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

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.

Keywords

TIPIC syndrome / syndrome of transient idiopathic perivascular inflammation of the carotid artery / inflammation / carotid artery / neck pain

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

Funding

ФГБНУ «Научный центр неврологии»Research Center of Neurology

RIGHTS & PERMISSIONS

Eco-Vector