RESUMO
Dissection of the internal carotid artery (ICA) accounts for 5% to 25% of ischemic strokes in young adults. We report a case of spontaneous recanalization of a traumatic ICA dissection in which carotid duplex (CDU) and transcranial color-coded duplex ultrasound (TCCD) were used. A 47-year-old male presented with intermittent episodes of headache, blurry vision, anisocoria, and loss of taste sensation following a whiplash injury while body surfing. Magnetic resonance angiogram (MRA) of the neck revealed absent flow in the cavernous ICA and a clot at the skull base. Carotid duplex, used to further evaluate flow, demonstrated reverberating color Doppler and spectrum signal. A TCCD showed ICA occlusion and smaller-caliber intracranial ICA. The patient reported for follow-up after 1 month on anticoagulation therapy. Upon his return, CDU and TCCD were normal and the ICA showed normal color and spectrum signals. Computed tomography angiogram confirmed ultrasound findings of a dramatic improvement of ICA patency. Additionally, the patient reported that his headaches had resolved. Extracranial CDU and TCCD are useful for monitoring patient progress in cases of spontaneous recanalization following carotid artery dissection. These inexpensive and noninvasive imaging modalities proved to be critical in the initial and follow-up evaluations of the extracranial and intracranial vascular system, providing a strong alternative to expensive magnetic resonance imaging and invasive angiograms and offering more hemodynamic information than "static" MRA.
Assuntos
Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Transcraniana/métodos , Esportes Aquáticos/lesões , Traumatismos em Chicotada/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/fisiopatologia , Dissecação da Artéria Carótida Interna/tratamento farmacológico , Dissecação da Artéria Carótida Interna/etiologia , Dissecação da Artéria Carótida Interna/fisiopatologia , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Hemodinâmica , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Remissão Espontânea , Fatores de Tempo , Traumatismos em Chicotada/tratamento farmacológico , Traumatismos em Chicotada/etiologia , Traumatismos em Chicotada/fisiopatologiaRESUMO
Perspectives on academic and social aspects of children's school experiences were obtained from deaf and hearing children and their (deaf or hearing) parents. Possible differences between (1) the views of children and their parents and (2) those of hearing children and their parents compared to deaf children and their parents were of particular interest. Overall, parents gave their children higher school friendship ratings than the children gave themselves, and hearing children and their parents were more positive about children's friendships than were deaf children and their parents. Both children and parents also saw deaf children as less successful in reading than hearing children. However, deaf children's having deaf parents, attending a school for the deaf, and using sign language at home all were associated with more positive perceptions of social success. Use of cochlear implants was not associated with perceptions of greater academic or social success. These and related findings are discussed in the context of parent and child perspectives on social and academic functioning and particular challenges confronted by deaf children in regular school settings.