Ascending pharyngeal artery collateral circulation simulating internal carotid artery hypoplasia

Complete occlusion of the cervical segment of the internal carotid artery may result in a collateral circuit between an enlarged ascending pharyngeal artery and the intracranial segment of the internal carotid artery. This anastomosis may simulate a severely stenotic or hypoplastic internal carotid artery. Differentiation between these entities is particularly important if carotid endarterectomy for relief of stenosis is contemplated.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46658/1/234_2004_Article_BF00327693.pd

Orbital anastomoses of the anterior deep temporal artery

The anterior deep temporal artery may provide a major collateral pathway to the intracranial circulation through anastomoses with branches of the ophthalmic artery. Review of carotid angiograms in 26 patients with internal carotid artery occlusive disease revealed anterior deep temporal to ophthalmic artery anastomoses in 16 cases. This route of collateral blood flow was associated in most instances with total occlusion of the cervical portion of the internal carotid artery. Three cases demonstrating the angiographic anatomy of the anterior deep temporal artery and its potential anastomoses with branches of the ophthalmic artery are presented. L'artère temporale profonde antérieure peut être à l'origine de circulation colatérale grâce à ses anastomoses avec l'artère ophtalmique. Une telle anastomose a été constatée 16 fois sur 26 cas de thrombose de l'artère carotide interne. Über die A. temporalis anterior ist über Anastomosen zu den Ästen der A. ophthalmica ein Kollateral-Kreislauf zu den intracraniellen Gefäßabschnitten möglich. Bei 26 Patienten mit einem A. carotis interna-Verschluß zeigte sich dieser Kreislauf in 16 Fällen. Es wird über 3 Fälle ausführlich berichtet, bei denen die angiographische Anatomie der A. temporalis anterior und die möglichen Anastomosen mit Ästen der A. ophthalmica besprochen wird.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46672/1/234_2004_Article_BF00335020.pd

Evaluation of Intereye Corneal Asymmetry in Patients with Keratoconus. A Scheimpflug Imaging Study

Purpose: To assess the correlation between keratoconus severity and intereye asymmetry of pachymetric data and posterior elevation values and to evaluate their combined accuracy in discriminating normal corneas from those with keratoconus. Methods: This study included 97 patients: 65 subjects with bilateral normal corneas (NC) and 32 with keratoconus (KC). Central corneal thickness (CCT), thinnest corneal thickness (ThCT) and posterior elevation (PE) at the thinnest point of the cornea were measured in both eyes using Scheimpflug imaging. Intereye asymmetry and its correlation with keratoconus severity were calculated for each variable. The area under the receiver operating characteristic curve (AUROC) was used to compare predictive accuracy of different variables for keratoconus. Results: In normal eyes, intereye differences were significantly lower compared with the keratoconus eyes (p<0.001, for CCT, ThCT and PE). There was a significant exponential correlation between disease severity and intereye asymmetry of steep keratometry (r(2) = 0.55, p<0.001), CCT (r(2) = 0.39, p<0.001), ThCT (r(2) = 0.48, p<0.001) and PE (r(2) = 0.64, p<0.001). After adjustment for keratoconus severity, asymmetry in thinnest pachymetry proved to be the best parameter to characterize intereye corneal asymmetry in keratoconus. This variable had high accuracy and significantly better discriminating ability (AUROC: 0.99) for KC than posterior elevation (AUROC: 0.96), ThCT (AUROC: 0.94) or CCT (AUROC: 0.92) alone. Conclusions: There is an increased intereye asymmetry in keratometry, pachymetry and posterior corneal elevation values in keratoconic patients compared to subjects with normal corneas. Keratoconus patients with more severe disease are also more asymmetric in their disease status which should be taken into account during clinical care

Temporal comparative analysis of computed tomography with ultrasound for intracranial hemorrhage in premature infants

This study focuses on comparison of computed tomography and ultrasound in premature infants with intracranial hemorrhage and its complications. It was determined that close correlation (95%) exists between CT and ultrasound for evaluation of ventriculomegaly. Although there is reasonable correlation for the identification and localization of periventricular, intraventricular and choroidal hemorrhages, ultrasound defined such lesions at higher rates. Subarachnoid blood and periventricular edema were diagnosed better or exclusively by CT

Enhancement and demyelination of the intraorbital optic nerve. Fat suppression magnetic resonance imaging

Conventional spin-echo magnetic resonance imaging (MRI) of intraorbital optic neuritis is hampered by the adjacent high signal and chemical shift artifact of orbital fat. Frequency-selective saturation pulse MRI reduces these problems and was used to determine its utility in evaluation of intraorbital optic neuritis. Eight consecutive patients with optic neuritis underwent MRI within 1 week of the onset of visual loss. Conventional MRI with T1, proton density, and T2 weighting and frequency-selective saturation pulse MRI with T1, proton density, and T2 weighting were performed. After administration of intravenous gadopentetate dimeglumine, T1-weighted conventional and frequency-selective saturation pulse MRI were performed. Frequency-selective saturation pulse MRI showed gadopentetate dimeglumine enhancement in the intraorbital optic nerve in 7 patients and the intracranial optic nerve in 3 patients. Conventional MRI failed to show optic nerve gadopentetate dimeglumine enhancement in patients with intraorbital lesions, but did show intracranial lesions. Frequency-selective saturation pulse MRI showed bilateral optic nerve enhancement in 3 patients with unilateral visual signs and symptoms. Proton density and T2-weighted conventional MRI of the brain showed no convincing signal aberrations in the optic nerves. In the MRI evaluation of intraorbital optic neuritis: (1) frequency-selective saturation pulse fat suppression MRI is superior to T1-weighted conventional MRI in the detection of gadopentetate dimeglumine enhancement; (2) frequency-selective saturation pulse proton density and T2-weighted MRI is superior to proton density and T2-weighted conventional MRI; (3) frequency-selective saturation pulse MRI showed gadopentetate dimeglumine enhancement as well as proton density/T2-weighted signal aberration in exactly the same portion of the intraorbital optic nerve

Intra-arterial chemotherapy for bilateral retinoblastoma via left ophthalmic artery and right anterior deep temporal artery

A 12-month-old boy with a history of bilateral retinoblastoma refractory to systemic chemotherapy, laser therapy and cryotherapy, with excellent response to previous intra-arterial melphalan infusion, presents with active tumour deposits in the right eye. Repeat intra-arterial chemotherapy was recommended. Previous bilateral melphalan infusion was uneventful using flow-guided catheterisation technique. Direct catheterisation of the right ophthalmic artery was unsuccessful despite employment of several flow-guided and over-the-wire catheters. Superselective catheterisation of the ipsilateral middle meningeal artery was unable to identify an anastomotic connection to the ophthalmic artery; however, angiography of the anterior deep temporal artery identified an alternate route for chemotherapy infusion. The anterior deep temporal artery was successfully and safely catheterised to infuse chemotherapy into the ophthalmic artery. The anterior deep temporal artery is an important potential anastomotic connection to the ophthalmic artery that can be used safely and effectively for central retinal artery chemotherapy infusion for retinoblastoma treatment