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3. Antic B, Roganovic Z, Tadic R, Ilic S. Chondroma of the cervical spinal canal. Case report. J Neurosurg Sci 1992;36:239-41. Central retinal artery occlusion 4. Baber WW, Numaguchi Y, Kenning JA, Harkin JC. Periosteal chondroma of the cervical spine: One more cause of neural foramen enlargement. with ophthalmoparesis in Surg Neurol 1988;29:149-52. 5. Calderone A, Naimark A, Schiller AL. Case report 196: Juxtacortical spontaneous carotid artery chondroma of C2. Skeletal Radiol 1982;8:160-3. 6. Lozes G, Fawaz A, Perper H, Devos P, Benoit P, Krivosic I, dissection et al. Chondroma of the cervical spine. Case report. J Neurosurg 1987;66:128-30. 7. Maiuri F, Corriero G, De Chiara A, Giamundo A, Benvenuti D, Sir, Gangemi M. Chondroma of the cervical spine: A case report. Acta Neurol Spontaneous carotid arterial dissection is a nontraumatic (Napoli) 1980;2:204-8. tear or disruption in the wall of the internal carotid artery 8. Palaoglu S, Akkas O, Sav A. Chondroma of the cervical spine. Clin Neurol Neurosurg 1988;90:253-5. (ICA) without a clear etiology. It represents a major cause 9. Shurland AT, Flynn JM, Heller GD, Golden JA. Tumor of the cervical of in younger patients, comprising about 10–25% spine in an 11-year-old girl [clinical]. Clin Orthop Relat Res 1999:287- of ischemic cerebral events. Patients can present with a 90, 293-5. range of symptoms from being completely asymptomatic 10. Slowik T, Bittner-Manioka M, Grochowski W. Case reports and technical notes. Chondroma of the cervical spine. Case report. J Neurosurg to having facial/neck pain, headaches, Horner’s syndrome, 1968;29:276-9. , or transient ischemic attacks (TIAs) and 11. Willis BK, Heilbrun MP. Enchondroma of the cervical spine. stroke. Isolated central retinal artery occlusion (CRAO) as Neurosurgery 1986;19:437-40. a presenting manifestation of spontaneous carotid artery 12. Wani AA, Zargar JI, Ramzan AU, Malik NK, Lone I, Wani M. Isolated enchondroma of atlas. Turk Neurosurg 2011;21:226-9. dissection is rare. Here, we report a middle-aged male patient 13. Russo V, Platania N, Graziano F, Albanese V. Cervical spine chondroma who presented with acute spontaneous right carotid artery arising from C5 right hemilamina: A rare cause of spinal cord dissection with monocular visual loss of the right eye due compression. Case report and review of the literature. J Neurosurg Sci to CRAO. 2010;54:113-7. 14. Morard M, De Tribolet N, Janzer RC. Chondromas of the spine: Report of two cases and review of the literature. Br J Neurosurg A 45-year-old male patient presented with a history of acute 1993;7:551-6. loss of vision in the right eye in a single day. There was 15. Abeloos L, Maris C, Salmon I, Baleriaux D, Sadeghi N, Lefranc F. preceding history of severe, throbbing pain on the right Chondroma of the dural convexity: A case report and literature review. Neuropathology 2012;32:306-10. side of the neck radiating to the right hemicranial region 16. Ghogawala Z, Moore M, Strand R, Kupsky WJ, Scott RM. Clival associated with two episodes of vomiting. A day prior to the chondroma in a child with Ollier's disease. Case report. Pediatr onset of , he had similar symptoms lasting Neurosurg 1991;17:53-6. for a few seconds that improved with eye massage. There 17. Traflet RF, Babaria AR, Barolat G, Doan HT, Gonzalez C, Mishkin MM. Intracranial chondroma in a patient with Ollier's disease. Case report. J was no history of head or neck trauma. He was conscious and Neurosurg 1989;70:274-6. had severe pain with tenderness in the right lateral aspect 18. Staals EL, Bacchini P, Mercuri M, Bertoni F. Dedifferentiated of the neck. There was no perception of light and a relative chondrosarcomas arising in preexisting osteochondromas. J Bone Joint afferent pupillary defect (RAPD) in the right eye. The right Surg Am 2007;89:987-93. 19. Choi BB, Jee WH, Sunwoo HJ, Cho JH, Kim JY, Chun KA, et al. MR was dilated with an absent direct and consensual light differentiation of low-grade chondrosarcoma from enchondroma. Clin reflex in the right eye. The fundus examination revealed Imaging 2013;37:542-7. opacification of the right , attenuated retinal arteries, 20. Turel MK, Rajshekhar V. Primary spinal extra-osseous intradural ‘boxcar’ appearance of retinal arteries, and disc edema mesenchymal chondrosarcoma in a young boy. J Pediatr Neurosci 2013;8:111-2. [Figure 1]. There was mild , chemosis, and restriction 21. Habrand JL, Schneider R, Alapetite C, Feuvret L, Petras S, Datchary J, of right eye abduction and elevation. Magnetic resonance et al. Proton therapy in pediatric skull base and cervical canal low-grade angiography (MRA) of neck vessels and circle of Willis bone malignancies. Int J Radiat Oncol Biol Phys 2008;71:672-5. showed smooth tapering of the right ICA (flame sign) soon after the bifurcation of common carotid artery with a thin stream of blood flow distally (string sign). There was filling of Access this article online the right middle cerebral artery (MCA) from the left anterior Website: Quick Response Code www.neurologyindia.com cerebral artery (ACA) and ICA via the anterior communicating artery [Figures 2 and 3]. Fluid-attenuated inversion recovery DOI: (FLAIR) image showed hyperintensity in right ACA/MCA 10.4103/0028-3886.152682 border zone, with restriction on diffusion-weighted imaging PMID: (DWI) [Figure 4]. The complete hemogram, renal, hepatic, xxxxx and thyroid function tests were normal. The lipid profile

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a b c Figure 1: Fundus examination of the right eye (a and b) shows opacification of retina, boxcar appearance of retinal arteries, and disc edema. (c) Fundus examination of the left eye shows normal disc, retinal arteries, and glow

a b c Figure 2: Magnetic resonance angiography (MRA) of neck vessels and circle of Willis (a and b) showing ‘string’ sign (red arrow) in distal common carotid artery (CCA) and internal carotid artery (ICA), ‘flame’ sign in ICA (white arrow); (c) nonvisualization of ICA and filling of middle cerebral artery (MCA) from anterior cerebral artery (ACA) (red arrow)

a b c

d e f Figure 3: MRA of neck vessels (a) normal both CCA; (b) decrease in right ICA caliber (red arrow); (c and d) thin stream of flow eccentrically: ‘Crescent’ sign in right ICA (red arrow); and (e and f) nonvisualization of right ICA

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a b c d Figure 4: Magnetic resonance imaging (MRI) brain (a and b) DWI shows right frontal (ACA/MCA border-zone) hyperintensity suggesting restriction (red arrow); (c and d) apparent diffusion coefficient (ADC) shows corresponding hypointensity suggesting an acute infarct

and serum homocysteine levels were normal. The patient probable mechanism of CRAO in our patient was distal initially received heparin as an anticoagulant therapy and embolization from the thrombus at the site of dissection. was subsequently shifted to warfarin therapy. Intravenous Ophthalmoparesis and chemosis may have been due to the dexamethasone (4 mg thrice a day) was also given for 3 days involvement of the intracavernous portion of the ICA causing along with acetazolamide to reduce intraocular pressure. oculomotor, and paresis consequent to The pain subsided, but the sudden visual loss showed no reactive inflammation improvement. Ocular are a rare but serious complication of carotid Spontaneous dissections of the ICA have been well artery dissection. Spontaneous carotid artery dissection documented in the literature. Cervical ICA dissections should be included in the differential diagnosis of CRAO. commonly occur 2–3 cm distal to the carotid bulb. The dissection leads to blood accumulation within the layers Rohan Mahale, Anish Mehta, of the artery resulting in an intramural hematoma that can Suryanarayana Sharma, Mahendra Javali, Malavika K.1, R. Srinivasa spread along the vessel both proximally and distally. This Departments of Neurology, and 1Ophthalmology, MS Ramaiah intramural hematoma can cause stenosis or occlusion of Medical College and Hospital, Bangalore, Karnataka, India the vessel lumen. The endothelial disruption predisposes to E-mail: [email protected] local thrombus formation that may occlude the artery and References result in distal embolization that may precipitate brain infarction or ocular ischemia. Carotid dissections typically 1. Newman NJ, Kline LB, Leifer D, Lessell S. Ocular stroke and carotid cause ipsilateral frontotemporal headaches with neck pain artery dissection. Neurology 1989;39:1462-4. in 26% of ICA dissections. Ocular strokes due to carotid 2. Galetta SL, Leahey A, Nichols CW, Raps EC. Orbital ischemia, ophthalmoparesis, and carotid dissection. J Clin Neuro Ophthalmol artery dissection are rare. Newman et al., reported two 1991;11:284-7. patients with permanent ocular vasoocclusion consequent 3. Rao TH, Schneider LB, Patel M, Libman RB. Central retinal artery to dissection of the ipsilateral ICA.[1] Galetta et al., reported occlusion from carotid dissection diagnosed by cervical computed a patient with bilateral traumatic carotid dissections who tomography. Stroke 1994;25:1271-2. 4. Lubin J, Capparella J, Vecchione M. Acute monocular blindness had acute monocular visual loss due to ophthalmic artery associated with spontaneous common carotid artery dissection. Ann occlusion along with proptosis, ophthalmoparesis, and Emerg Med 2001;38:332-5. chemosis.[2]

Access this article online There are two previously reported cases of CRAO as an initial Website: Quick Response Code manifestation of carotid dissection. Rao et al., described a www.neurologyindia.com patient with traumatic ICA dissection who developed an DOI: ipsilateral isolated CRAO.[3] Similarly, Lubin et al., described 10.4103/0028-3886.152685 a patient with spontaneous common carotid artery dissection manifesting as CRAO.[4] Central retinal artery is PMID: a branch of the ophthalmic artery and is an end-artery. The xxxxx

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