracranial and lead to different symptoms. Very small aneurysms or larger aneurysms that do not exert pressure or influence adjacent structures in any way may remain asymptomatic in both cases.

Intracranial

It has been reported that, on average, 2,5% of the population is affected by an intracranial carotid artery aneurysm, most of which lead to no significant clinical manifestations [1]. The symptoms greatly depend on the specific location of the aneurysm and indicate a neurological, cerebral pathology. Intracranial CAAs may manifest with diplopia, persistent headaches, and cranial nerve palsy, such as a palsy of the abducens nerve (VI cranial nerve) [2]. An aneurysmal rupture is a medical emergency and patients present with complaints related to a hemorrhagic stroke or subarachnoid hemorrhage; death may even ensue [3]. A hemorrhagic stroke will manifest with focal deficits, such as a facial droop, visual impairment or aphasia, alongside a decreased level of consciousness, nausea, and vomiting. Subarachnoid hemorrhage usually causes photophobia, intense headache, meningismus signs or fainting. Aneurysms that have a diameter of over 2,5 cm have a 50% chance of rupturing [4].

Extracranial

Extracranial CAAs are a rare medical occurrence. Affected cases are expected to exhibit symptoms related to a transient ischemic attack (TIA), as transient strokes are caused by aneurysmal emboli [5] [6]. A transient ischemic attack is a stroke whose symptoms last for a brief period of time and may involve a variety of deficits, including loss of orientation and confusion, lightheadedness, ataxia, numbness of one body side, memory disturbances and other symptoms [7]. Although a TIA stops producing signs after minutes or a few hours, patients have an augmented risk of stroking severely in the near future. Extracranial aneurysms located in the common carotid artery may also present as a mass in the neck area.

• Pain

  During the year before admission, the attacks had become more frequent, and the duration of pain increased to 30 minutes. She had also felt foreign body sensations in her throat regardless of painful episodes. [jnnp.bmj.com]

  Sometimes, they can be very painful. Usually, this pain occurs along the side of the neck or face. Medical treatment is necessary if the pain is persistent and long lasting. Otherwise, if it is untreated, it can lead to the serious complications. [ic.steadyhealth.com]

  This pain is so severe that most individuals describe it as the "worst pain ever felt," according to the Merck.com. [livestrong.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 13, 2019 [patientslikeme.com]

  Associated clinical features may include pain, haematuria, refractory hypertension, thromboembolism, dissection and rupture. [ 7 ] Dissections A tear in the tunica intima results in blood splitting the tunica media. [patient.info]

• Swelling

  He was transferred to our department and diagnosed as having left acute subdural hematoma and acute brain swelling. Emergent evacuation of hematoma and external decompression were performed. [ncbi.nlm.nih.gov]

  These symptoms can vary, depending upon what is compressed, but may include facial swelling, hoarseness or difficulty swallowing. Rarely, carotid artery aneurysms can rupture, or burst, which is a life-threatening problem. [my.clevelandclinic.org]

  Episodes of transient blindness, syncope, swelling neck and pulsating tinnitus may also occur. Examination may reveal neurological deficits, Horner's syndrome (half of cases), hemiparesis, carotid bruit. [patient.info]

• Surgical Procedure

  We report the case of an ECAA surgically treated and we reviewed the different therapeutic experiences in the literature. KEY WORDS: Carotid artery injuries - Saccular aneurysm - Endovascular procedures - Operative surgical procedures [minervamedica.it]

  There are few reports in the medical literature about the etiology of this disease, relating it to atherosclerosis, arteritis and alterations due to trauma or after a surgical procedure. The natural history of this disease has not been defined. [jvascbras.org]

  Discussion Extracranial carotid artery (ECA) aneurysms are rare, only 0.1% to 2% of all surgical procedures of the ECA were performed for ECA aneurysms [ 2, 3 ]. [panafrican-med-journal.com]

  Introduction Extracranial carotid artery aneurysms (ECAA) are rare with an incidence varying from 0.09 to 2.0% of all carotid surgical procedures.[ 1, 2 ] Aneurysms of the extracranial carotid artery are defined as a dilatation of 50% or more of the diameter [journals.plos.org]

  But, while planning the surgical procedure one should consider factors such as proximal and distal diameters, size and etiology of aneurysm with condition of contralateral carotid artery and collateral flow originating from posterior circulation ( 3 ) [ispub.com]

• Fever

  An 11-year-old female child presented with acute onset fever, headache, chemosis followed by diplopia, right-sided ptosis with ophthalmoplegia. Magnetic resonance imaging revealed bilateral cavernous sinus thrombosis. [ncbi.nlm.nih.gov]

  Fever, a severe headache on one side of the head, and jaw pain when chewing can be symptoms. Carotid hypersensitivity syndrome: In a few people, applying pressure to the carotid sinus can cause fainting from a sudden drop in blood pressure. [webmd.com]

• Coronary Atherosclerosis

  Restenosis rates between 24% and 38% have been reported in studies using Jomed coronary stent grafts in cases of coronary atherosclerosis, which is not different from the restenosis rates of regular bare stent placement. [ajnr.org]

• Hoarseness

  A 44-year-old female was admitted with hoarseness and swallowing disorders. Diagnostic imaging revealed dissection and obliteration of the right internal carotid artery (ICA) 23 mm from the carotid bifurcation. [ncbi.nlm.nih.gov]

  These symptoms can vary, depending upon what is compressed, but may include facial swelling, hoarseness or difficulty swallowing. Rarely, carotid artery aneurysms can rupture, or burst, which is a life-threatening problem. [my.clevelandclinic.org]

  If the patient has headaches and a hoarse voice during this palpation, it may indicate an aneurysm. [bookinghealth.com]

  As the aneurysm dilates, it squeezes against nerves and veins, leading to symptoms such as facial swelling and tingling, numbness on the face or in the mouth, loss of voice or hoarseness, difficulty speaking and difficulty swallowing. [livestrong.com]

  It may lead to difficulty in swallowing, hoarseness of voice or swelling on face. Rupture of aneurysm is the most dreaded complication. If the aneurysm is small, physician may recommend wait and watch approach. [tandurust.com]

• Dysphagia

  These patients may have complaints such as dysphagia, headache and neck pain, feeling of retroorbital pressure, otalgia and cerbrovascular symptoms. [ispub.com]

• Thrombosis

  Following parent artery occlusion, thrombosis of the posterior fossa and spinal cord veins caused a progressive worsening of the neurological status to a "locked-in" state. The patient fully recovered with anticoagulation therapy. [ncbi.nlm.nih.gov]

  They cause symptoms from thrombosis, embolisation or compression of adjacent structures, causing venous thrombosis or neuropathy. Femoral aneurysms These are the second most common peripheral aneurysm. [patient.info]

  In the review on treatment of aneurysms in Progress in Neurological Surgery in 1969, techniques such as encasement with plastic compounds, piloinjection, stereotactic copper or electric thrombosis and metallic thrombosis and profound hypothermia in anaesthesia [books.google.it]

• Vascular Disease

  Spontaneous fistulae usually result from a ruptured carotid aneurysm, in collagen vascular disease, atherosclerotic disease, hypertension, or at childbirth 3. 2. Flow: high or low flow 3. [sonoworld.com]

  […] disorders with mcc 300 Peripheral vascular disorders with cc 301 Peripheral vascular disorders without cc/mcc Convert I72.0 to ICD-9-CM Code History 2016 (effective 10/1/2015) : New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) [icd10data.com]

  The critical role of hemodynamics in the development of the cerebral vascular disease. A review. J Neurosurg. 2010;112:1240-53. [ Links ] 4. Aguiar PH, Isolan G, Tahara A. Carotid cave aneurysms. Neurosurg Q. 2008;18(4):239-45. [ Links ] 5. [scielo.org.mx]

• Carotid Bruit

  Examination may reveal neurological deficits, Horner's syndrome (half of cases), hemiparesis, carotid bruit. [patient.info]

• Heart Disease

  To our knowledge, these vascular anomalies have not been reported in Hardikar syndrome and the high association of congenital heart disease in the individuals with Hardikar syndrome has not been further addressed. [ncbi.nlm.nih.gov]

• Neck Pain

  Pelliccia et al. headache and neck pain. Neurological examination was normal. CT scan of the head and the neck showed frontal and skull base fractures involving the right sphenoid sinus and walls of the right carotid canal (Fig. 1). [docksci.com]

  These patients may have complaints such as dysphagia, headache and neck pain, feeling of retroorbital pressure, otalgia and cerbrovascular symptoms. [ispub.com]

• Tinnitus

  Headaches can occur without any reason due to fatigue Bad sleep Dizziness Tinnitus Pulsation of blood vessels passing through the head and ears, which you have not noticed before Diagnosis It is impossible to diagnose carotid artery aneurysm without special [bookinghealth.com]

  Episodes of transient blindness, syncope, swelling neck and pulsating tinnitus may also occur. Examination may reveal neurological deficits, Horner's syndrome (half of cases), hemiparesis, carotid bruit. [patient.info]

• Headache

  Symptoms Frequent and severe headaches. [bookinghealth.com]

  Intracranial CAAs may manifest with diplopia, persistent headaches, and cranial nerve palsy, such as a palsy of the abducens nerve (VI cranial nerve). [symptoma.com]

  Abstract A 65-year-old man presented with a hyperplastic anomalous anterior choroidal artery (AChA) associated with a ruptured internal carotid artery aneurysm at the origin of a perforating artery manifesting as sudden onset of headache and vomiting. [ncbi.nlm.nih.gov]

  Figure 1: Subarachnoid haemorrhage predominantly on the right side after the first episode of headache and vomiting. [ommegaonline.org]

• Confusion

  A transient ischemic attack is a stroke whose symptoms last for a brief period of time and may involve a variety of deficits, including loss of orientation and confusion, lightheadedness, ataxia, numbness of one body side, memory disturbances and other [symptoma.com]

  Looping or kinking of carotid arteries are the conditions mostly confused with carotid artery aneurysms ( 3 )(Table 2). [ispub.com]

  [5] [6] Symptoms of a subarachnoid hemorrhage differ depending on the site and size of the aneurysm. [6] Symptoms of a ruptured aneurysm can include: a sudden severe headache that can last from several hours to days nausea and vomiting drowsiness, confusion [en.wikipedia.org]

• Dysarthria

  Her symptoms of dysarthria have resolved. [ncbi.nlm.nih.gov]

Carotid artery aneurysms may be asymptomatic or symptomatic. Asymptomatic ones may be incidentally diagnosed during evaluation carried out for another cause, by means of a brain or cervical computerized tomography scan (CT) or magnetic resonance imaging scan (MRI) [1]. Other imaging modalities that may be employed to diagnose symptomatic carotid artery aneurysms include a CT or MRI scan as well as diffusion-weighted imaging (DWI), magnetic resonance angiography (MRA) and T2-weighted imaging (T2WI). The final precise diagnosis is rendered possible by means of an arteriography, which allows for the comprehensive assessment of the cerebral and cervical vessels [8].

• Hypercholesterolemia

  A 46-year-old male chronic smoker with chronic hypertension and hypercholesterolemia had a recurrent internal carotid artery aneurysm 1 year after embolization. [ncbi.nlm.nih.gov]

Treatment consisted of either conservative treatment in 11% of the cases or invasive treatment in 89% of the cases. Invasive treatment comprised surgery in 94%, endovascular approach in 5%, and a hybrid approach in 1% of the patients. [ncbi.nlm.nih.gov]

Detailed neurologic examinations were performed before treatment, immediately after treatment, 2 weeks after treatment, and later during follow-up. [ajnr.org]

Treatment and prognosis Management options can range from traditional surgical repair to endovascular repair (stent placement - combined stent placement and coil embolization 7 ). [radiopaedia.org]

In saccular and fusiform aneurysms with local extension and in an anatomically accessible neck, resection of the aneurysm and replacement by vein or prosthetic graft is the preferred technique and that with a better prognosis. [elsevier.es]

Older patients and those with poorer Hunt and Hess grades on admission have a poor prognosis. [en.wikipedia.org]

CONCLUSION In the setting of carotid artery aneurysms with a poor natural history prognosis consisting of stroke and death and difficult surgical treatment, endovascular stent grafting will likely emerge as the treatment of choice similar to this case [evtoday.com]

Clinical course and prognosis of temporal lobe epilepsy survey of 666 patients. Brain. 1971. 94: 173-90 4. Kuba R, Krupa P, Okacova L, Rektor I. [surgicalneurologyint.com]

The underlying etiology was trauma in five (35.7%), prior carotid endarterectomy in five (35.7%), and degenerative atherosclerosis in four (28.6%). [ncbi.nlm.nih.gov]

"Epidemiology and genetics of intracranial aneurysms". European Journal of Radiology. 82 (10): 1598–605. doi : 10.1016/j.ejrad.2012.12.026. [en.wikipedia.org]

Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM (2010) Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol 8: 92–102. pmid:21079638 View Article PubMed/NCBI Google Scholar 17. [journals.plos.org]

Etiology and Epidemiology Most common etiological factor for AEICA is atherosclerosis with an incidence of 34 to 70% in different series. [ispub.com]

Comprehension of the pathophysiological mechanism associated with the rupture of ICCA and early diagnosis of the related symptoms are essential in order to plan a correct treatment that includes the management of the aneurysm rupture and of possible complications [ncbi.nlm.nih.gov]

In contrast, the pathophysiological mechanisms and natural course of ECAA are largely unknown. Understanding the pathophysiological background may add to prediction of risk for adverse outcome and need for surgical exclusion. [journals.plos.org]

A review of pathophysiology, radiological imaging, clinical manifestations and management is presented and discussed. Introduction Mirror aneurysms are paired aneurysms found within similar distributions on bilateral intracranial arteries. [ommegaonline.org]

We examined the pathophysiology underlying the development of olfactory hallucinations. We found craniotomy clipping and focal resection to be useful from the standpoint of seizure control. [surgicalneurologyint.com]

Coil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion. [ncbi.nlm.nih.gov]

Treatment Guidelines For Carotid Aneurysm The main aim of treatment for carotid aneurysm is to address the symptoms and prevent complications from occurring. Treatment is always warranted to prevent TIA and stroke. [tandurust.com]

Prevention See the separate Primary Prevention of Cardiovascular Disease and Cardiovascular Risk Assessment articles. [patient.info]

If this occurs, or in order to prevent this from occurring, treatment may be warranted. Other symptoms can occur secondary to pressure of the aneurysm on surrounding structures such as veins and nerves. [my.clevelandclinic.org]

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7. Sehatzadeh S. Is Transient Ischemic Attack a Medical Emergency? An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2015; 15(3): 1–45
8. Roger W. Countee and Thurairasah Vijayanathan. Extra-Arachnoid and Extracranial Aneurysms of the Carotid Artery: Diagnosis and Management. J Natl Med Assoc. 1982 Sep; 74(9): 857–870.