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Paired Bilateral Internal Carotid Artery Aneurysms: An Imaging Review 1 Joseph R. Grajo, M.D., 2 Midhir J. Patel, B.S., 3 Raul Otero, M.D. 1 University of South Florida, Department of Radiology, Tampa, FL 2 Morsani College of Medicine, Tampa, FL 3 Radiology Associates of Tampa, Tampa, FL.
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Paired Bilateral Internal Carotid Artery Aneurysms: An Imaging Review
1Joseph R. Grajo, M.D., 2Midhir J. Patel, B.S., 3Raul Otero, M.D.
1University of South Florida, Department of Radiology, Tampa, FL
2Morsani College of Medicine, Tampa, FL
3Radiology Associates of Tampa, Tampa, FL
History: Patient is a 46 year old female with PMH of TIA, supraclinoidaneurysm and bipolar disorder presenting with headaches and blurry vision for past three days along with one syncopal episode. She rates the headache pain 6 out of 10, dull, non-localized with unknown trigger. She reports a syncopal episode but denies any falls or trauma to her head. She also reports transient vision blurriness but no central deficit or complete blindness.
Imaging Studies: CT Head w/o contrast showed no acute intracranial hemorrhage or mass. MRI w/o contrast showed no signs of acute ischemia. CTA and MRA showed four focal outpouchings of the internal carotid artery (ICA) at the origins of ophthalmic arteries, two on each side. There was adequate filling of the bilateral anterior, posterior and middle cerebral arteries. Vertebral, basilar and cerebellar arteries were normal.
Interventions: Cerebral angiogram confirmed and characterized the presence of four ICA aneurysms. Paraophthalmic right ICA aneurysm measuring 5.9x3.3mm with 3.3mm neck near the origin of ophthalmic artery. Paraclinoid right ICA aneurysm measuring 5.9x4.5mm projecting superiorly. Paraophthalmic left ICA aneurysm measuring 5.1x4.1mm with 4.2mm neck near the origin of ophthalmic artery. Paraclinoid left ICA aneurysm measuring 3.7x3.7mm with a 3.3mm neck projecting laterally. Right ICA aneurysms were treated by cerebral angiogram and coil embolization.
1) Discuss the incidence and pathophysiology of intracranial aneurysms.
2) Review an interesting case of bilaterally paired internal carotid artery aneurysms.
3) Highlight the role of various imaging modalities in diagnosis and management of intracranial aneurysms.
Cerebral aneurysms have wide-ranging clinical presentations and are usually diagnosed incidentally. Variety in number, size and location of these vascular abnormalities is well documented. To the best of our knowledge, a case of bilaterally paired internal carotid artery aneurysms is not reported in the current literature. This case highlights such an occurrence in order to review the different imaging modalities that are currently available and their role in detection and treatment of intracranial aneurysms.
MethodsWe will discuss the utility of computed tomography angiogram (CTA), magnetic resonance angiogram (MRA) and cerebral angiogram in diagnosis and management of intracranial aneurysms. Our case includes discussion of the patient’s history and unique radiologic findings. The use of imaging for treatment will also be emphasized.
ResultsRadiologic findings of paired bilateral internal carotid artery aneurysms will be presented.
ConclusionThe diagnosis and management of cerebral aneurysms are critically dependent on imaging. Modalities such as CTA, MRA and cerebral angiography provide unprecedented precision in evaluation of intracranial aneurysms. This case demonstrates the importance of considering these vascular anomalies in the differential diagnosis for various clinical presentations.
Imaging Modalities & Management
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