Multi-level isolated spinous process fractures with delayed deterioration observed radiographically: A case report

AbstractWe describe a rare case of multi-level isolated spinous process fractures not clearly detected on admission and subsequently diagnosed on radiography 2months after traumatic injury. Early recognition of a small crack in the spinous process and treatment with rest and immobilization is crucial to prevent chronic back pain or stiffness

Acute internal carotid artery occlusion after carotid endarterectomy

AbstractWe report two cases of acute carotid artery (CA) occlusion following carotid endarterectomy (CEA). Case 1: a 58-year-old man was admitted with transient right-sided hemiparesis. Magnetic resonance imaging (MRI) and MR angiography (MRA) revealed cerebral infarction in the left cerebral hemisphere and left CA stenosis. Ten days after admission, he underwent CEA. 24h after surgery, he developed right hemiplegia. MRI and MRA demonstrated a slightly enlarged infarction and left internal carotid artery (ICA) occlusion. Emergency reoperation was performed and complete recanalization achieved. The patient made a clinically significant recovery. Case 2: a 65year-old man underwent a right-sided CEA for an asymptomatic 80% CA stenosis. 48h after surgery, his family noticed he was slightly disorientated. MRI and MRA revealed multiple infarctions and right ICA occlusion. He was treated with antiplatelet therapy without reoperation because sufficient cross-flow from the left ICA through the anterior communicating artery was demonstrated by angiography, and his neurological symptoms were mild. His symptoms gradually alleviated and he was discharged 14days after surgery. With ICA occlusion after CEA, immediate re-operation is mandatory with severe neurological symptoms, whereas individualized judgement is needed when the symptoms are mild