TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity

Fellows’ Journal Club

This study included 47 patients from 10 centers presenting between January 2009 through April 2016with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities. The authors conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. The authors conclude that this study improves the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: Transient Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.

Abstract

Figure 2 from paper
CTA shows a left posterolateral eccentric perivascular infiltration (arrowhead) surrounding the carotid artery, with a distinct low-density soft intimal plaque (arrow).

BACKGROUND AND PURPOSE

The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity.

MATERIALS AND METHODS

From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets.

RESULTS

The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others.

CONCLUSIONS

Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.

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TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.