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.

• 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]

• 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]

  diseases I73.0 Raynaud's syndrome Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. [icd10data.com]

• Carotid Bruit

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

• Skin Lesion

  Abstract Behcet disease (BD) is a chronic systemic inflammatory disorder characterized by recurrent oral and genital ulcerations, üveitis, and skin lesions. Vascular system involvement is common in BD. [ncbi.nlm.nih.gov]

• Chemosis

  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]

• Retinal Pigmentation

  Hardikar syndrome is a multiple congenital anomaly syndrome first characterized in 1992 by Hardikar et al. to describe two individuals with cholestasis, cleft lip/palate, retinal pigmentation, intestinal abnormalities, and genitourinary anomalies. [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

  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]

  Symptoms Frequent and severe headaches. [bookinghealth.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]

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].

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3. Connolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–1737.
4. Wiebers DO, Whisnant JP, Huston J, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103–110.
5. Choudhary AS, Evans RJ, Naik DK, Tripathi RK, Wickremesekera JK. Surgical management of extracranial carotid artery aneurysms. ANZ J Surg. 2009;79:281–7.
6. El-Sabrout R, Cooley DA. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg. 2000;31:702–12.
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.