Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature

Marangi, Antonio; Moretto, Giuseppe; Cappellari, Manuel; Micheletti, Nicola; Tomelleri, Giampaolo; Bovi, Paolo

doi:10.2147/ndt.s106845

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…Common risk factors for arterial dissection patients include hypertension, tortuous vessels, and/or a history of vascular infection. Currently, there are no specific preventative therapeutics for arterial dissections, however, patients are often prescribed therapies such as the angiotensin II blocker, losartan, not only to manage hypertension ( 113 , 114 , 153 , 228 ), but also because of its unique reverse-remodeling properties, which other antihypertensive agents such as angiotensin converting enzyme inhibitors lack. In Marfan syndrome, for example, the pathological changes in the aortic root are thought to be related to angiotensin II receptor 1 (ART1) signaling and the reverse-remodeling effects of losartan are mediated by blocking ART1 signaling and downstream TGF-β signaling ( 259 ).…”

Section: Discussion – Common Features Of Dissectionsmentioning

confidence: 99%

“…The frequency of infection was lower in those with a single artery dissection (odds ratio, 2.1) than in those with multiple arteries affected (odds ratio, 6.4) ( 228 ). As with aortic dissections and SCAD, again there are case studies linking syphilis infection with CeAD ( 113 , 114 ). Developmental defects in the neural crest, resulting in congenital heart defects, are thought to link heart development with CeAD ( 229 ).…”

Section: Spontaneous Arterial Dissectionsmentioning

confidence: 99%

“…Other agents that cause vascular injury have also been linked to aortic dissection including infections, such as syphilis ( 112 ). Though now rare, in cases of syphilis where the infection has been ongoing for more than 10 years, cardiovascular sequelae, including aortic dissection, are common, ( 113 , 114 ). An increase in aortic dissections following COVID-19 infections has been reported and long term effects of infection are yet to be fully realized ( 115 ).…”

Section: Spontaneous Arterial Dissectionsmentioning

confidence: 99%

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Arterial dissections: Common features and new perspectives

Bax

Romanov

Junday

et al. 2022

Front. Cardiovasc. Med.

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Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations – such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.

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Section: Discussion – Common Features Of Dissectionsmentioning

confidence: 99%

Section: Spontaneous Arterial Dissectionsmentioning

confidence: 99%

Section: Spontaneous Arterial Dissectionsmentioning

confidence: 99%

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Arterial dissections: Common features and new perspectives

Bax

Romanov

Junday

et al. 2022

Front. Cardiovasc. Med.

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“…A minor direct or indirect trauma is mainly related to coughing, sneezing, sexual intercourse, and defecation [45,57,82]. Local and general infections, as well as other types of inflammation, including various types of arteritis, can also result in arterial dissections [48,51,58,83]. Iatrogenic injuries of the cervical and intracranial arteries are possible as well, including local anesthetic injection, and neck, oral, transnasal and skull base surgery [49,55,84].…”

Section: Predisposing Factors and Causesmentioning

confidence: 99%

“…Since the ICA, VA and basilar artery (BA) dissections (ICAD and VBAD) are usually presented as case reports [6,37,38,[46][47][48][49][50][51][52][53][54][55][56] or as smaller groups of patients [1,8,27,36,41,43,[57][58][59][60][61][62][63], we decided to present them in a group of 188 patients. In addition to a detailed examination of each patient, a comparison between the ICAD and VBAD will be presented as well.…”

Section: Introductionmentioning

confidence: 99%

Vertebrobasilar and internal carotid arteries dissection in 188 patients

Brkić

Jaramaz

Vukicevic

et al. 2021

Journal of Clinical Neuroscience

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Spontaneous Bilateral Internal Carotid Arteries Dissection with Acute Stroke - A Case for Stent Implantation and Antithrombotic Therapy and literature review

Wang

Cai

et al. 2023

Preprint

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Background Internal Carotid Arteries Dissection (ICAD) is a rare but important cause of severe acute ischemic stroke. Patients with ICAD are mostly treated with the antithrombotic regimen (anticoagulation, signal antiplatelet and dual antiplatelet), or endovascular treatment. The recurrence rate of carotid artery dissection stroke is relatively low. Here, we present a case of middle-aged male patient with acute ischemic strokes was caused by spontaneous bilateral ICAD. Stent placement in combine with antiplatelet therapy is a beneficial treatment method for such patient, as a preferred option. Case presentation: We present a case of a 54 -year-old male with no history of arteriopathy who presented with left limber weakness and slurred speech. Cerebral magnetic resonance imaging (MRI) showed acute large area cerebral infarcts in the right hemisphere. Digital subtraction angiography (DSA) demonstrated that the right internal carotid artery (ICA) occlusion at the cervical portion. He was found to have dissections in the right intracranial carotid arteries. He was treated with dual antiplatelet therapy and right carotid artery stent implantation. However, the patient still developed new neurological deficits, after stenting and balloon dilatation in the right carotid artery and postoperative antiplatelet therapy. MRI showed that acute left cerebral hemisphere infarction. Cervical computed tomography angiography and DSA revealed status of right carotid artery stent implantation and left ICA occlusion. Similarly, stent was performed in his left carotid artery, and dual antiplatelet therapy still continued. He was seen in the clinic at 6 months with follow-up imaging revealing improvement in the dissections. Conclusion The preferred option for patients with ICAD is to receive medication. If the ischemic event still occurs, invasive treatment should be carried out. However, ischemic stroke events were treated effectively with stenting and postoperative antiplatelet therapy.

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Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature

Cited by 3 publications

References 10 publications

Arterial dissections: Common features and new perspectives

Arterial dissections: Common features and new perspectives

Vertebrobasilar and internal carotid arteries dissection in 188 patients

Spontaneous Bilateral Internal Carotid Arteries Dissection with Acute Stroke - A Case for Stent Implantation and Antithrombotic Therapy and literature review

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