The relationship between bone health and type of intracranial internal carotid calcifications in patients with ischemic stroke.

INTRODUCTION: Vascular calcifications, primarily in the aorta and its proximal branches, are commonly observed among subjects with impaired bone health. In this study, we sought to determine if a comparable association holds true for the calcifications in the intracranial internal carotid arteries (IICA), in general and also for particular calcification patterns. METHODS: A consecutive series of ischemic stroke patients were prospectively enrolled into the study, where computed tomography angiography source images were used to determine the presence and type of IICA calcifications, and dual-energy X-ray absorptiometry was used to determine the bone mineral density in the left femoral neck region. IICA calcifications were categorized as none, intimal, medial, and mixed types based on previously validated classification schemes. Their relationships with femoral bone T-scores were evaluated by bivariate and multivariate analyses. RESULTS: Femoral neck T-score was highest among patients without any vascular calcifications (n=65), when compared to the bone density measures among patients with any type of calcification (n=185) (p<0.001). After adjustment for age, gender, vascular risk factors, and serum biomarkers related to bone health, the T-score remained significantly associated only with the pattern of intimal calcification [OR 0.63 (0.42 - 0.95), p=0.028]. CONCLUSIONS: Our findings suggest that the intracranial vasculature, in particular the internal carotid arteries, is not immune to the interplay between suboptimal bone health and vascular calcifications. This association was most robust for an intimal type of IICA calcification pattern, while no such relationship could be demonstrated for other types of vascular calcifications.

Hemangioma fusocelular en las fosas nasales y los senos etmoidales en un lactante de 4 meses de edad / Spindle cell hemangioma of nasal passage and ethmoidal sinus in a 4-month old infant

El hemangioma fusocelular es una neoplasia vascular benigna infrecuente. Afecta la dermis y la hipodermis de la parte distal de las extremidades; la afectación de la cabeza y el cuello es muy poco frecuente y nunca se informó compromiso de los senos paranasales. Este es el caso de un lactante de 4 meses con obstrucción nasal desde las 2 semanas debido a un tumor en los senos etmoidales que obstruía las fosas nasales. Se diagnosticó hemangioma fusocelular y se extirpó parcialmente el tumor. A los seis meses de seguimiento, se observó una regresión mínima con lesiones residuales. A los 30 meses, se observó que el tumor residual había desaparecido. El hemangioma fusocelular es infrecuente en cabeza y cuello y, a veces, la presentación no es indicativa del diagnóstico. El examen histopatológico ayuda con el diagnóstico diferencial y el tratamiento. La sensibilización sobre el hemangioma fusocelular podría aumentar los casos informados.

Spindle cell hemangioma (SCH) is a benign unusual vascular neoplasm. It does not have gender predilection and can occur at all ages. The disease affects dermis and subcutis of distal extremities predominantly; head and neck involvement is very rare, paranasal sinus involvement has not been reported before. Herein we present a 4-month-old infant with nasal obstruction since two weeks of age due to a mass in ethmoid sinus obliterating the nasal passage. After the histopathological diagnosis of SCH, the tumor was partially resected. In the sixth month follow-up, there was minimal regression of residual lesions. In the imaging studies performed 30 months after the surgery, the residual mass was found to be disappeared. SCH is not frequent in the head and neck, and presentation of some patients may not suggest the diagnosis. Histopathology is important for differential diagnosis and to orientate treatment. Awareness of SCH may increase the reported cases