Accepted: 11 July 2023 DOI: 10.1111/eve.13867_1
C A S E R E POR T
Neurologic deficits and surgical treatment in a horse affected with internal carotid artery tortuous elongation
Astrid B. M. Rijkenhuizen 1 | Franziska Kaske 2 | Johanna Rikart 2 | Julien Racine 2 | Claudia Engerand 2
1 European Equine Surgeon Consultant , Wijk bij Duurstede , the Netherlands 2 Pferdeklinik Leichlingen , Leichlingen , Germany
Correspondence : Astrid B.M. Rijkenhuizen Email:
a.rijkenhuizen@gmail.com
SUMMARY
A 2- year- old Warmblood gelding was presented with a history of bilateral feed material coming from the nostrils secondary to dysphagia, coughing and impairment of physical develop- ment, since purchase at 6 months of age. Endoscopy of the right guttural pouch was unremarkable, however, in the left guttural pouch, a distended (aneurysm), pulsating, tortuous elongated internal carotid artery (ICA) (Figure 1) was ob- served. Computed tomography revealed that in the dorsal aspect of the medial compartment of the left guttural pouch adjacent to the jugular foramen, the ICA turned anti- clockwise creating a small loop of 1 cm diameter. This loop had a faint linear, soft tissue attenuating connection to the caudodorsal wall of the guttural pouch and was slightly larger in diameter
medial Key points Stylohyoid ICA
• Distension of the ICA artery (aneurysm) as well as tor- tuous elongation might cause neurologic deficits due to compressive cranial nerve palsy because of the close topographical relationship between the cranial nerves and the ICA. In case of dysphagia and regurgitation, this diagnosis may be considered.
FIGURE 1 Endoscopic view of the left guttural pouch with a distended (aneurysm), coiling ICA. Yellow arrows point towards the neurovascular plica.
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• Embolisation of affected abnormal ICA is a valid thera- peutic option when nerve compression is suspected. • Nerve recovery may be difficult to predict.
compared to the right ICA. A malformation of the left ICA was diagnosed, most likely congenital. A secondary compression and neuropathy of one or multiple nerves of the associated lower cranial nerves in the neurovascular plica (IX, X) was sus- pected explaining the clinical signs of dysphagia. The slightly larger diameter of the left ICA could represent congestion of the vessel or an early aneurysm formation. Based on these findings, endovascular balloon occlusion (nondetachable bal- loon) of the left ICA was performed to relieve the compres- sion on the affected nerves. The occlusion of the ICA resolved the clinical signs within 7 weeks after surgery.
K E YWORDS aneurysm , dysphagia , equine , internal carotid artery , occlusion
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Equine Vet Educ. 2024;36:10.
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