Pathological tortuosity of the internal carotid arteries in childhood

Abstract

Objective — to identify the incidence of PT ICA in pediatric patients and assess their clinical significance depending on the clinical and anatomical forms. Methods and subjects. On the basis of the Department of Vascular Surgery of the Department of Emergency and Restorative Vascular Surgery of the Institute of Emergency and Restorative Surgery named after V. K. Husaka of the National Academy of Sciences of Ukraine, together with the Donetsk regional children’s psychoneurological dispensary, we conducted a screening study of brachiocephalic arteries in 420 children in the period from 2005 to 2007. The age of the patients is from 2 to 16 years, the average age is (9 ± 4) years. The control group consisted of 100 people without complaints, neurological deficits, and psycho‑emotional retardation. A comprehensive examination included an examination by a pediatrician, a pediatric neurologist, a cardiologist, a vascular surgeon, a psychoneurologist, a duplex scan of the brachiocephalic vessels, a study of cardiac hemodynamics (electrocardiography, echocardiography), and magnetic resonance imaging of the brain as indicated. The criteria for the hemodynamic significance of LV were considered to be: the presence of a septal inflection of the ICA, an angle < 60°, microaneurysms, loop formation, blood flow acceleration in the zone of LV > 140 cm/s, the value of the resistivity index in the presence of a microaneurysm < 0.5, in the absence of a microaneurysm > 0.7. The type of PZ ICA was determined according to the classification of J. Weibel and W. Fields (1965) with additions by J. Vollmar (1976). Results. Hemodynamically significant ISA was detected in 108 (25.7 %) children of the main group (in 32 (30 %) boys and 76 (70 %) girls), the presence of transient ischemic attacks was in 8 (7.4 %), ischemic stroke was in 5 (4.6 %) school‑age patients due to disease progression. The most clinically unfavorable clinico‑anatomical forms are S‑like PZ ICA (42 (39 %)) and loop formation (11 (10 %)). The most frequent neurological disorders in preschool children caused by the pathological tortuosity of the internal carotid arteries are delayed language development (29 (27 %), impaired adaptation in a team, delayed self‑care skills (delayed in neuropsychological development) (33 (31 %)), impaired emotional sphere and behavior (irritability, mild excitability) (84 (78 %)), sleep disturbances (16 (15 %)). The most serious neurological disorders in children with pathological tortuosity of the internal carotid arteries occur during the school period, which is the result of the progression of early cerebrovascular insufficiency. At this age, the following manifestations of early cerebrovascular insufficiency are typical: headache (100 (93 %)), decreased vision (35 (32 %)), decreased performance at school (88 (82 %)), irritability, anxiety, reduced work capacity, attention disorders (96 (89 %)), cerebral circulation disorders (5 (4.6 %)).Predominant neurological disorders in preschool‑aged children with PT ICA: delayed language development (29 (27 %)), delayed self‑care skills (delayed neuropsychological development) — 33 (31 %); disorders of the emotional sphere and behavior — 84 (78 %), sleep disorders (16; 15 %). Conclusions. Timely detection and early diagnosis of ICA in children by a screening examination prevent the progression of cerebrovascular insufficiency.