Cerebral Ischemia Due to Congenital Malformations of Brachiocephalic Arteries—Case Reports

Abstract

Seven cases of congenital anomalies of brachiocephalic arteries are presented; malformations include unilateral absence of the internal carotid artery (ICA) (n = 3), unilateral hypoplasia of the ICA (n = 2), agenesis of the innominate artery (n = 1), and atresia of the subclavian artery (n = 1). All patients but 1 exhibited symptoms of cerebrovascular insufficiency at the time of radiologic investigation; they were not affected by other cardiovascular malformations, except right aortic arch in 2 cases and left cervical arch in another case. Two patients suffering from congenital subclavian steal syndrome underwent surgery to correct the vascular malformations. Embryogenesis and natural history of such malformations are briefly discussed.

Basal Encephalocele Associated With Hypoplasia of the Internal Carotid Artery -Case Report-

“…Aplasia of the ICA depends on abnormal regression of the first and third aortic arches during the formative stage of the vasculature during the 4th and 5th weeks of embryogenesis. 7,14) Normal development of the chondrocranium of the skull base starts from the 5th week and continues to the 10th week. In the present case, 3D CT demonstrated absence of the bony carotid canal and the anterior clinoid process, a defect in the floor of the pituitary fossa, and protrusion of abnormal bone in the middle cranial fossa.…”

Diagnosis of congenital absence of internal carotid artery by power angio sonography

“…It is rarely diagnosed in childhood. A review of the literature suggests that this malformation has not previously been described in a preterm infant [4,9,12].…”

“…However, these complications are not typical in childhood [13]. The literature describes different symptoms due to malperfusion of the auditory system or the pituitary gland [4,7]. Moreover, cerebral hemiatrophy is possible [1].…”

“…If ICA lesions secondary to trauma, hypercoagulopathy, or atherosclerosis can be excluded, congenital absence of the ICA is likely [7±9]. Although the manifestation of this condition in infants and children is rare [4] and the onset of neurological symptoms slow because they require additional disease, there is a particular interest in screening patients in order to detect organic manifestations early in their course. Thus, the possibility and benefit of intervention like extracranial-intracranial bypass or endovascular occlusion of aneurysma can be discussed.…”

Agenesis of Internal Carotid Artery Associated with Symptomatic Partial Epilepsy

“…Approximately 25-35% of cases have been reported to have associated aneurysms (Lie, 1968;Moyes 1969;Tangchai and Khaoborisut, 1970;Teal et al, 1973;Rosen et al, 1975;Naito et al, 1977;Servo, 1977;Wega et al, 1980;Afifi et al, 1987;Kunishio et al, 1987;Petrela et al, 1987;Quint et al, 1989), on the anterior communicating artery, basilar artery, contralateral middle cerebral artery (MCA), or carotid siphon. Some patients have symptoms related to circulation insufficiency (Tharp et al, 1965;Savastano et al, 1992) or compression by enlarged intracranial collateral vessels or associated aneurysms (Verbiest, 1954;Wakai et al, 1987). Sporadic cases have been reported associated with cerebral hemiatrophy (Teal et al, 1973;Afifi et al, 1987), Klippel-Trenaunay syndrome (Goldstein et al, 1984), neurofibromatosis (Chen et al, 1994), coarctation of aorta (Verdeille et al, 1988), olivopontocerebellar atrophy (Okabe et al, 1989), dextrocardia (Casiglia et al, 1990), arachnoid cyst (Kidooka et al, 1992),and hemangioma of the tongue (Murotani and Hiramato, 1985).…”