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West syndrome, also called Infantile Epileptic Spasms Syndrome (IESS), is a rare and severe form of epilepsy that starts in infancy. It is marked by infantile spasms, a chaotic brain activity pattern on EEG (hypsarrhythmia), and developmental delays or regression. Key characteristics Infantile spasms: Brief episodes of muscle stiffening or jerking, often in clusters. Movements may be mild twitches or stronger “jackknife” bends of the body. Hypsarrhythmia: Abnormal and disorganized brain activity seen on EEG. Developmental regression: Infants may stop progressing or lose skills like rolling, sitting, or babbling. Symptoms and onset Symptoms usually appear between 3 and 12 months of age. Spasms are brief but frequent, often happening after waking. Causes The condition can be linked to structural brain problems, genetic mutations, metabolic disorders, or infections. Diagnosis EEG is used to detect hypsarrhythmia. MRI can show brain abnormalities. Genetic and laboratory tests may reveal underlying causes. Treatment There is no cure. Treatment aims to stop spasms and support development. Medications: Vigabatrin, ACTH, and corticosteroids are commonly used. Diet therapy: The ketogenic diet may reduce seizures in some children. Surgery: Considered if seizures come from a specific brain area and don’t respond to other treatments. Rehabilitation: Psychomotor therapy helps address developmental delays.

What Is a Carotid Artery Aneurysm? A carotid artery aneurysm is an abnormal bulge or ballooning in one of the carotid arteries. These arteries are major blood vessels that supply blood to the brain, head, face, and neck. You have two common carotid arteries, one on each side of your neck. As each artery travels upward, it divides into: The internal carotid artery, which supplies blood to the brain The external carotid artery, which supplies blood to the face and neck Carotid artery aneurysms can develop in any of these arteries, but they most commonly occur in the internal carotid artery. An aneurysm forms when a section of the artery wall becomes weak. As blood pressure pushes against this weakened area, the vessel wall bulges outward and becomes thinner, increasing the risk of rupture. The larger the aneurysm grows, the more dangerous it can be—similar to an overinflated balloon. How Serious Is a Carotid Artery Aneurysm? Carotid artery aneurysms affect blood vessels that supply the brain, so complications can be serious: Blood clots may form inside the aneurysm and travel to the brain, causing: Transient ischemic attack (TIA) (“mini-stroke”) Ischemic stroke Large aneurysms may rupture, leading to: Hemorrhagic stroke Life-threatening bleeding Some aneurysms remain small and stable for years, while others grow quickly and require treatment. True vs. False (Pseudoaneurysm) Carotid Artery Aneurysms True Carotid Artery Aneurysm Involves all three layers of the artery wall (intima, media, adventitia) Most commonly caused by atherosclerosis The artery wall bulges outward uniformly False Carotid Artery Aneurysm (Pseudoaneurysm) Involves only one or two layers of the artery wall Appears as a sac attached by a narrow “neck” Often caused by: Trauma Infection Complications from medical procedures Both types can lead to serious complications and may require treatment. Who Is Affected? Most commonly affects adults in their 50s or 60s Can affect adults of any age Rare in children Very rare overall: fewer than 1 in 100 aneurysms involve the carotid arteries Symptoms of a Carotid Artery Aneurysm Stroke or TIA Symptoms (Most Common) TIAs and strokes are medical emergencies. Call emergency services immediately if any of the following occur: Vision loss or difficulty seeing Difficulty walking or loss of balance Dizziness or coordination problems Numbness or weakness in the face, arm, or leg (especially one side) Sudden, severe headache Slurred or confused speech Difficulty understanding others Symptoms From Local Pressure If the aneurysm presses on nearby nerves or veins, symptoms may include: Headache Hoarseness Neck pain Facial swelling A pulsating lump in the neck Difficulty swallowing Vision problems Contact your healthcare provider if you experience any of these symptoms. Causes of Carotid Artery Aneurysms Possible causes include: Atherosclerosis (most common) Weakening of artery walls due to: Connective tissue disorders Fibromuscular dysplasia Medical procedure complications (e.g., carotid surgery, radiation therapy) Traumatic injuries (e.g., blunt trauma, gunshot wounds) Risk Factors Factors that increase risk include: Family history of aneurysms High blood pressure (hypertension) Smoking or tobacco use Diagnosis Carotid artery aneurysms are diagnosed through: Physical Exam Listening for abnormal blood flow sounds (carotid bruit) Medical & Family History Identifies inherited risks and underlying conditions Imaging Tests Ultrasound CT scan Magnetic resonance angiography (MRA) Additional tests may include: Brain imaging to assess blood flow Genetic testing Screening of the aorta or other arteries Some aneurysms are found incidentally during imaging for other reasons. Treatment Options Treatment depends on aneurysm size, growth rate, location, and symptoms. Surveillance (Watchful Waiting) Regular imaging every 6–12 months Suitable for small, symptom-free aneurysms Blood pressure and cholesterol medications may be prescribed Open Surgery Removal of the diseased artery segment Blood flow restored using a bypass graft Graft may be synthetic or taken from another blood vessel Endovascular Stent Grafting Minimally invasive A stent graft is placed inside the artery through a catheter Creates a new pathway for blood flow Suitable for select aneurysms based on size and location Outlook and Prognosis Outcomes vary: Some aneurysms remain stable for years Others grow and require intervention Surgical and endovascular treatments are effective but carry risks Your healthcare provider will guide you based on your individual condition. Prevention and Risk Reduction You can lower your risk by: Quitting smoking Eating a heart-healthy diet Exercising regularly Limiting alcohol intake Managing blood pressure and cholesterol Taking medications as prescribed Attending regular medical checkups Living With a Carotid Artery Aneurysm Follow your provider’s lifestyle recommendations Ask about activity restrictions Attend all follow-up appointments Report new or worsening symptoms promptly Questions to Ask Your Doctor Where is my aneurysm located? How large is it? Do I need treatment now or later? What are my treatment options? What are the risks and benefits? Are there activity restrictions? How often will I need imaging or follow-ups?

What Is a Cerebral Arteriovenous Fistula? A cerebral arteriovenous fistula (AVF) is an abnormal direct connection between an artery and a vein in the brain. How Normal Blood Flow Works In a healthy circulatory system: Blood flows from arteries → capillaries → veins Capillaries slow blood flow so oxygen and nutrients can be delivered to brain tissue Veins then carry blood back to the heart What Happens in an AVF In a cerebral AVF: Blood bypasses the capillaries Blood flows directly from an artery into a vein This causes high-pressure arterial blood to enter veins that are not designed to handle it Over time, this abnormal circulation can: Reduce oxygen delivery to brain tissue Increase pressure inside veins Raise the risk of bleeding and neurological damage Cerebral AVFs may be congenital (present at birth) or acquired later in life. Symptoms of a Cerebral Arteriovenous Fistula Symptoms vary depending on the size, location, and blood flow of the AVF. Some people have no symptoms initially, while others develop serious complications. Common symptoms include: Hemorrhagic stroke due to bleeding in the brain Sudden severe headache Weakness or numbness Difficulty speaking or moving Seizures Pulsatile tinnitus (a rhythmic “whooshing” sound in the ear) Audible bruit (a sound caused by turbulent blood flow) Neck or back pain Neurological deficits depending on the affected brain area Symptoms can worsen suddenly if bleeding occurs, which is a medical emergency. Causes of Cerebral Arteriovenous Fistulas Cerebral AVFs can develop for several reasons: Congenital Causes Abnormal blood vessel development during fetal growth Present at birth, though symptoms may appear later Acquired Causes Trauma (e.g., head injury, gunshot or stab wounds) Surgical or medical procedures involving blood vessels Vascular conditions, such as aneurysms or other malformations Spontaneous formation, especially in older adults Note: AVFs created surgically for dialysis are intentional and occur outside the brain. Cerebral AVFs are abnormal and potentially dangerous. Complications and Related Conditions If left untreated, a cerebral AVF can lead to serious complications: Brain Bleeding (Intracranial Hemorrhage) Veins exposed to high arterial pressure may rupture Can cause stroke, brain damage, coma or death Seizures Caused by irritation of brain tissue from abnormal blood flow or bleeding Heart Strain and Heart Failure Large AVFs force the heart to pump harder Over time, this can lead to high-output heart failure Blood Clots Turbulent blood flow increases clot formation Can result in deep vein thrombosis (DVT) or pulmonary embolism