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The aim was to examine the effects of modalities of acute resistance exercise (RE) on cognition and hemodynamics including internal carotid artery (ICA) blood flow (BF). Twenty adults completed familiarization and experimental visits. One-repetition maximum (1RM) for bilateral leg extension was quantified, and baseline executive functioning was determined from three run-in visits. Subsequent visits included three randomized, volume-equated, acute exercise bouts of 30 %1RM+blood flow restriction (BFR), 30 %1RM, and 70 %1RM. Both 30 %1RM trials completed four sets of exercise (1 × 30, 3 × 15), and the 70 %1RM condition completed four sets of 8 repetitions. BFR was induced with 40 % of the pressure to occlude the femoral arteries. 11 min following each exercise, participants completed the Stroop and Shifting Attention Tests. Baseline and post-exercise values were used to calculate change scores. The resulting mean change scores were evaluated with mixed factorial ANOVAs. A p≤0.05 was considered significant. All measured outcome variables increased in response to exercise. The ANOVAs for cognitive scores indicated no significant (p>0.05) interactions. For cognitive flexibility and executive function index, there were main effects of Sex. Change scores of the females were significantly greater than the males for cognitive flexibility (7.6 ± 5.9 vs. -2.6 ± 8.4 au; p=0.007) and executive function index (7.4 ± 4.6 vs. -2.5 ± 6.5 au; p=0.001). For ICA BF, there was no significant interaction or any main effect. The females exhibited a smaller exercise-induced increase in blood pressure compared to the males (17.7 ± 5.9 vs. 11.0 ± 4.1 mmHg; p=0.010). Each RE modality yielded acute improvements in cognition, but only for females. There were no cognitive improvements related to BFR such that each RE bout yielded similar results.

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Patulous Eustachian tube is a physical disorder in which the normally closed Eustachian tube remains open intermittently. Internal carotid artery (ICA) anomalies accompanied by Eustachian tube anomalies have been described very rarely in the literature. To the best of our knowledge, the presented case is the second case in the literature. In this report, we present a rare case of ICA anomalies accompanied by a bilateral patulous Eustachian tube in a 51-year-old woman.

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INTRODUCTION:  The sphenoid sinus (SS), a paired paranasal sinus located within the sphenoid bone, is crucial in various physiological and pathological processes. Its anatomical variations are of significant interest in clinical practice, particularly in otolaryngology, neurosurgery, and radiology. This study aims to determine the anatomical variations of the SS and related structures using computed tomography (CT). MATERIALS AND METHODS: An observational study was conducted at a tertiary care center. The study included 300 patients aged 7-70 who underwent CT brain scans. Exclusions included prior sinonasal surgeries, tumors, nasal polyposis, recurrent pituitary lesions, head trauma, and past orbital or cranial surgeries. Three-dimensional reconstructions assessed SS dimensions, pneumatization types, and variations in the internal carotid artery and optic nerve. RESULTS: A study on the types of SSs revealed that the reseller type is the most common, accounting for 45% of cases (135 instances). The sellar type accounts for 36% (110 instances), while the conchal type is the least common, observed in 18.33% of cases (55 instances). A significant association between the SS type and variations between neurovascular structures was seen, which was confirmed using chi-square tests. There was a statistically significant relationship between carotid artery variations and SS, with the normal course being predominant at 200 individuals (73.33%). Approximately 40 cases (13.33%) present with dehiscence through the sinus, while 30 individuals (10%) show close proximity. Other, less common variations are observed in 10 patients (3.33%). Optic nerve variations displayed distinct frequencies, with the normal course prevailing in 250 cases (83.33%). Approximately 30 cases (10%) exhibit close proximity to surrounding structures, while 15 cases (5%) present with dehiscence through the sinus. Other less common optic nerve variations are observed in five patients (1.67%). CONCLUSION:  Comprehensive knowledge of SS anatomy through CT scans is essential for enhancing surgical outcomes and ensuring patient safety.

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BACKGROUND: Internal carotid artery (ICA) occlusion is the major cause of ischemic stroke. The effect of collateral vessels on cerebral hemodynamics in ICA occlusion remains unclear. This study investigated the correlation between collateral vessels and the peak systolic velocity of the middle cerebral artery (MCA) in patients with ICA occlusion. METHODS: The relevant collateral vessels included the anterior communicating (ACoA), posterior communicating (PCoA), and internal-external carotid (IECCA) arteries, respectively. Patients with unilateral ICA occlusion (n = 251) underwent transcranial Doppler imaging to detect the peak systolic velocity (PSV) of the MCA and other intracranial arteries. The clinical symptoms were assessed using the National Institutes of Health Stroke Scale (NIHSS). RESULTS: Patients with ACoA collaterals had significantly higher PSVMCA scores and significantly lower NIHSS scores than those without ACoA collaterals (p < 0.001). Patients without any notable collaterals and those with only IECCA had the lowest PSVMCA and highest NIHSS scores. The PSVMCA and NIHSS scores were negatively correlated (r = -0.566, p < 0.001). CONCLUSION: Collateral circulation patency in unilateral ICA occlusion was closely associated with clinical symptoms, and patients with ACoA collaterals may have favorable outcomes. (ClinicalTrials.gov Identifier: NCT02397655).

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Although the cavernous sinus and internal carotid artery are in close proximity to the sphenoid sinus, vascular complications in sphenoid sinusitis are rare due to the intervening mucosa and bone. Variations like dehiscence or aggressive infection can cause vascular complications, leading to cavernous sinus thrombosis, while perivascular inflammation of the internal carotid artery can result in stenosis or occlusion. Untreated or aggressive sphenoid sinusitis can cause neurological complications such as cerebral infarcts, meningitis, subdural empyema, cerebral abscess, and cranial nerve injuries. Magnetic resonance imaging (MRI) of the brain with angiography can depict these complications at an early stage. Additionally, mastoiditis can cause dural venous sinus thrombosis, which, if left untreated, can result in venous infarcts. We report a case of an 11-year-old male with sphenoid sinusitis who developed a left middle cerebral artery (MCA) territory infarct, cavernous sinus thrombophlebitis, subdural empyema, and meningitis. He also developed left transverse and sigmoid sinus thrombosis due to left mastoiditis.

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Background: To investigate the correlation between retinal vascular changes and ICA stenosis by measuring retinal vessels using full-width-at-half-maximum (FWHM) and intelligent image recognition. Methods: This research selected patients who were admitted to the Vascular Surgery Department of Quzhou People's Hospital from January 2018 to December 2020 and were preparing for Carotid Artery Stenting (CAS). Participants were divided into two groups: without ICA stenosis (Group 0) and with ICA stenosis (Group 1). A total of 109 cases were included in the study, with 50 cases in Group 1 and 59 cases in Group 0. Vascular images of superior temporal zone B of the retina were obtained by spectral domain optical coherence tomography (SD-OCT). The edges of retinal vessels were identified by FWHM. Each vessel of all subjects was measured three times with the FWHM, and the average value was taken to obtain the retinal arteriolar lumen diameter (RALD), retinal arteriolar outer diameter (RAOD), retinal venular lumen diameter (RVLD), and retinal venular outer diameter (RVOD),Arterial Wall Thickness (AWT),Venular Wall Thickness (VWT)=(RVOD-RVLD)/2,Arteriovenous Ratio (AVR) = RAOD/RVOD. Results: We found that compared to Group 0, Group 1 had smaller RALD (P < 0.001) and RAOD (P < 0.001), and wider RVOD (P < 0.001), with thicker VWT (P < 0.001). When compared with the contralateral eye in Group 1, the ipsilateral eye exhibited even smaller RALD,RAOD and AVR (P < 0.001, P < 0.001, P < 0.001). After CAS, the RALD,RAOD and AVR in Group 1 increased (P < 0.001, P < 0.001, P < 0.001),while the RVLD and RVOD decreased (P < 0.05, P < 0.001). Our research reveals a significant correlation between retinal vascular changes and internal ICA stenosis. Conclusion: Utilizing SD-OCT in conjunction with the FWHM,we achieved a non-invasive, intelligent, stable, and precise acquisition of data pertaining to retinal vessels. These findings underscore a significant correlation between alterations in retinal vascular structure and the presence of ICA stenosis, as demonstrated by our research.

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Skull base osteomyelitis (SBO) is a severe and uncommon infection that typically affects the skull base and may arise from undiagnosed otogenic or sinonasal infection. This case describes a rare presentation of SBO, accompanied by thrombosis of the bilateral internal carotid artery with neurological deficits in a resource-limited environment, illustrating diagnostic and management dilemmas. A male patient aged 40 years with poorly controlled type 2 diabetes presented with sudden onset loss of consciousness and worsening right-sided weakness. MRI studies revealed SBO with cerebral involvement with thrombosis in major cerebral arteries and multiple brain infarcts. After receiving broad-spectrum antibiotics and supportive care shortly after admission, the patient developed septic shock and died two days after admission. The fast course of the disease in this case shows how severe SBO and its complications may be, calling for early diagnosis and intensive management of SBO, especially in diabetic patients. The fact that Staphylococcus epidermidis was established as a causative agent of disease in the absence of artificial heart valves or joints, it is becoming clear that there is a need to increase awareness of such rare pathogens, and probably new strategies for handling such infections should be developed. Additional research is required to elucidate the precise role of the pathogen and refine treatment approaches, especially for low-resource healthcare systems.

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OBJECTIVE: To summarize the ultrasound diagnostic key points and imaging characteristics of absence of the internal carotid artery (ICA), and to explore the application value of carotid artery ultrasound in the diagnosis of ICA absence. METHODS: Sixteen patients diagnosed with ICA absence at our hospital were retrospectively analyzed. Clinical data, ultrasound images, and other relevant imaging data were reviewed. The ultrasound diagnostic key points and related imaging characteristics of ICA absence were summarized. Combined with a literature review, the application of carotid artery ultrasound in the diagnosis of ICA absence was discussed. RESULTS: Among the 16 patients, there were 10 males and 6 females ages ranging from 13 to 80 years. Among them, 5 patients had a history of cerebral infarction, 1 patient had a history of subarachnoid hemorrhage, and 10 patients had no history of stroke. Among the 16 patients, there were 10 left-sided lesions, 5 right-sided lesions, and 1 bilateral lesion. Three patients had concomitant aneurysms. Carotid ultrasound examinations in all 16 ICA absent patients revealed that a significantly slender common carotid artery (CCA) diameter compared to the contralateral (3.91 ± 0.73 vs. 6.92 ± 1.42, p < 0.001). On the side of ICA absence, the bifurcation of the carotid artery was not detected, with the CCA directly continuing as a single artery (external carotid artery, ECA). The temporal superficial artery percussion test was positive in all cases, and the blood flow spectrum of the single artery (ECA) on the side of the absent ICA showed a serrated pattern during diastole. On the side where the ICA was absent, the blood flow spectrum morphology of the CCA and ECA was consistent. Based on other relevant imaging examinations, the patients were classified into Lie types: A (10 cases), B (2 cases), C (1 case), D (1 case), and 2 cases were unclassified. CONCLUSION: Carotid artery ultrasound has the advantages of easy operation, affordability, non-invasiveness, and capable of dynamic and high repeatability. Compared to other imaging examinations, it can provide more evidence for the diagnosis of ICA absence, and is suitable for widespread application and promotion.

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Agenesis or hypoplasia of the internal carotid artery (ICA) may easily be confused with dissection or occlusion. We report a case of a 24-year-old female with complaint of acute left-hand hypoesthesia and a history of occasional intermittent numbness of her right hand with myoclonic jerking. Because previous imaging studies over 2 years were interpreted as occlusion of the left ICA secondary to carotid dissection, the treating physician had prescribed anticoagulant therapy. During transcranial Doppler (TCD) examination, the spectral waveform was unexpectedly normal, prompting a repeat review of all imaging due to the TCD results. Magnetic resonance angiography (MRA) revealed the same "flame-like" appearance of the ICA origin. Late-phase digital subtraction angiography showed a small caliber cervical ICA (occluded at the skull base). Computed tomography demonstrated absence of the carotid canal, confirming an absent intracranial portion of the ICA and establishing a correct diagnosis of left internal carotid hypoplasia. Vascular ultrasound and TCD examinations are noninvasive and inexpensive tools that can improve the interpretation and understanding of the clinical significance of other "static" radiographic tests (MRA, digital subtraction angiography ). An accurate diagnosis is essential to avoid risky, aggressive treatment, such as anticoagulation for an "absent" dissection.

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OBJECTIVE: To evaluate internal carotid artery's (ICA) anatomical relationships with atlantoaxial joints and posterior pharyngeal wall and to illustrate ICA injury risk during transoral procedures to upper cervical spine. METHODS: Cervical spine computed tomography angiography (CTA) of 238 patients were retrospectively evaluated. Each ICA was classified into one of three zones: areas medial (Zone 1), anterior (Zone 2), or lateral (Zone 3) to the atlantoaxial joint. For an ICA in Zone 1, the shortest distances to the posterior pharyngeal wall and midsagittal plane were measured. For an ICA in Zone 2, the closest distances to the midsagittal plane and anterior cortex of the C1-2 complex were measured. RESULTS: Fifteen ICAs in Zone 1 were found in 12 (5%) patients, with three female patients having bilateral ICAs medial to the atlantoaxial joint. The incidence of ICA in Zone 1 was higher in females than in males. In cases of ICAs in Zone 2, the ICAs were close to the anterior cortex of C1-2 complex, with the shortest distance being 2.6±1.5 mm. A total of 39.9% of patients had bilateral ICAs in Zone 3. CONCLUSION: Transoral surgeries in the upper cervical spine carry potential ICA injury risk. They should be carefully deliberated in patients whose ICAs are in Zone 1. In cases of ICAs in Zone 2, meticulous subperiosteal stripping and gentle traction should be performed on the posterior pharyngeal wall. Preoperative identification of the course of ICAs is mandatory in patients undergoing transoral surgeries in the upper cervical spine.

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Most anatomic features of the internal carotid artery (ICA) are described as a straight course to the skull base free of branches. In some cases, the excessive elongation of the internal carotid artery in a confined space results in a curvature showing a "C" or "S" shape, or in an abnormal vascular shape made of a single or double vessel loop. These anatomic variants are called dolichoarteriopathies of the internal carotid artery. The correlation between dolichoarteriopathy of the ICA and stroke is still questionable, however it is believed that it can be associated with cerebral ischemia with a clinical symptomatology that accompanies ischemic stroke. We report a case of a 41-year-old patient, with a history of hypertension, who was admitted for right hemiparesis with Broca's aphasia. The rest of the clinical examination was normal. Radiological investigations confirmed an acute left sylvian ischemic stroke with an abrupt occlusion of the posterior trunk of the left M2 segment on the CT angiogram, an excessive elongation of the ICA on both sides, describing a shape of coils or loops. Etiologic workup for ischemic stroke was negative.

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BACKGROUND: Carotid artery dissection is an important cause of stroke. However, the predictors of ischemic stroke in patients with carotid artery dissection are controversial. The study aimed to analyze the predictors of ischemic stroke in patients with carotid artery dissection through retrospective medical records. METHODS: Data of discharged patients diagnosed with carotid artery dissection during 2019-2023 were retrospectively collected. Based on the occurrence of ischemic stroke, the patients were divided into the ischemic stroke or non-ischemic stroke groups. Based on the results of univariate analyses, variables with an associated P value < 0.05 were introduced into the multivariable logistic regression analysis. . RESULTS: A total of 165 patients were included in the study, with an average age of 55.00 (48.00, 66.00) years, including 86 patients with internal carotid artery dissection and 79 patients with vertebral artery dissection. Ischemic stroke occurred in 69 patients with carotid artery dissection. Multivariate logistic regression analysis indicated that diabetes (odds ratio [OR]: 3.144, 95% confidence interval [CI]: 1.552-6.508, P<0.002) and high white blood cells count (OR: 1.157, 95% CI: 1.02-1.327,P = 0.028) were related to the incidence of ischemic stroke in patients with carotid artery dissection. CONCLUSION: Ischemic stroke caused by carotid artery dissection causes severe damage to the nervous system. This study found that diabetes and high white blood cells count were associated with the incidence of ischemic stroke in patients with carotid artery dissection. Therefore, monitoring and controlling blood glucose levels and infections is essential in patients with carotid artery dissection to reduce the incidence of stroke.

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BACKGROUND: Anatomical variations of origin of the internal carotid artery (ICA) are very uncommon and may pose a diagnostic and therapeutic challenge. OBJECTIVE: We report a case of direct origin of the right ICA from the innominate artery (aplasia of common carotid artery) and a case of duplication of right ICA in healthy patients who performed duplex ultrasound (DUS) for primary cardiovascular prevention screening. METHODS: In both cases, the ultrasound scan was performed both in a transverse plane and on the longitudinal axis, and in one of the two cases, a computed tomography angiography was performed to confirm the diagnosis. A review of the current literature about anatomical variations of origin of carotid arteries was also performed. RESULTS: The most frequent congenital anomaly is represented by the aplasia of the CCA, followed by the agenesis and by the duplication of the ICA. In most cases, the anomaly is discovered occasionally and symptoms are aspecific. Diagnosis is usually confirmed through a multimodality imaging approach, including DUS of extracranial carotid arteries, magnetic resonance imaging (MRI), and computed tomographic angiography. In most cases, treatment was conservative, with pharmacological therapy aimed at the symptoms. CONCLUSION: The recognition of such variations is mandatory, particularly when the patient needs a surgical treatment that may involve the vessel with the anatomical variations.

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A 17-year-old boy presented with a high-grade fever. The patient had been previously diagnosed with Cornelia de Lange syndrome (CdLS). The patient visited a local physician and was diagnosed with sinusitis. Owing to persistent fever, the patient was referred to our hospital. At the initial presentation, his body temperature was 38.2°C, while maintaining previous living activities and neurological function. Despite changing the antibiotic to amoxicillin, the patient's fever persisted with worsened activity. At the second presentation, the patient presented with left hemiparesis. Blood examination revealed increased white blood cell count and serum C-reactive protein level. Emergency magnetic resonance imaging revealed acute cerebral infarcts in the right cerebral hemisphere, with evident stenosis in the right paraclinoid segment of the internal carotid artery (ICA). In addition, an abscess was found in the cerebellar hemisphere, which was punctured through the burr hole. Computed tomography performed after the completion of antibiotic therapy revealed a restored diameter of the stenotic ICA. Sinusitis can cause ischemic stroke due to compressive stenosis of the paraclinoid ICA, particularly in patients with CdLS. Sinusitis should be preferentially managed in patients with CdLS.

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Congenital absence of the internal carotid artery is a rare anatomical variant. The primarily reported origins of the ophthalmic artery associated with this variant are the posterior communicating, middle cerebral, and external carotid arteries. We report the case of a patient without an internal carotid artery whose ophthalmic artery originated from the contralateral internal carotid artery. The superior hypophyseal and prechiasmal arteries may contribute to collateral flow to the orbit from the contralateral internal carotid artery.

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Background: This study aims to evaluate the efficacy and complications of endovascular treatment for hemorrhage caused by ruptured internal carotid artery pseudoaneurysms following radiotherapy in nasopharyngeal carcinoma (NPC) patients. Methods: This study retrospectively analyzed NPC patients who underwent endovascular treatment for ruptured internal carotid artery pseudoaneurysm hemorrhage after radiotherapy at Zhongshan People's Hospital from January 2016 to December 2022. The study aims to assess the postoperative hemostasis rate, postoperative rebleeding rate, complication rate, and 1-year postoperative survival rate. Results: During the study period, 36 patients underwent endovascular treatment, of which 24 patients underwent embolization of the internal carotid artery and 12 patients underwent stenting of the internal carotid artery. The procedure success rate was 100%. The rebleeding rate at 1 year after the procedure was 5.6% (2/36, one patient with stent placement and one patient with coil embolization), and the complication rate was 11.1% (4/36, four patients with coil embolization patients). Two patients developed large-area cerebral infarction after the procedure, and two patients had different degrees of neurological impairment after the procedure. The 1-year survival rate was 91.7% (33/36). Conclusion: Ruptured internal carotid artery pseudoaneurysm hemorrhage after radiotherapy is rare but life-threatening. Endovascular treatment with coil occlusion or stenting reconstruction of the internal carotid artery provides immediate hemostasis and elimination of the pseudoaneurysm with a low rate of recurrence, which may be effective in reducing patient mortality.

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This case study aims to elucidate the rare occurrence of bilateral internal carotid artery agenesis combined with a bovine aortic arch. The main objectives are to explore the incidence, embryological origins, clinical manifestations, and associated anomalies of this unique vascular condition. The study involves a detailed investigation of a 55-year-old male with a history of recurrent transient ischemic attacks (TIAs) using MRI and CT scan. The patient's medical history, clinical examination, and imaging results were systematically analyzed to provide a thorough understanding of the anatomical variations. The main findings include the rare coexistence of bilateral ICA agenesis and a bovine aortic arch, making this the 39th documented occurrence of bilateral ICA agenesis and the first recorded instance of its association with a bovine aortic arch. Also, the study highlighted the demographic characteristics, clinical presentations, and associated anomalies observed in the 38 documented cases of bilateral internal carotid artery agenesis. This case report contributes valuable insights into the rarity of bilateral internal carotid artery agenesis and its unprecedented association with a bovine aortic arch. The findings emphasize the importance of heightened anatomical awareness in clinical practice, particularly. Recognizing and understanding such variations is crucial for accurate diagnosis, appropriate management, and improved patient outcomes. Further research in this area is warranted to deepen our understanding of these complex vascular anomalies.

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The article presents a case of a 54-year-old female patient who, over the course of 2 years, suffered 5 cerebrovascular accidents (CVA) due to infectious arteritis of both internal carotid arteries (ICA) and basilar artery as a complication of sphenoiditis and otitis. According to neuroimaging data, the steno-occlusive process in the ICA developed gradually, starting with the intracranial ICA narrowing with the contrast enhancement by vessel wall, the development of its occlusion six months later, and the detection of the extracranial ICA occlusion with the formation of «flame sign¼ at its mouth a year later. Repeated examination of the cerebrospinal liquid at an early stage of the disease revealed cytosis up to 367/3 and protein 0.66 g/l. The correct diagnosis was established only after 3 years with a retrospective analysis of clinical, neuroimaging, and laboratory data. Therefore, targeted antibiotic therapy was not carried out, which led to the progression of ICA occlusion and repeated strokes. Infectious arteritis should be taken into account in the differential diagnosis of the causes of the ICA occlusive process.

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This research examined the impact of aerobic exercise intensity and dose on acute post-exercise cerebral shear stress and blood flow. Fourteen young adults (27 ± 5 years of age, eight females) completed a maximal oxygen uptake ( V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ ) treadmill test followed by three randomized study visits: treadmill exercise at 30% of V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ for 30 min, 70% of V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ for 30 min and 70% of V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ for a duration that resulted in caloric expenditure equal to that in the 30% V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ visit (EqEE). A venous blood draw and internal carotid artery (ICA) ultrasound were collected before and immediately following exercise. ICA diameter and blood velocity were determined using automated edge detection software, and blood flow was calculated. Using measures of blood viscosity, shear stress was calculated. Aerobic exercise increased ICA shear stress (time: P = 0.005, condition: P = 0.012) and the increase was greater following exercise at 70% V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ (∆4.1 ± 3.5 dyn/cm2) compared with 30% V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ (∆1.1 ± 1.9 dyn/cm2; P = 0.041). ICA blood flow remained elevated following exercise (time: P = 0.002, condition: P = 0.010) with greater increases after 70% V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ (Δ268 ± 150 mL/min) compared with 30% V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ (∆125 ± 149 mL/min; P = 0.041) or 70% V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_2}\max }}$ EqEE (∆127 ± 177 mL/min; P = 0.004). Therefore, aerobic exercise resulted in both intensity- and dose-dependent effects on acute post-exercise ICA blood flow whereby vigorous intensity exercise provoked a larger increase in ICA blood flow compared to light intensity exercise when performed at a higher dose.