ObjectiveSpontaneous cervical artery dissection (CAD) is a cerebrovascular disease typically considered to affect the young population. Literature reports cases in the elderly only as incidental findings, making the diagnosis unlikely in older patients. Incidence and pathogeny in this specific population remain to be assessed.MethodsWe reviewed patients aged over 70 years admitted for spontaneous CAD in the Stroke Unit of the University Hospital of Nancy (northeastern France) over a period of 12 years as well as all reported cases in literature.ResultsDuring this period, only two patients aged over 70 years were diagnosed with internal carotid artery dissection in our center. The first patient was diagnosed with the typical radiological feature of long tapered stenosis due to mural hematoma. The second patient presented with the classic painful Horner syndrome. Literature review identified only two case reports and eight studies with an age range above 70 years. Headache was present in nearly all documented cases. Radiological features were the same as those usually described in younger patients.ConclusionsEven if spontaneous CAD in patients aged over 70 years would appear to be rare, it does occur with comparable clinical and radiological features as in the younger population. CAD is probably underdiagnosed in this population due to a higher prevalence of more common causes of stroke at this age. However, a simple investigation into headache or the Horner syndrome during the patient’s diagnostic workup would lead to adapted exploration of cervical arteries and improve detection of CAD in the elderly.
NOIwich SUMMARYOptic nerve disease has been reported in patients with renal failure. A toxic aetiology has been postulated. The incidence of this complication of renal failure has not been determined. We observed 60 patients with renal fail ure on dialysis for 24 months to determine the incidence of optic neuropathy. Four patients developed typical acute ischaemic optic neuropathy. Their case notes were reviewed in order to determine the pathogenesis. Each patient had long-standing renal failure and its sequelae of anaemia and hypertension. The immediate causes of ischaemia were hypotension in 1, severe anaemia in 1, and generalised atherosclerosis in 2 patients.Optic neuropathy is a well-known complication of renal failure/dialysis. A neurotoxic type of optic neuropathy in uraemic patients with a serum urea nitrogen level of more than 35.7 mmol/I was reported by Knox and associates, 1 who implicated hypertension and anaemia as well as a raised serum urea nitrogen. Medical management with haemodialysis was followed by improvement of vision in 4 of their patients. In 1 patient resumption of cortico steroid therapy was followed by improvement in vision, but the patient whose vision improved the most rapidly was managed by prompt use of both dialysis and oral corticosteroids.Hamad and associates described a similar type of optic neuropathy 2 in patients maintained on dialysis. In 1 case desferrioxamine toxicity was suspected. Other risk factors identified were again hypertension, anaemia and a raised serum urea nitrogen. Their third patient had profound loss of vision, and the likelihood of an atypical non-arteritic acute ischaemic optic neuropathy (AI ON) in a young patient in that particular clinical setting was noted.In contrast, all 4 of our patients had typical non-arteritic acute ischaemic optic neuropathy. PATIENTS AND METHODSAll 60 patients attending the renal dialysis unit had oph
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