Presentation
We present a case of bilateral carotid artery occlusion presented with intraventricular hemorrhage. [ncbi.nlm.nih.gov]
Entire Body System
- Asymptomatic
Although controversial, some believe that medical therapy for asymptomatic carotid stenosis has improved to the point where a 3% periprocedural risk of stroke is too high, and carotid revascularization for most asymptomatic patients should not be performed [interventions.onlinejacc.org]
The prevalence of asymptomatic internal carotid artery occlusion is unknown, particularly for bilateral occlusion. [ncbi.nlm.nih.gov]
He commented: "In the US, 90% of carotid intervention is for asymptomatic stenosis, but 90% of patients with asymptomatic stenosis would be at lower risk with intensive medical therapy than with intervention." [medscape.com]
Convert to ICD-10-CM : 433.10 converts approximately to: 2015/16 ICD-10-CM I65.29 Occlusion and stenosis of unspecified carotid artery Approximate Synonyms Asymptomatic carotid artery stenosis Atherosclerosis carotid artery Atherosclerosis carotid artery [icd9data.com]
[…] period among asymptomatic patients. [aafp.org]
- Coronary Atherosclerosis
The major treatable risk factors for carotid artery atherosclerosis are similar to those for coronary atherosclerosis. Therefore patients with carotid stenosis should be screened for diabetes mellitus, dyslipidemia and hypertension. 2. [clinicaladvisor.com]
Progression of carotid atherosclerosis in Japanese patients with coronary artery disease. Stroke. 1992;23:946-51. [ Links ] 33. Pellegrino L, Prencipe G, Vairo F. [scielo.br]
Obesity, hyperlipidemia, sedentary lifestyle, and cigarette smoking, are major factors (they are also implicated as causes of coronary atherosclerosis and insufficiency). [dartmouth.edu]
Cardiovascular
- Heart Disease
Chang et al. and Collice at al. reported a high prevalence of hypertension and heart disease [2, 13]. In our patient group, the prevalence of hypertension was 90%, and the prevalence of ischaemic heart disease was 75%. [hindawi.com]
There was no association with claudication, female gender, diabetes, TIA, stroke, obesity, smoking, and ischemic heart disease (Table 5). [scielo.br]
Topic Search / More Heart Resources More Heart Resources Diseases & Conditions There are many types of heart diseases and conditions that can affect the structures or function of the heart, blood vessels, chest and vascular system. [my.clevelandclinic.org]
Your treatment will depend on your symptoms, how severe the disease is, and your age and overall health. Heart-Healthy Lifestyle Changes Your doctor may recommend heart-healthy lifestyle changes if you have carotid artery disease. [nhlbi.nih.gov]
- Carotid Bruit
Carotid bruits are not sensitive or specific enough to confirm or exclude significant carotid stenoses. [ 3 ] Absence of carotid bruit in patients with cardiovascular disease does not exclude a carotid stenosis. [patient.info]
About 4 percent of adults have asymptomatic neck bruits, but a carotid bruit is a poor predictor of extracranial carotid artery disease or high-grade stenosis. 25 By actuarial analysis, persons with asymptomatic carotid bruits have an estimated annual [aafp.org]
Carotid Bruit <ul><li>A carotid bruit is auscultated with diaphragm of stethoscope at the level of thyroid cartilage. </li></ul><ul><li>A high-pitched prolonged carotid bruit fading into diastole is often associated with tightly stenotic lesions. [slideshare.net]
- Systolic Murmur
बड़बड़ाहट Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex is common. [helpebookhindi.wikifoundry.com]
Eyes
- Diplopia
Another symptom that might raise a red flag would be when a patient reports ischemic diplopia, PCON Editorial Board member John A. McCall Jr., OD, said in an interview. “Anytime a patient has double vision, it’s due to a microclot,” he said. [healio.com]
The two commonest ocular lesions are homonymous hemianopia and uniocular blindness or optic atrophy, although diplopia, ptosis, papilloedema, and pupillary changes may occur. Uniocular blindness may be transient (amaurosis fugax) or permanent. [ijo.in]
Luo et al. found that among 42 patients with OIS, 35 presented with more than two ocular symptoms, including visual loss, ocular/periorbital pain, amaurosis fugax, photophobia, floaters, metamorphopsia, phosphenes, and diplopia. [27] Visual Loss Decrease [eyewiki.aao.org]
Alone or in various combinations, vertigo, bilateral blurring or loss of vision, ataxia, diplopia, bilateral or unilateral (occasionally alternating) sensory and motor deficits, and syncope are common manifestations of vertebrobasilar insufficiency. [dartmouth.edu]
- Transient Blindness
Symptoms of carotid artery stenosis include transient blindness in one eye, weakness or numbness of an arm, leg or the face, or the temporary inability to speak or to understand conversation. [newsnetwork.mayoclinic.org]
Transient blindness, amaurosis fugax, has previously been reported in patients with a fully occluded ipsilateral internal carotid, unequivocally indicating the collateral pathway to be a mechanism for retinal embolization (2). [spandidos-publications.com]
blindness after coronary artery bypass surgery 116 Medikal pulmoner arter kateter komplikasyonu pulmonary artery catheter complication 117 Medikal sağ atriuma dikilen pulmoner arter kateteri pulmonary artery catheter suturing to the right atrium wall [tureng.com]
Psychiatrical
- Suggestibility
This suggests the need for intensified medical therapy in ACAO. © 2016 American Heart Association, Inc. [ncbi.nlm.nih.gov]
The authors suggest, with accuracy, that no (or little) systematic follow-up data are available on such patients and that publications are anecdotal. [ajnr.org]
Neurologic
- Stroke
The Kaplan-Meier ipsilateral stroke-free survival curves are shown in Figs 8 A and 8 B. [ajnr.org]
Don Heck, Novant Health Forsyth Comprehensive Stroke Center, Winston Salem, North Carolina 27103. [interventions.onlinejacc.org]
CONCLUSIONS: The rate of ischemic stroke following carotid sacrifice remains high and most strokes are thromboembolic in nature. Our testing protocol did not eliminate the risk of hypoperfusion-related stroke. [ncbi.nlm.nih.gov]
Thrombolysis for Acute Ischemic Stroke. [journals.plos.org]
- Dizziness
Clinical symptoms included dizziness, amaurosis fugax, persistent limb numbness, and transient ischemic attack. [ncbi.nlm.nih.gov]
An 86-year-old male patient in our study with bilateral occlusion and widespread atherosclerosis without focal neurological signs was examined by ultrasound for nonspecific dizziness. [hindawi.com]
Predominant symptoms and signs included visual-ipsilateral monocular or retrochiasmal symptoms (88%), motor weakness (88%), sensory disturbance (59%), dizziness/lightheadedness (53%), and syncope (24%). [n.neurology.org]
Sudden loss of vision or blurred vision in one or both eyes Weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body Slurred speech, difficulty talking or understanding what others are saying Loss of coordination Dizziness [my.clevelandclinic.org]
Differentiating symptomatic and asymptomatic patients is critical: Patients often are diagnosed with carotid artery stenosis after seeing a doctor for dizziness, blurry vision, floaters in the vision or generalized weakness. [newsnetwork.mayoclinic.org]
- Intracranial Hemorrhage
Two cases suffered from post-procedural intracranial hemorrhagic complications. [ncbi.nlm.nih.gov]
One patient in that series suffered an intracranial hemorrhage (5%). [interventions.onlinejacc.org]
) Diseases of the circulatory system I60-I69 2019 ICD-10-CM Range I60-I69 Cerebrovascular diseases Type 1 Excludes traumatic intracranial hemorrhage ( S06.- ) Use Additional code to identify presence of: alcohol abuse and dependence ( F10.- ) exposure [icd10data.com]
- Hemianesthesia
On the following day, the patient presented with left hemiplegia with hemianesthesia (National Institutes of Health Stroke Scale score = 14). [ncbi.nlm.nih.gov]
</li></ul><ul><li>When the origins of both the ACA and MCA are occluded at the top of the carotid artery, abulia or stupor occurs with hemiplegia, hemianesthesia, and aphasia or anosognosia. [slideshare.net]
Findings related to the ACA territory are as follows: Crural paresis > arm paresis Frontal signs (eg, abulia) Findings related to the anterior choroidal artery territory are as follows: Hemiparesis Hemianesthesia Homonymous hemianopia Lacunar syndromes [emedicine.medscape.com]
- Hypesthesia
[…] a TIA or stroke include </li></ul><ul><ul><li>sudden disorders of the speech ( dysarthria or aphasia ), </li></ul></ul><ul><ul><li>vision ( amaurosis fugax ), </li></ul></ul><ul><ul><li>limb power( paralysis ), </li></ul></ul><ul><ul><li>sensation ( hypesthesia [slideshare.net]
Workup
Our case highlights the utility of urgent cardiovascular workup and referral to a subspecialist pending further workup. [hindawi.com]
However, in the setting of symptoms suggestive of stroke or TIA, workup for this condition may be indicated. [unboundmedicine.com]
Nondiabetic patients younger than 70 years with no cardiac symptoms and normal findings on electrocardiography (ECG) may undergo CEA without further cardiac workup. [emedicine.medscape.com]
Asymptomatic carotid artery occlusion (ACAO) is most frequently discovered as an incidental finding during radiological workup for cerebrovascular disease or after auscultation of a neck bruit. 3 Improvements in ultrasound technology and wide-scale diffusion [ahajournals.org]
A basic workup should therefore include a complete blood cell count with differential, serum protein electrophoresis, and immunoelectrophoresis. Table 2. [eyewiki.aao.org]
Other ECG Findings
- Ischemic Changes
changes on brain CT scan (less than one third of the MCA territory); ( 4 ) attempted ET. [ajnr.org]
Anterior communicating artery collateral flow protection against ischemic change during carotid endarterectomy. J Neurosurg 1993;79:379–382. [pubs.rsna.org]
Treatment
Treatment consisted of surgery for eight aneurysms and endovascular embolization for 13 aneurysms. No invasive treatment was recommended for 14 aneurysms (eight patients with single aneurysm). [ncbi.nlm.nih.gov]
Prognosis
Patients were evaluated by modified Rankin Scale in terms of prognosis at discharge and after 3 months. [ncbi.nlm.nih.gov]
The nature and severity of the presenting ischaemic symptoms did not appear to have a significant impact on prognosis. [karger.com]
Etiology
Progressive occlusion of a major intracranial artery, independently from the etiology, can lead to the development of collateral arterial networks that supply blood flow to distal territories beyond the occlusion. [ncbi.nlm.nih.gov]
Stroke etiology was 2 cardioembolic, 11 atherothrombotic, and a single unspecified case. [ajnr.org]
Epidemiology
Further studies on the epidemiology of de novo aneurysms after carotid artery occlusion are warranted. [ncbi.nlm.nih.gov]
[…] artery occlusion, vertebrobasilar occlusion, dissections, cerebral venous and sinus thrombosis, thrombolysis, mechanical recanalization materials, and treatment concepts and results, with information on anatomy, imaging studies, etiology, symptoms, epidemiology [medical-dictionary.thefreedictionary.com]
Epidemiology [ 1 ] Moderate-to-severe asymptomatic carotid atherosclerotic stenosis occurs in 2-5% of European women and 2-8% of European men aged over 60 years. The prevalence is much higher in high-risk groups. Risk factors Increasing age. [patient.info]
The epidemiology of obesity. Gastroenterology. 2007;132:2087-102. [ Links ] 18. Wendelhag I, Wiklund O, Wikstrand J. Arterial wall thickness in familial hypercholesterolemia. [scielo.br]
Pathophysiology
Complete occlusion of extracranial internal carotid artery: clinical features, pathophysiology, diagnosis and management Bhomraj Thanvi 1, Tom Robinson 2 1 Department of Integrated Medicine, Glenfield General Hospital, University Hospitals of Leicester [pmj.bmj.com]
We hypothesize that most of these cases share similar pathophysiology with the more common perinatal arterial ischemic stroke but differ by a persistent identified thrombus in the carotid artery at the time of first imaging, leading to a more severe and [ncbi.nlm.nih.gov]
The cerebral hemodynamic insufficiency has been considered as the primary pathophysiological factor for patients with ICA or MCA occlusion. [clinicaltrials.gov]
Prevention
Abstract Inadvertent occlusion of an internal carotid artery (ICA) during stenting may be a catastrophic situation requiring a bailout operation to prevent permanent neurologic sequelae. [ncbi.nlm.nih.gov]