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    "A pain in the neck..." by Dr. Daniel Geiger

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    "A pain in the neck..." by Dr. Daniel Geiger

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    © All Rights Reserved
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    287 views15 pages

    Case 2

    Uploaded by

    GEIGERmsk
    "A pain in the neck..." by Dr. Daniel Geiger

    Copyright:

    © All Rights Reserved
    Flag for inappropriate content
    of 15

    A pain in the neck

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    Patient Details & Clinical History


    An 54 year old female is referred from the neurologist for a CT angiogram of the head and neck. She complains a mild headache and pain with neck rotation. A prior color doppler study of the neck vessels demonstrates a 60 % stenosis of the left ICA and also shadowing for presence of a dense calcified structure adjacent to the internal carotid arteries bilaterally (US examination not available) . A previous neck x ray also showed moderate degenerative changes to the cervical spine (not available). Otherwise her clinical history is unremarkable.

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    CT Study Details
    64 Slices MDCT Detector configuration, 0.6 mm x 64 Section thickness, 1.0 mm Recon Kernel, B20 AEC Dose Reduction Technique HCCM 400 mg I/mL (4 mL/s) Bolus Triggered Arterial Phase

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    Arterial Phase Axial View

    View the MDCT Angiogram Acquisitions along with the Volume Rendering in the videoboxes below

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    MIP Reconstructions
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    MIP Reconstructions
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    MIP Reconstructions
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    CT Findings
    What do you think is the main CT finding? Left ICA Stenosis Right ICA Stenosis Cerebral Aneurysm Cervical Arthrosis Cervical Spondylosis ICA/ECA Kinking Vascular Anomalies

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    Volume Rendering
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    Volume Rendering
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    Caldwell, Waters and Sagital Projections


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    RaySum Ray Sum

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    Diagnosis Please

    ?
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    Are these possible diagnoses?


    Left ICA stenosis Vascular Anomalies Vasculitis Eagles Syndrome Left ICA Kinking Cerebral Aneurysm

    Diagnosis

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    Arterial Phase Axial View

    In the next slide the final diagnosis

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    The Correct Diagnosis is: Eagles Syndrome


    associated with a Left ICA Stenosis (60%) and Left ICA Kinking. The Eagles syndrome is an aggregate of symptoms (headache, pain on rotation of the neck, foreign body sensation, disphagia) caused by an elongated styloid process (>3cm) or a stylohyoid ligament ossification, wich the cause remains unclear. Can occur monolaterally or bilaterally, and in many cases remains asymptomatic.
    Selected References: Murtagh RD, Caracciolo JT, Fernandez G. : CT findings associated with Eagle syndrome, AJNR Am J Neuroradiol. 2001 Aug;22(7):1401-2. Chuang WC, Short JH, McKinney AM et Al. : Reversible left hemispheric ischemia secondary to carotid compression in Eagle syndrome: surgical and CT angiographic correlation., AJNR Am J Neuroradiol. 2007 Jan;28(1):143-5.

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