Transient idiopathic perivascular inflammation of the carotid artery syndrome (TIPIC syndrome) is a rare variant of non-atherosclerotic arteriopathy

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Abstract

BACKGROUND: Transient Idiopathic Perivascular Inflammation of the Carotid artery (TIPIC) or carotidynia is a clinical and radiological syndrome manifested as ipsilateral neck pain and an ipsilateral perivascular infiltrate according to ultrasound and magnetic resonance imaging. Due to the low awareness of physicians, this pathology is often mistakenly regarded as dissection or atherosclerosis of the carotid arteries, which leads to additional unnecessary diagnosis and treatment.

CLINICAL CASE DESCRIPTION: Here, we present a case of idiopathic carotidynia with a discussion of the diagnostic algorithm and management of patients with unilateral neck pain.

CONCLUSION: Timely and competently interpreted ultrasound and magnetic resonance imaging studies of arteries is a key link in the diagnosis of carotidynia. The complete regression of symptoms and pathological changes in the arteries without a specific therapy classifies it as a benign variant of non-atherosclerotic arteriopathy.

About the authors

Anastasia V. Belopasova

Research Center of Neurology, Moscow

Author for correspondence.
Email: belopasova@neurology.ru
ORCID iD: 0000-0003-3124-2443
SPIN-code: 3149-3053

MD, PhD

Russian Federation, Moscow

Polina S. Miglyachenko

Lomonosov Moscow State University

Email: miglyachencko.polina@yandex.ru
ORCID iD: 0009-0005-8751-9327
Russian Federation, Moscow

Andrey O. Chechetkin

Research Center of Neurology, Moscow

Email: chechetkin@neurology.ru
ORCID iD: 0000-0002-8726-8928
SPIN-code: 9394-6995

MD, PhD

Russian Federation, Moscow

Marina V. Dreval

Research Center of Neurology, Moscow

Email: dreval.mv@neurology.ru
ORCID iD: 0000-0002-7554-9052
SPIN-code: 2221-9226

MD, PhD

Russian Federation, Moscow

Larisa A. Dobrynina

Research Center of Neurology, Moscow

Email: dobrynina@neurology.ru
ORCID iD: 0000-0001-9929-2725
SPIN-code: 2824-8750

MD, PhD

Russian Federation, Moscow

References

  1. Caplan LR, Biller J. Non-atherosclerotic vasculopathies. In: Caplan L.R., ed. Caplan’s stroke: a clinical approach. Cambridge University Press; 2016. Р. 386–438.
  2. Agarwal A, Bathla G, Kanekar S. Imaging of Non-atherosclerotic Vasculopathies. J Clin Imaging Sci. 2020;10:62. doi: 10.25259/JCIS_91_2020
  3. Simma B, Martin G, Müller T, Huemer M. Risk factors for pediatric stroke: Consequences for therapy and quality of life. Pediatr Neurol. 2007;37(2):121–126. doi: 10.1016/j.pediatrneurol.2007.04.005
  4. Fay T. Atypical neuralgia. Arch Neurol Psychiatry. 1927;18:309–315.
  5. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia. 1988;8 Suppl 7:1-96. PMID: 3048700.
  6. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(Suppl 1):9–160. doi: 10.1111/j.1468-2982.2003.00824.x
  7. Lecler A, Obadia M, Savatovsky J, et al. TIPIC syndrome: Beyond the myth of carotidynia, a new distinct unclassified entity. AJNR Am J Neuroradiol. 2017;38(7):1391–1398. doi: 10.3174/ajnr.A5214
  8. Lecler A, Obadia M, Sadik JC. Introduction of the TIPIC syndrome in the next ICHD classification. Cephalalgia. 2019;39(1):164–165. doi: 10.1177/0333102418780485
  9. Hayashi S, Maruoka S, Takahashi N, Hashimoto S. Carotidynia after anticancer chemotherapy. Singapore Med J. 2014;55(9):e142–144. doi: 10.11622/smedj.2014127
  10. Corral de la Fuente E, Barquín Garcia A, Saavedra Serrano C, et al. Myocarditis and carotidynia caused by Granulocyte-Colony stimulating factor administration. Mod Rheumatol Case Rep. 2020;4(2):318–323. doi: 10.1080/24725625.2020.1754552
  11. Jabre MG, Shahidi GA, Bejjani BP. Probable fluoxetine-induced carotidynia. Lancet. 2009;374(9695):1061–1062. doi: 10.1016/S0140-6736(09)61694-9
  12. Venetis E, Konopnicki D, Jissendi Tchofo P. Multimodal imaging features of transient perivascular inflammation of the carotid artery (TIPIC) syndrome in a patient with Covid-19. Radiol Case Rep. 2022;17(3):902–906. doi: 10.1016/j.radcr.2021.12.005
  13. Upton PD, Smith JG, Charnock DR. Histologic confirmation of carotidynia. Otolaryngol Head Neck Surg. 2003;129(4):443–444. doi: 10.1016/S0194-59980300611-9
  14. Калашникова Л.А., Добрынина Л.А. Диссекция артерий головного мозга: ишемический инсульт и другие клинические проявления. Москва, 2013. 208 с. [Kalashnikova LA, Dobrynina LA. Cervical artery dissection: Ischemic stroke and other clinical manifestations. Moscow; 2013. 208 p. (In Russ).]
  15. Stanbro M, Gray BH, Kellicut DC. Carotidynia: Revisiting an unfamiliar entity. Ann Vasc Surg. 2011;25(8):1144–1153. doi: 10.1016/j.avsg.2011.06.006
  16. Taniguchi Y, Horino T, Hashimoto K. Is carotidynia syndrome a subset of vasculitis? J Rheumatol. 2008;35(9):1901–1902.
  17. Taniguchi Y, Horino T, Terada Y, Jinnouchi Y. The activity of carotidynia syndrome is correlated with the soluble intracellular adhesion molecule-1 (sICAM-1) level. South Med J. 2010;103(3):277–278. doi: 10.1097/SMJ.0b013e3181cf39e2
  18. Abrahamy M, Werner M, Gottlieb P, Strauss S. Ultrasound for the diagnosis of carotidynia. J Ultrasound Med. 2017;36(12): 2605–2609. doi: 10.1002/jum.14321
  19. Ulus S, Aksoy Ozcan U, Arslan A, et al. Imaging spectrum of TIPIC syndrome. Clin Neuroradiol. 2018;18(Suppl 7):1–13. doi: 10.1007/s00062-018-0746-5
  20. Amaravadi RR, Behr SC, Kousoubris PD, Raja S. [18F] Fluorodeoxyglucose positron-emission tomography-CT imaging of carotidynia. AJNR Am J Neuroradiol. 2008;29(6):1197–1199. doi: 10.3174/ajnr.A1013
  21. Comacchio F, Bottin R, Brescia G, et al. Carotidynia: new aspects of a controversial entity. Acta Otorhinolaryngol Ital. 2012;32:266.
  22. Mathangasinghe Y, Karunarathne RU, Liyanage UA. Transient perivascular inflammation of the carotid artery; a rare cause of intense neck pain. BJR Case Rep. 2019;5(4):20190014. doi: 10.1259/bjrcr.20190014
  23. Sato S, Yazawa Y, Itabashi R, et al. [A case of carotidynia with carotid sinus hypersensitivity. (In Japan)]. Rinsho Shinkeigaku. 2010;50(10):714–717. doi: 10.5692/clinicalneurol.50.714
  24. Schaumberg J, Michels P, Eckert B, Röther J. [Recurrence of carotodynia or TIPIC syndrome. (In German)]. Nervenarzt. 2018;89(12):1403–1407. doi: 10.1007/s00115-018-0531-3

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2. Fig. 1. Results of magnetic resonance imaging of the neck of a patient with TIPIC syndrome in the acute period: а, в (3D-TOF-angiography) — local haemodynamically insignificant narrowing of the left common carotid artery lumen (white arrows); б, г (T2 fat-sat), д (T2), е (T1 fat-sat) — perivascular, eccentrically located zone of altered signal at the level of the left common carotid artery bifurcation (perivascular infiltrate is indicated by white arrows, red contour).

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3. Fig. 2. Results of magnetic resonance imaging of the neck of a patient with TIPIC syndrome in dynamics: acute period (а, б) and the control study after 2.5 weeks (в, г). The perivascular infiltrate zone is decreased, the arterial lumen is increased; the external contour of the artery has become clearer.

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4. Fig. 3. Magnetic resonance images of the neck of a patient with TIPIC syndrome: in the acute period (а, б) and control study after 2.5 weeks (г, д). The use of contrast enhancement in magnetic resonance imaging allows one to visualize the zone of perivascular inflammation (д) more clearly in comparison with the native study (б). The dynamic study shows a decrease in the perivascular infiltrate zone and an increase in the arterial lumen (в, е).

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5. Fig. 4. Ultrasound examination of the carotid arteries of a patient with TIPIC-syndrome in dynamics: а (longitudinal scan in the acute period of neck pain dated 21.01.2023): a hypo-/medium echogenic mass (the sizes are indicated by markers 1 and 2) with a smooth surface, 4 mm thick, resulting in ECST* stenosis of 40–45% is visualised along the anterior wall in the distal part and bifurcation of the common carotid artery and the mouth of the internal carotid artery. The blurring of the adventitia contour in the area of the detected mass (arrows in yellow colour) draws attention; б (longitudinal), в (transverse) scans (dated 15.02.2023): a homogeneous, medium echogenicity mass (white arrows) with a flat surface was detected along the anterior wall in the distal part and bifurcation of the common carotid artery, 2 mm thick (ECST stenosis about 20–25%); the adventitia contour was clear, no signs of perivascular tissue swelling near the detected mass were noted. * ECST criterion — European Carotid Surgery Trial.

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6. Fig. 5. Carotid artery adventitia: lymphocytic infiltrate in soft tissues, mast cells and rare polymorphonuclear leukocytes.

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