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IMAGE IN NEUROLOGY
Year : 2016  |  Volume : 19  |  Issue : 3  |  Page : 409-410
 

Kinked carotids: The "python" in the neck


1 Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab and Haryana, India
2 Department of Radiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab and Haryana, India

Date of Submission26-Aug-2015
Date of Decision08-Sep-2015
Date of Acceptance20-Sep-2015
Date of Web Publication25-Jul-2016

Correspondence Address:
Dheeraj Khurana
Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012, Punjab and Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.186846

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How to cite this article:
Takkar A, Khurana D, Khandelwal N. Kinked carotids: The "python" in the neck. Ann Indian Acad Neurol 2016;19:409-10

How to cite this URL:
Takkar A, Khurana D, Khandelwal N. Kinked carotids: The "python" in the neck. Ann Indian Acad Neurol [serial online] 2016 [cited 2019 Dec 10];19:409-10. Available from: http://www.annalsofian.org/text.asp?2016/19/3/409/186846



   Case Report Top


A 70-year-old hypertensive and diabetic lady presented with a right hemiparesis of 1-month duration. Her echocardiogram and lipid profile were unremarkable. Cranial magnetic resonance imaging (MRI) showed an infarct in the left basal ganglia. Computed tomography (CT) angiogram revealed severe kinking of the cervical internal carotid arteries (ICAs) bilaterally, resembling a python [Figure 1]a and b. Despite being on aspirin, she had three episodes of transient unilateral weakness over the next 6 months that abated with double antiplatelets.
Figures 1: (A) Computed tomography (CT) angiogram (volume rendered images) showing severe coiling cervical internal carotid arteries bilaterally, resembling a python (B)

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   Discussion Top


Anatomical variations of ICA have been clearly recognized for ages. Looping and kinking of the ICA is commonly observed in infants. ICA is formed from the third aortic arch and the dorsal aorta, hence, it is normally kinked in the embryo. [1] The persistence of the original fetal morphology produces different types of undulations and variations in the anatomy of ICA. Whether or not these are independent stroke risk factors or markers is controversial. [2]

Marked coiling of ICA may be a risk factor for stroke. [3] Though considered to be normal variation at some point, it is now believed that the presence of these undulations may be attributed to increased blood pressure. Long-standing aortic insufficiency with resultant high pulse pressure may also be contributory in causation of these undulations. [4]

Most available literature suggest that these carotid anomalies are rarely symptomatic unless other additional vascular risk factors are present in an individual. [2] Although an indisputable evidence for a connection between carotid anomalies and occurrence of vascular events does not exist, it is believed that "….development of symptoms may at times depend on the fortuitous positioning of the head in a such a way that the vessels are kinked rather than merely elongated." [3],[5]

Alleviation in the symptoms of patients after straightening of kinked carotid vessels has also been reported in literature, [5],[6],[7] providing an indirect evidence of the causal relationship between the two.

Our patient had extremely coiled carotid vessels and no other source of atheroembolism, with recurrent cerebrovascular events despite being on antiplatelet agents. The anomalies, when detected, deserve due consideration and should not be passed on as normal or benign variants. Their presence may warrant the need for an aggressive medical or surgical treatment to prevent adverse outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kelly AB. Tortuosity of the internal carotid in relation to the pharynx. J Laryngol Otol 1925;40:15-23.  Back to cited text no. 1
    
2.
Togay-Işikay C, Kim J, Betterman K, Andrews C, Meads D, Tesh P, et al. Carotid artery tortuosity, kinking, coiling: Stroke risk factor, marker, or curiosity? Acta Neurol Belg 2005;105: 68-72.  Back to cited text no. 2
    
3.
Desai B, Toole JF. Kinks, coils, and carotids: A review. Stroke 1975;6:649-53.  Back to cited text no. 3
[PUBMED]    
4.
Rosenthal RL, Grimsley BR. Images in clinical medicine. Kinked carotids. N Engl J Med 2010;362:448.  Back to cited text no. 4
[PUBMED]    
5.
Quattlebaum JK Jr, Wade JS, Whiddon CM. Stroke associated with elongation and kinking of the carotid artery: Long-term follow-up. Ann Surg 1973;177:572-9.  Back to cited text no. 5
[PUBMED]    
6.
Sanger PW, Robicsek F, Pritchard WL, Daughterty HK, Gallucci V. Cerebral ischemia caused by kinking of the carotid artery. N C Med J 1965;26:542-7.  Back to cited text no. 6
[PUBMED]    
7.
Ballotta E, Thiene G, Baracchini C, Ermani M, Militellio C, De Giau G, et al. Surgical vs medical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients: A prospective randomized clinical study. J Vasc Surg 2005;42:838-46.  Back to cited text no. 7
    


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