Title: Congenital Agenesis of the Unilateral Internal Carotid Artery Misdiagnosed as Occlusion or Stenosis on Time of Fight (TOF) MR Angiography & Importance of CT Scan Correlation which Make Difference in the Management Plan of Patient: A Case Report & Review of the Literature

Authors: Dr Rajendra Kumar Choudhary, Dr Rambir Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.66

Abstract

A 58-year-old-male presented with episodes of numbness left sided face, arm & leg for few seconds from last 2-3 months & few episodes of transient ischaemic attacks (TIA’s) in past. Physical examination showed high blood pressure (174/74). Case was misdiagnosed as occlusion or stenosis of internal carotid artry on magnetic resonance angiography utilizing the time-of-flight technique, but suspicion of ICA agenesis was raised by the absence of the typical flow void in the ICA region, on the spin-echo sequences (T2W). This finding was confirmed by magnetic resonance angiography of the cervical vessels, and axial computed tomography. CT scan showed agenesis of the left carotid canal. On magnetic resonance angiography of the cervical vessels, there was associated findings like hypoplastic right vertebral artery with accessory vertebral/collateral & complete occlusion or agenesis of right external carotid artery at its origin & atherosclerotic changes in right internal carotid artery.

Keywords: Internal carotid artery; Agenesis; Transient ischaemic attack; Misdiagnosed; Occlusion or stenosis.

References

  1. Midkiff RB, Boykin MW, McFarland DR, Bauman JA. Agenesis of the internal carotid artery with intercavernous anastomosis. AJNR Am J Neuroradiol 1995; 16: 1356–1359.
  2. Damry N, Hanquinet S, Christophe C, Janssen F, Delatte P, Perlmutter N. Bilateral congenital absence of the internal carotid artery with a primitive transmaxillary arterial anastomosis. Pediatr Radiol 1994; 24: 200–203.
  3. Turnbull I. Agenesis of the internal carotid artery. Neurology 1962; 12: 588–590.
  4. Lie TA. Congenital Anomalies of the Carotid Arteries. Amsterdam: Excerpta Medica Foundation; 1968:30–51.
  5. Verbiest H. Radiologic findings in a case with left the internal carotid artery agenesis & compression of several cranial nerve roots in the posterior fossa by basilar artery. Med Contemp 1954; 71;601-9.
  6. Florio F, Balzano S, Nardella M, et al. Congenital absence of the internal carotid artery. Cardiovasc Intervent Radiol 1999;22:74–78.
  7. Blustajn J, Netchine I, Frédy D, et al. Dysgenesis of the internal carotid artery associated with transsphenoidal encepha-locele: a neural crestsyndrome? AJNR Am J Neuroradiol. 1999;20: 1154–7.
  8. Quint DJ, Silbergleit R, Young WC. Absence of the carotid canals at skull base CT. Radiology. 1992;182:477–81.
  9. Tasar M, Yetiser S, Tasar A, et al. Congenital absence or hypoplasia of the carotid artery: radioclinical issues. Am J Otolaryngol. 2004; 25: 339–49.
  10. Rumboldt Z, Castillo M, Solander S. Bilateral congenital absence of the internal carotid artery. Eur Radiol. 2003; 13 Suppl 6:L130–2.
  11. Gailloud P, Clatterbuck RE, Fasel JHD, et al. Segmental agenesis of the internal carotid artery distal to the posterior communicating artery leading to the definition of a new embryologic segment. AJNR Am J Neuroradiol.2004;25:1189–93
  12. Cali RL, Berg R, Rama K. Bilateral internal carotid artery agenesis: a case study and review of the literature. Surgery. 1993; 113:227–33.
  13. Kidooka M, Okada T, Handa J. Agenesis of the internal carotid artery – report of a case combinedwith arachnoid cyst in a child. No To Shinkei. 1992; 44:371–5.
  14. Owada Y, Sakuta Y. Bilateral carotid artery agenesis with corpus callosum hypogenesis – a case report. No To Shinkei. 1995; 47:589–94.
  15. Okabe S, Oda N, Ishii M. Agenesis of left internal carotid artery associated with megadolicho-basilar anomaly and olivopontocerebellar atrophy. Rinsho Shinkeigaku. 1989; 29:1395–400.
  16. Moon WJ, Porto L, Lanfermann H, et al. Agenesis of internal carotid artery assoc-iated with con-genital anterior hypopitui-tarism. Neuroradiology.2002; 44:138–42.
  17. Baysefer A, Akay KM, Tasar M, et al. Congenital absence of internal carotid artery associated with hypogonadotropic hypogonadism – a case report. Vasc Endovascular Surg. 2002; 36:457–60.
  18. Smith RR, Kees CJ, Hogg ID. Agenesis of the internal carotid artery with an unusual primitive collateral: case report. J Neurosurg 1972; 37:460–462,
  19. Lie TA. Congenital anomalies of the carotid arteries. Amsterdom: Ecerpta Medica; 1968. p. 44-9.
  20. Neves WS, Kakudate MY, Cêntola CP, Garzon RG, Poça d’Água A, Sanches R. Ageness of internal carotid artery : a case report. Radiol Bras. 2008; 41(1):63–66.

Corresponding Author

Dr Rajendra Kumar Choudhary

Assistant Professor Dept of Radiodiagnosis

Dr S N Medical College Jodhpur Rajasthan