Mirror aneurysms of extracranial internal carotid arteries in a patient with beta-thalassemia major
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EVIDENCE- AND EXPERIENCED-BASED NEUROLOGY ARTICLE
Mirror aneurysms of extracranial internal carotid arteries in a patient with beta‑thalassemia major Onur Taydas1 · Fadime Guven2 · Hayri Ogul2,3 · Yasemin Ogul4 Received: 2 March 2020 / Accepted: 12 May 2020 © Belgian Neurological Society 2020
Abstract Beta-thalassemia major is a chronic disorder characterised by severe anemia. This patient with beta-thalassemia major is the first magnetic resonance (MR) angiographic case for symmetric mirror aneurysms of the extracranial internal carotid arteries. For diagnosis of vascular complications requires angiographic procedures such as catheter angiography, computed tomography angiography, MR angiography, or Doppler ultrasonography. Time-of-flight MR angiography is a non-invasive useful technique in diagnosis of the aneurysmatic patients. Keywords Beta-thalassemia major · Internal carotid artery · Mirror aneurysm · MR angiography
Introduction Beta-thalassemia major is a condition characterized by severe chronic anemia. This inherited disorder results in damage to the synthesis of beta-hemoglobin chains and require lifelong regular blood transfusions for the patients. Endothelial damage and arterial stiffness are considered to be associated with this chronic hemolytic anemia [1–3]. An extracranial internal carotid artery aneurysm is a rarely encountered vascular pathology accounting for less than 1% of all peripheral artery aneurysms. Unless diagnosed and treated, it can significantly affect patients’ quality of life and even result in death. It develops most often due to atherosclerosis and has potentially fatal complications, such as thromboembolism, rupture, and local compression. Other etiological factors include previous carotid endarterectomy, trauma, dissection, radiotherapy, fibromuscular dysplasia, * Hayri Ogul [email protected] 1
Department of Radiology, Medical Faculty, Sakarya University, Sakarya, Turkey
2
Department of Radiology, Medical Faculty, Ataturk University, Kazım Karabekir Mah. Terminal Cad. Site Polat Apt. B Blok, Kat 1, No 2, Erzurum, Turkey
3
Anesthesiology, Clinical Research Office, Ataturk University, Erzurum, Turkey
4
Department of Biochemistry, Erzurum Training and Research Hospital, Erzurum, Turkey
and connective tissue diseases and infections. The most common location of extracranial carotid artery aneurysms is the main carotid artery, followed by the internal carotid artery [4]. A few cases of an association between moyamoya disease and beta-thalassemia major have been previously reported [5, 6]. However, the mirror aneurysm of the internal carotid artery associated with beta-thalassemia major has not yet been described in publications written in English. To the best of our knowledge, this is the first report of this unusual condition. Our aim in this study was to raise clinicians’ awareness of a possible relationship between the two conditions by showing mirror aneurysms, which are already very rare entities, in a patient with beta-thalassemia.
Case presentation A 36-y
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