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Key Clinical MessageContrast‐enhanced transoral carotid ultrasonography (CETOCU) is a novel modality for imaging the distal extracranial internal carotid artery, which is not possible with conventional carotid ultrasonography. We present a representative case that demonstrates the usefulness of CETOCU.

Contrast-enhanced transoral carotid ultrasonography (CETOCU) is a novel examination modality that is superior to other modalities in the cases of pseudo-occlusion with severe arteriosclerotic stenosis of the distal internal carotid artery (ICA), and is also useful for noninvasively evaluating changes over time in the vessel distal to the stent following carotid artery stenting (CAS). We report a case of a patient who we evaluated with CETOCU for a pseudo-occlusive ICA before and after CAS.

Introduction:Generally, fingolimod administration is simply discontinued when fingolimod-associated macular edema (ME) appears, and the majority of cases are said to recover spontaneously. However, to the best of our knowledge, this is the 1st report regarding improvement of ME without discontinuation of fingolimod administration.Case presentation:The patient was a 66-year-old woman with relapsing-remitting multiple sclerosis. She was started on treatment with fingolimod to prevent recurrence, after which she developed ME that was probably due to fingolimod. The patient expressed a strong fear of recurrence if fingolimod was discontinued, so we continued fingolimod therapy and followed up the patient frequently. The ME improved after approximately 1 year without any need for concomitant treatment.Conclusion:We believe that the continuation of fingolimod therapy with strict follow-up examination is one option for treatment, though strategies for managing rapid deterioration of ME should be borne in mind.