Transient ischaemic attack at the admission unit: Expect the unexpected

Abstract

Sažetak:51-godišnji muškarac je pregledan u prijemnoj ambulantni Urgentnog Centra, zbog ponavljanih ataka desnostranog piramidnog deficita i sumnjom na tranzitorni ishemijski atak. Neurološki i fizikalni nalaz je bio uredan, osim registrovane ovalne, bezbolne, nepokretne tumorske mase, lokalizovane pored sternokleidomastoidnog mišića, na levoj strani vrata. CT mozga i neuroultrazvučne dijagnostičke metode su bile uredne. CT vrata sa kontrastom i CT angiografija su prikazale bogato-vaskularizovanu tumorsku masu, bez kompresije na okolne vaskularne strukture. Isključena je stenoza karotidne arterije i dijagnostikovana patološka vaskularizacija tumora iz spoljašnje karotidne arterije. Nakon hirurške resekcije tumora, patohistološki nalaz je potvrdio metastazu papilarnog karcinoma tiroidne žlezde. Ključne reči: tranzitorni ishemijski atak, karotidna arterija, papilarni karcinom tiroidne žlezde Summary:We report a 51-year-old Caucasian male admitted at the Admission Unit of the Emergency Centre with recurrent right-sided hemiparesis suggesting transient ischemic attack. Neurological and physical examination was normal, save for the oval, painless, immobile tumour mass at the left side of the neck, near the sternocleidomastoid muscle. Imaging of brain parenchyma and vascular structures were normal. A contrast neck CT scan and neck CT angiography verified well-vascularised cervical tumour mass of the left side, without compression on the surrounding blood vessels. CT angiography excluded carotid artery stenosis, but revealed pathological vascularisation of cervical tumour mass from external carotid artery. Surgical resection of the cervical mass was done and histopathological analysis revealed metastasis of papillary thyroid carcinoma.