Abstract
A 72-year-old woman presented to her general practitioner with a 4-week history of right neck swelling. Clinical examination elicited a pulsatile mass consistent with a carotid artery aneurysm. Five days later the patient noticed her tongue movements had become awkward with associated dysarthria. Computed tomography confirmed a 4cm internal carotid artery aneurysm arising just distally to the carotid bifurcation. She proceeded to transfemoral diagnostic carotid angiography. Balloon occlusion of the right internal carotid artery origin was performed for a ten-minute period without any neurological deficit. The decision was taken to proceed to surgical ligation of the origin of the internal carotid artery. Her symptoms of dysarthria have resolved.
Highlights
A 72-year-old woman presented to her general practitioner with a 4-week history of right neck swelling
Following discussion at the vascular multidisciplinary meeting, the patient proceeded to transfemoral diagnostic carotid angiography with electroencephalography monitoring under local anaesthesia
Symmetrical flow was demonstrated in both cerebral hemispheres via left carotid angiography
Summary
A 72-year-old woman presented to her general practitioner with a 4-week history of right neck swelling. Clinical examination elicited a pulsatile mass consistent with a carotid artery aneurysm. She had no cardiovascular risk factors and was a non-smoker. At the vascular outpatient clinic, a 4cm non-tender expansile swelling was identified in the right anterior neck triangle (Fig 1). The origin of the ICA aneurysm was confirmed just distally to the carotid bifurcation with normal filling of the right middle cerebral artery (Fig 3). The patient commented that her tongue movements and dysarthria had already appeared to improve on day 2 following surgery. She was discharged home on warfarin therapy for three months. Follow-up carotid duplex ultrasonography demonstrated no flow in the aneurysm sac
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