CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020; 39(01): 016-017
DOI: 10.1055/s-0039-1698817
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Spontaneous Convexity Subarachnoid Hemorrhage Caused by Internal Carotid Occlusion: Radiological Features

Hemorragia subaracnóidea espontânea na convexidade causada por oclusão da carótida interna: Características radiológicas
1  Department of Neurosurgery, Centro Especializado em Neurologia e Neurocirurgia Associados (CENNA), Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
2  Department of Neurosurgery, Divisão de Neurocirurgia, Hospital Antônio Targino, Campina Grande, Paraíba, PB, Brazil
,
Radmila Agra Cariry Targino de Holanda
2  Department of Neurosurgery, Divisão de Neurocirurgia, Hospital Antônio Targino, Campina Grande, Paraíba, PB, Brazil
,
José Targino Neto
2  Department of Neurosurgery, Divisão de Neurocirurgia, Hospital Antônio Targino, Campina Grande, Paraíba, PB, Brazil
,
Luciano Ferreira de Holanda
2  Department of Neurosurgery, Divisão de Neurocirurgia, Hospital Antônio Targino, Campina Grande, Paraíba, PB, Brazil
3  Department of Medical Sciences, Faculdade de Medicina, Universidade Federal de Campina Grande (UFCG), Paraíba, PB, Brazil
› Author Affiliations
Further Information

Address for correspondence

Benedito Jamilson Araújo Pereira, MD
Rua Martiniano de Carvalho 669, apto. 1.105, Bela Vista, São Paulo, SP, 01321-001
Brazil   

Publication History

20 May 2019

21 August 2019

Publication Date:
31 October 2019 (online)

 

Abstract

A 79-year-old patient was admitted to the emergency room with transitory monoparesis in the left hand and dysphasia. The brain computed tomography (CT) and magnetic resonance imaging (MRI) showed a spontaneous right convexity subarachnoid hemorrhage (cSAH). Digital subtraction angiography (DSA) confirmed an asymptomatic occlusion of the right internal carotid artery (ICA) . Cases related to stenosis have already been described, but there is no similar report of a case related to occlusion, even though the pathophysiology of both entities is similar. Atraumatic SAH has been associated with intracranial and extracranial artery stenosis.


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Resumo

Paciente de 79 anos foi admitida na sala de emergência, com monoparesia braquial transitória à esquerda e disfasia. O exame de tomografia cerebral (TC) e ressonância magnética mostraram uma hemorragia subaracnóidea na convexidade no hemisfério direito (cSAH). A angiografia por subtração digital confirmou uma oclusão da artéria carótida interna (ACI) direita assintomática. Casos como esses relacionados à estenose já foram descritos, porém, relacionados à oclusão, não há relato semelhante, embora a fisiopatologia de ambas as entidades seja semelhante. cSAH tem sido associada à estenose de artérias intracraniana e/ou extracraniana.[1]


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Case Report

A 79-year-old patient was admitted to the emergency room with transitory monoparesis in the left hand and dysphasia. The brain computed tomography (CT) ([Fig. 1A-C]) and magnetic resonance imaging (MRI) ([Fig. 1D-F]) showed a spontaneous right convexity subarachnoid hemorrhage (cSAH). Digital subtraction angiography (DSA) confirmed an asymptomatic occlusion of the right internal carotid artery (ICA) ([Fig. 2]). Cases related to stenosis have already been described, but there is no similar report of a case related to occlusion, even though the pathophysiology of both entities is similar. Atraumatic SAH has been associated with intracranial and extracranial artery stenosis.[1]

Zoom Image
Fig. 1 (A-C) Axial, coronal and sagittal cranial computed tomography (CT) showing a hyperdense cortical lesion corresponding with a right convexity subarachnoid hemorrhage; (D-F) magnetic resonance imaging (MRI): axial T1-weighted gradient echo sequence image showing subacute right sulcal subarachnoid hemorrhage.
Zoom Image
Fig. 2 Digital subtraction angiography (DSA): (A-B) antero-posterior and profile DSA of the right common carotid artery (CCA) showing occlusion of the right internal carotid artery (ICA); (C-D) vascularization of the right cerebral parenchyma by collateral circulation through the polygon of Willis, via the anterior and posterior communicating arteries respectively.

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Conflict of Interests

The authors have no conflict of interests to declare.


Address for correspondence

Benedito Jamilson Araújo Pereira, MD
Rua Martiniano de Carvalho 669, apto. 1.105, Bela Vista, São Paulo, SP, 01321-001
Brazil   


  
Zoom Image
Fig. 1 (A-C) Axial, coronal and sagittal cranial computed tomography (CT) showing a hyperdense cortical lesion corresponding with a right convexity subarachnoid hemorrhage; (D-F) magnetic resonance imaging (MRI): axial T1-weighted gradient echo sequence image showing subacute right sulcal subarachnoid hemorrhage.
Zoom Image
Fig. 2 Digital subtraction angiography (DSA): (A-B) antero-posterior and profile DSA of the right common carotid artery (CCA) showing occlusion of the right internal carotid artery (ICA); (C-D) vascularization of the right cerebral parenchyma by collateral circulation through the polygon of Willis, via the anterior and posterior communicating arteries respectively.