Carotid Narrowing

Carotid narrowing tied to memory, thinking decline
By AuntMinnie.com staff writers

April 22, 2014 -- The narrowing of the carotid artery may be linked to problems in learning, memory, thinking, and decision-making, according to research to be presented at this week's American Academy of Neurology annual meeting in Philadelphia.

A team of researchers led by Dr. Brajesh Lal of the University of Maryland found a higher risk of symptoms in patients with narrowing of the carotid artery than in patients with similar risk factors but no carotid artery narrowing.

The team studied 67 people with asymptomatic carotid stenosis (ACS) and a 50% reduction in the diameter of the artery, as well as 60 people with vascular risk factors but without ACS. The risk factors included diabetes, high blood pressure, high blood cholesterol, and coronary artery disease, according to the team.

All study participants received extensive testing for overall thinking abilities and specific aspects of thinking, such as processing speed, learning, memory, decision-making, and language. The group of patients with ACS performed significantly worse on the overall memory and thinking tests, including tests for motor and processing speed, as well as learning and memory, according to the researchers. They did not find a difference in language scores between the two groups.

If these findings are confirmed in larger studies, they hold significant implications for new treatment targets and open the door for more questions, such as whether these patients should be treated more aggressively with medications, cognitive rehabilitation, or even surgery to open up the artery, Lal said in a statement. He anticipates a large number of follow-up studies to search for causes and the best treatment option for this newly identified morbidity associated with carotid narrowing, he added.

MEDULLARY THYROID CARCINOMA (MTC) with REMARKABLE CALCIFICATIONS

Various patterns of calcifications may be seen in thyroid cancers  on ultrasonography  (USG)  of thyroid. Coarse calcifications seen in medullary thyroid carcinoma (MTC) are generally associated with posterior shadowing  on thyroid ultrasound.

 We briefly report this case  of MTC with an emphasis on its radiological features.

A  45-year-old  post-menopausal  female presented with  a goiter  (8  cm  ×  7  cm)  of  ten years duration. History was uneventful otherwise. Thyroid function tests were: free T3-2.20 pg/ml  (ref.  range: 1.71-  3.71), free T4-1.18  ng/100ml (ref. range: 0.7-1.48) and TSH-1.42 µIU/ml (ref. range: 0.35-4.94)  respectively. Subsequently,  thyroid  ultrasound revealed prominent  calcifications and increasedvascularity  (Figure 1), (Figure 2).

Computed Tomography (CT) scan  of neck showed large (80 mm × 78 mm) well defined, calcified mass lesion in the left lobe of the thyroid (Figure  3).  Fine  needle aspiration biopsy  (FNAB) confirmed evidence of MTC. A highly elevated calcitonin (20,000  pg/ml) (ref. range: < 5 pg/ml) was consistent with the diagnosis of  MTC.

MTC  may be associated with dense, irregular foci  of calcifications which  are in contrast with  homogeneous calcifications of other thyroid  tumors.  MTC,  first described by Hazard et al. in 1959, has become the focus of increasing clinical and experimental investigations.

However,  in thyroid carcinomas,  ultrasonographic evidence of an  abundance of calcifications may be  rarely seen nowadays due to improved health awareness and earlier diagnosis. To conclude, in an asymptomatic patient with long  standing goiter, coarse macrocalcifications in imaging findings should make the physician vigilant in ruling out MTC.