Resolution of Existing Intimal Plaque in a Patient with Carotidynia

Woo, J. K H; Jhamb, Ashu; Heran, Manraj K. S.; Hurley, Michael C.; Graeb, D A

doi:10.3174/ajnr.a0939

Cited by 22 publications

(11 citation statements)

References 4 publications

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“…The general consensus of imaging findings of carotidynia is 1) continuous involvement of the distal CCA, bifurcation, or proximal ICA, 2) concentric enhancement of the carotid wall and surrounding tissue, and 3) slight luminal narrowing. [3][4][5][6][7] The MRA findings of our patient were consistent with the usual findings but also showed a mural thrombus and intimal disruptions. A few cases of carotidynia with thrombus formation have been reported, but none of them had the complication of ischemic stroke.…”

Section: Discussionsupporting

confidence: 73%

“…2 There are some case reports of fairly consistent magnetic resonance imaging (MRI) and computed tomography findings suggestive of carotid inflammation around the carotid bifurcation. [3][4][5][6] In rare cases carotidynia may present with a carotid arterial thrombus or disruption of the intimal plaque. 5,6 Furthermore, there is little information available about carotidynia accompanied with acute ischemic stroke.…”

mentioning

confidence: 99%

“…[3][4][5][6] In rare cases carotidynia may present with a carotid arterial thrombus or disruption of the intimal plaque. 5,6 Furthermore, there is little information available about carotidynia accompanied with acute ischemic stroke.Here we present a case of carotidynia with acute ischemic stroke that was related to previous carotid sinus massage (CSM) performed by the patient. Carotidynia is characterized by unilateral neck pain around the carotid artery.…”

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confidence: 99%

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Carotidynia presenting with acute ischemic stroke after carotid sinus massage

Kwak

Chung

Lee

et al. 2017

Ann Clin Neurophysiol

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Carotidynia is characterized by unilateral tenderness around the carotid artery, especially near the carotid bifurcation, as first described in 1927 by Temple Fay. 1 The pain often radiates to the ipsilateral mandible, cheek, eye, and ear, and it may occur continuously or periodically. Inflammatory components demonstrated in histological examinations have been implicated in carotidynia, but the findings have not been definitive. 2 There are some case reports of fairly consistent magnetic resonance imaging (MRI) and computed tomography findings suggestive of carotid inflammation around the carotid bifurcation. [3][4][5][6] In rare cases carotidynia may present with a carotid arterial thrombus or disruption of the intimal plaque. 5,6 Furthermore, there is little information available about carotidynia accompanied with acute ischemic stroke.Here we present a case of carotidynia with acute ischemic stroke that was related to previous carotid sinus massage (CSM) performed by the patient. Carotidynia is characterized by unilateral neck pain around the carotid artery. We describe a 50-year-old woman who presented with transient left-side weakness and right-side neck pain. She frequently massaged the uncomfortable neck area during the symptomatic course of the condition. Magnetic resonance imaging revealed multifocal cerebral infarctions and a carotid intramural thrombus ipsilateral to the carotidynia.Long-term carotidynia might result in the involvement of an intramural thrombus and intimal disruption, and ischemic stroke after carotidynia may be provoked by carotid sinus massage.

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Section: Discussionsupporting

confidence: 73%

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confidence: 99%

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confidence: 99%

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Carotidynia presenting with acute ischemic stroke after carotid sinus massage

Kwak

Chung

Lee

et al. 2017

Ann Clin Neurophysiol

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“…Our patient and those of other authors 13 received no treatment and the disease resolved on its own. Others have treated with calcium channel blockers 14 , steroids 9,15 , triptans 16 , and nonsteroidal anti-inflammatory drugs 17 , also with resolution. Whether these cases would have resolved without treatment is unknown.…”

mentioning

confidence: 99%

CTA, MR, and MRA Imaging of Carotidynia: Case Report

Lee

Swartz²,

McEvilly³

et al. 2009

Can. J. Neurol. Sci

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Carotidynia is a term first coined by Fay in 1927 1 to describe a particular type of idiopathic neck pain, tending to be unilateral and associated with tenderness to palpation over the carotid bifurcation. This reproduction of pain with palpation later came to be known as a positive Fay sign. Patients are afebrile and lack any other systemic symptoms associated with infection or malignancy. Despite this characterization, a large differential diagnosis exists. There are a number of case studies on the subject of carotidynia. Included in these reports are various debates as to the existence of carotidynia as a distinct pathological entity, a "catch all" description of symptoms produced by different etiologies, or simply a poorly understood syndrome. In 1988, the International Headache Society accepted acute idiopathic carotidynia as a valid entity and defined a set of four criteria 2 : A. At least one of the following overlying the carotid artery: 1. tenderness, 2. swelling, or 3. increased pulsations; B. Appropriate investigations not revealing a structural abnormality; C. Pain over the affected side of the neck; may project to the ipsilateral side of the head; D. A self-limiting syndrome of less than two weeks duration. Explicit to these original criteria is the understanding that other organic diseases in the differential diagnosis have been ruled out. This includes a variety of vascular, inflammatory, neoplastic, neurologic and musculoskeletal conditions, including vascular injury and dissection. In 2004, carotidynia was removed from this society's diagnostic criteria after cases were reported with imaging findings 3. The current understanding of carotidynia as a clinical syndrome has been criticized for its lack of attention to imaging characteristics. There have been case reports demonstrating imaging findings on ultrasound, computed tomography (CT), computed tomography angiography (CTA), magnetic resonance (MR), magnetic resonance angiography (MRA), and positron emission tomography (PET). In effect, carotidynia by definition is a symptom of pain, yet it is also the name for the specific diagnosis of an inflammatory carotid wall disease that is the subject of this report. In the following case study, we describe clinical findings of a patient diagnosed with carotidynia who presented with neck pain, and demonstrate the CTA, MR, and MRA imaging including follow-up imaging. CASE REPORT A 51-year-old woman developed sudden onset of pain on the left side of her neck while lying in bed one evening. She THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES

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“…Other conditions mimicking idiopathic carotidynia should be evaluated separately. Some of these potentially mortal conditions are plaque formation in the carotid artery lumen, carotid artery dissection, Takayusu arteritis, nasopharyngeal carcinoma, total carotid artery occlusion, and septic embolisation to the carotid bulb [25][26][27][28][29][30][31]. In the absence of fever, chills, confusion, vision change or other positive neurological symptoms or signs, our suggestion is to obtain only a carotid ultrasound and doppler imaging studies routinly.…”

Section: Carotidyniamentioning

confidence: 98%

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders

Aydíl

Kızıl

Köybaşıoğlu

2011

Eur Arch Otorhinolaryngol

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Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on head and neck area. As a result, most of the patients with these syndromes are either overlooked without having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face region or entities related to neuromusculoskeletal system may result in more appropriate and effective management of such conditions while avoiding unnecessary medical and surgical treatments. In this review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known craniofacial and neck pain entities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia, superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.

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Resolution of Existing Intimal Plaque in a Patient with Carotidynia

Cited by 22 publications

References 4 publications

Carotidynia presenting with acute ischemic stroke after carotid sinus massage

Carotidynia presenting with acute ischemic stroke after carotid sinus massage

CTA, MR, and MRA Imaging of Carotidynia: Case Report

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders

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