Symptoms.—Aneurism of the carotid artery usually occurs where the common carotid bifurcates into the internal and external carotid arteries. On the right side it most frequently appears where the artery springs from the innominate artery. Its special symptoms are dysp difficulty in swallowing, hoarseness, a brassy cough, vertigo. and tinnitus aurium.
Carotid aneurism first appears as a small tumor, which may grow very rapidly.
Case of aneurism of the internal ca rotid following scarlet fever in a girl, aged IS years, severe inflammation of the throat being a prominent symptom. A month after the onset the aneurism appeared in the left sterno-mastoid re gion, immediately below the mastoid. It was the size of a walnut, reducible, and pulsating energetically. On explor atory puncture with a Pravaz syringe blood was obtained. No treatment was employed. Gradual improvement took place, and the patient spontaneously re covered in three months. Lyot and Retit (Revue des Sciences Med., July, '97).
Case of aneurism of the internal ca rotid artery following tonsillar abscess in a girl S years old. The left tonsil and the wall of the pharynx were markedly protruded; this, with the enlarged sub maxillary glands, closely resembled post pharyngeal abscess. The tumor, how ever, showed marked expansile pulsation, and aspiration brought away nothing but pure blood. During the opening of a tonsillar abscess the carotid artery had been wounded, causing the loss of a pint or more of blood. The child recovered and an aneurism gradually developed. The common carotid was ligated just below its bifurcation. The aneurism ceased and did not return. The clot in the sac, however, suppurated and was opened, and a discharge came from the left ear, which, however, finally disap peared. The throat returned to its nor mal size and complete recovery ensued. P. Wulff (Miinchener med. Woeh., May 15, 1900).
Differential Diagnosis. — At the root of the neck it is sometimes difficult to ascertain whether the carotid alone is involved. Aneurisms of the subelavian, the innominate, and the aortic arch may simulate those of the carotid when these are close to the clavicles.
Enlarged cervical glands may be taken for aneurism; but, as these are usually multiple and not endowed with powers of auto-expansion, their diagnosis is easily established. Cysts and vascular growths of the thyroid resemble aneu risms in some cases. Cysts in the cer vical region are very rare, while any growth connected with the thyroid gland follows the movements of the latter dur ing deglutition.
Abscess may be taken for aneurism, especially cold abscess, but the facies is different, and the growth, though pulsatile through the pressure upon the underlying large vessels, is not expansile. An ordinary abscess can easily be recognized by its characteris tics, which differ entirely from those of aneurism.
Prognosis.—Spontaneous cure is rarely observed. The usual course of an aneu rism is to progress until rupture into the pharynx or trachea or externally takes place. Some cases remain dormant for a long while, and suddenly undergo the process of development.
Treatment. — All methods should be supplemented by recumbency and diet. Proximal compression, when feasible, should always be tried, and, where the arterial coats are seriously diseased, should supersede ligation. Needling should supplement pressure when the ease is progressing rapidly. Possibly it is advisable in all cases suitable for com pression, and is certainly to be employed where this method fails in cases with highly atheromatous vessels. Proximal ligation, having been rendered much safer of late by the use of aseptic pre cautions, less-absorbent ligatures, and the avoidance of all injury to the arte rial walls by employing the stay-knot, is permissible when the arterial walls are relatively sound, until experience decides whether or not needling is clearly indi cated. Since recurrence after proximal ligation almost certainly results from non-deposition of white thrombi and their maintenance in contact with the aneurismal wall from lack of proper changes of its lining, needling is clearly indicated. Where the location prevents proximal arrest of the blood-current, needling is the best operation; possibly distal compression — rarely feasible might aid in the deposition of thrombi. For the reasons already given, although occasionally successful, the indications for the permanent introduction of such foreign bodies as wire, horse-hair, etc., into aneurismal sacs are so much better met by needling that such procedures had better not be adopted. The modern revival of the older method of extir pation of aneurisms should not be at tempted for spontaneous cervical aneu risms. (Nancrede.) Extirpation of an aneurism of the carotid may, however, be followed by good results, even when the common carotid is involved.