S5 supplementary file) with increased pulsatility in the residual http://www.selleckchem.com/products/chir-99021-ct99021-hcl.html flow (Fig. S6 supplementary file), or tapering stenosis (Fig. 5). During follow up, the regression of the hematoma will develop, and restitution of color coded filling of the arterial lumen will be visible (Fig. S9 supplementary file). Resolution of the hematoma is the most specific sign for CCAD [34] and [39]. Double lumen (Figure 6 and Figure 7), an irregular membrane

crossing the lumen, is usually found in arteries originating from the aortic arch, and multivessel involvement if present. If the dissection spreads to the subclavian artery, typical hemodynamic spectra in vertebral artery suggesting subclavian steal syndrome are found. In the real and false lumen different hemodynamic spectra are found (Figure 6 and Figure 7). Stenosis and/or occlusion

of an arterial segment not affected by atherosclerosis involve distal part of the ICA 2.0 cm or more downstream of the carotid bifurcation (Fig. click here S7 supplementary file) or V2–V4 segment of the vertebral artery. Increased or decreased pulsatility upstream or downstream of the suspected arterial lesion (Fig. S8 supplementary file) will suggest the presence of CCAD, as well as >50% difference in the BFV compared to the same segment of the artery on the unaffected side. If the hematoma compromises the flow, intracranial redistribution of hemodynamics will be detected by means of TCD or TCCD. It often shows diminished intracranial velocities in the ICA siphon and the MCA. Usually anterior collateral pathway is detected, and in most instances the posterior collateral pathway. Neurosonology enables noninvasive monitoring of the course of dissection, since resolution of the hematoma is the most specific finding. It enables also monitoring the microembolic signals (MES) in correlation with the clinical picture. Amelioration of the clinical finding is found in correlation with reduction of MES, and worsening of the clinical picture was found in patients with increase of the number of MES. Therefore neurosonology

offers the possibility of monitoring the therapeutic effect. Aneurysms of the extracranial internal carotid artery are extremely rare [40]. They are divided in two categories: true and pseudoaneurysm. In order to talk about true click here aneurysms, the diameter of the vessel expands at least 50% that is possible even with a tiny dilation of internal carotid artery. Most common etiological factor is atherosclerosis, and hypertension is frequently found. They are typically fusiform in shape although saccular aneurysms are also seen. Patients are usually younger if the underlying cause is not atherosclerosis, and the possible diagnoses are tuberculosis, HIV, or Takayasu arteritis. Salmonella and syphilis are the main causes of mycotic aneurysms. Fibromuscular dysplasia, collagen tissue disorders and irradiation are among the rare causes.