Concurrent subarachnoid haemorrhage and internal carotid artery dissection: a transcranial colour-coded sonography diagnosis

• Published in: Journal of ultrasound Vol. 26; no. 4; pp. 771 - 776
• Main Authors: Parodi, Francesca, Severi, Ilaria, Flora, Giammarco, Cioni, Samuele, Vallone, Ignazio Maria, Betti, Veronica, Martini, Giuseppe, Tassi, Rossana
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2023; Springer Nature B.V
• Subjects: Abnormalities; Blood Flow Velocity; Carotid arteries; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal, Dissection - complications; Carotid Artery, Internal, Dissection - diagnostic imaging; Carotid Artery, Internal, Dissection - therapy; Color; Diagnosis; Female; Flow velocity; Hemorrhage; Humans; Medicine; Medicine & Public Health; Occlusion; Oxygenation; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - etiology; Subarachnoid Hemorrhage - therapy; Ultrasonic imaging; Ultrasonography, Doppler, Transcranial; Ultrasound; Veins & arteries; Ventricular assist devices; Transcranial colour-coded sonography; Non-pulsatile flow; Subarachnoid haemorrhage; Carotid artery dissection
• ISSN: 1876-7931; 1971-3495; 1876-7931
• DOI: 10.1007/s40477-022-00686-z

We report the case of a young woman affected by an aneurysmal subarachnoid haemorrhage (SAH) and numerous anatomic abnormalities. A Transcranial Colour-Coded Duplex Sonography, performed with the aim of monitoring the vasospasm, showed a non-pulsatile flow with loss of sharp systolic peak and lowering of mean flow velocities in the right extracranial Internal Carotid Artery (ICA) and all its intra-cranial branches. This event suggested a possible concomitant acute right ICA sub-occlusion with a lack of collateral circulation. This type of flow is typically found in systemic and brain arteries of patients undergoing to venous–arterial extracorporeal membrane oxygenation or to left ventricular assist devices. The absence of an adequate cerebral collateral circulation might be the explanation for this type of atypical flow. Aneurysms and arterial dissections contribute to SAH and ischemic stroke events, leading to long-term physical and cognitive disability. In our case, the prompt neurosonological diagnosis leaded to patient’s good outcome.