Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms.
OBJECTIVE
To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA), with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome.


METHODS
There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5%) of which 20 (50%) were giant aneurysms. Among those cases, 5 patients evolved with STICA (25%). Symptoms and findings at presentation were recorded and compared with those at outcome.


RESULTS
Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80%), diabetes mellitus (40%) and dislipidemy (40%). All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA.


CONCLUSIONS
STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.
Vasconcellos
Lucas Perez de
LP
Santa Casa Medical School of São Paulo, SP, Brazil. lucas.vasconcellos@terra.com.br
Flores
Juan Antônio Castro
JA
Conti
Mário Luiz Marques
ML
Veiga
José Carlos Esteves
JC
Lancellotti
Carmen Lúcia Penteado
CL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002341:Carotid Artery Thrombosis / Q000209:etiology*; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult