Presentation
Suspected acute ischemic stroke (stroke code). NECT and CECT revealed a left thalamic infarction without other findings.
Patient Data
Bilateral internal carotid loops reaching the retropharyngeal space.
Their abnormal proximity to pharyngeal mucosa (submucous location) could be life-threatening if otorhinolaryngologists or anesthesiologists damage the ICA while performing surgeries or other procedures in the oral cavity or oropharynx.
Note the widening of the retropharyngeal space due to bilateral internal carotid loops (red arrows).
Case Discussion
A wide range of ICA abnormalities from 10 to 56%, has been reported based on literature:
Older people: in relation with arteriosclerotic pathology or fibromuscular dysplasia.
Children: carotid abnormalities explained as congenital etiology are rarely reported.
The retropharyngeal location of the ICA as well as tortuosity, kinking and coiling are some of these anomalies. These anomalies may result from the embryological development as well as secondary to atherosclerotic changes.
ICA anomalies may be life threatening if, while performing neck surgeries, surgeons damage the retropharyngeal ICA causing an acute hemorrhage.