Browsing by Author "Cimbaljevic, Nikola (58298947200)"

This is a case report of a 63-year-old man who presented with a pseudoaneurysm of the left common carotid artery following a previous neck injury. The pseudoaneurysm was discovered incidentally during a routine Doppler ultrasound of the neck after the patient suffered a stroke with right-sided hemiparesis and dysphasia. A multi-detector computed tomography angiography scan showed a 25-mm pseudoaneurysm with a partial thrombus in the lumen, originating from the left common carotid artery. The patient underwent open surgery with reconstruction done by the interposition of a prosthetic graft between the common and internal carotid arteries. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. The rarity of extracranial carotid artery pseudoaneurysms and their potential to cause serious complications such as stroke and rupture underscores the need for prompt diagnosis and management. The question of the best treatment remains controversial, and there are no studies that directly compare the success of open surgery and endovascular treatment of extracranial carotid artery pseudoaneurysm. Regular ultrasound monitoring should be performed in patients with confirmed neck trauma and/or operations to detect any delayed onset of carotid pseudoaneurysms. © Association of Surgeons of India 2023.

Todd’s paralysis is a neurological deficit that is observed in <10% of patients following epileptic seizures. Cerebral hyperperfusion syndrome (CHS) is a rare complication following carotid endarterectomy (CEA), seen in 0-3% of the patients, characterized by focal neurological deficit, headache, disorientation, and sometimes seizures. In this case report, we present a case of CHS after CEA followed by seizures and Todd’s paralysis that mimicked postoperative stroke. A 75-year-old female patient was admitted for CEA of the right internal carotid artery, following a transient ischemic attack two months prior. Four hours after CEA with graft interposition, the patient suffered a temporary weakness of the left arm and leg followed by generalized spasms within a few seconds. CT angiography showed regular patency of the carotid arteries and the graft, and brain CT showed no sign of oedema, ischemia or hemorrhage. However, left-sided hemiplegia occurred following the seizure, and the patient suffered four more seizures over the next 48 hours, with persisting hemiplegia. On the second postoperative day, the motor skills of the left side fully recovered, and the patient was communicative, and of orderly mental status. Brain CT performed on the third postoperative day showed entire right hemisphere oedema. A moderate hemiparesis with seizures as a consequence of CHS after CEA has been described, however in all cases with seizures and hemiplegia, the underlying cause was always a verified stroke or intracerebral hemorrhage. This case highlights the importance of considering Todd’s paralysis in patients with seizures after CEA due to CHS and prolonged periods of hemiplegia after the seizures. © 2023 EDIZIONI MINERVA MEDICA.