Young Stroke Secondary To Fibromuscular Dysplasia Causing Carotid Artery Dissection

2021 ◽  
Author(s):  
Rumesh Ranasinghe ◽  
Shifa Azher ◽  
Udaya Ralapanawa ◽  
Parackrama Karunathilake
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Young Patients ◽  
Hemorrhagic Transformation ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Left Internal Carotid Artery ◽  
Childbearing Age

Abstract Background: Fibromuscular dysplasia (FMD) is a rare, medium-sized arteriopathy affecting less than 7% of the population. It affects predominantly young women of childbearing age. Stroke caused by fibromuscular dysplasia of the carotid artery is uncommon and reported to range between 0.6% by angiography and 1.1% by autopsy. Case Presentation: A 35-year-old mother of two children, previously well, was admitted to our hospital with right-sided spastic hemiparesis with upper motor neuron type facial nerve palsy. Non-contrast CT (NCCT) brain on admission revealed left-sided middle cerebral arterial territory infarction with possible hemorrhagic transformation with midline shift. She had progressive neurological features where NCCT brain in 24 hours showed an increase in the size of the hemorrhage. Magnetic resonance imaging (MRI) of the brain, including angiogram of neck vessels, revealed acute dissection of the left internal carotid artery with acute thrombosis, left frontoparietal hemorrhagic infarction, and the constellation of MRI showed features suggestive of left cervico-cranial fibromuscular dysplasia complicated by acute internal carotid artery dissection. She was started on low-dose aspirin, and 40 mg of atorvastatin and anticoagulants were not started because of the bleeding risk as she had a hemorrhagic transformation infarction. She was discharged and referred for inward physiotherapy and planned to repeat the MRI brain with the neck vessel angiogram in three weeks and arranged digital subtraction angiography in three months. Unfortunately, she was lost for follow-up.Conclusion: Detailed evaluation of the young patients with ischaemic stroke is helpful to diagnose rare diseases such as FMD involving carotid arteries leading to a better treatment choice between anticoagulation vs. antiplatelet therapy.

scholarly journals Symptomatic internal carotid artery dissection and kinking in a patient with fibromuscular dysplasia

2021 ◽  
Vol 20 ◽  
Author(s):  
Victor Bilman ◽  
Luca Apruzzi ◽  
Domenico Baccellieri ◽  
Francesca Sanvito ◽  
Luca Bertoglio ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Young Patients ◽  
Duplex Ultrasound ◽  
Carotid Artery Dissection ◽  
Uneventful Recovery ◽  
Artery Dissection ◽  
History Of

Abstract Isolated dissection of the internal carotid artery (ICA) is rare in young patients and is a cause for strong suspicion of fibromuscular dysplasia (FMD), especially when associated with artery elongation and tortuosity. The natural history of cerebrovascular FMD is unknown and management of symptomatic patients can be challenging. We report the case of a 44-year-old female patient with a history of transient ischemic attack in the absence of cardiovascular risk factors, associated with an isolated left ICA dissection and kinking. Carotid duplex ultrasound confirmed the diagnosis of dissection and demonstrated severe stenosis of the left ICA. The patient underwent surgical repair and histopathological evaluation confirmed the diagnosis of FMD with dissection. An autogenous great saphenous vein bypass was performed and the patient had an uneventful recovery. Cervical carotid artery dissection can be related to underlying arterial pathologies such as FMD, and the presence of ICA tortuosity highlights certain peculiarities for optimal management, which might be surgical.

Abstract 1122‐000020: Assessing Correlation Between Styloid Length and Internal Carotid Artery Dissection in EAGLE Syndrome Patients

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Smit Shah ◽  
Souvik Sen ◽  
Rachel Mascari ◽  
Jonathan King ◽  
Aaron Gambrell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
P Value ◽  
Left Internal Carotid Artery ◽  
Internal Carotid Artery Dissection ◽  
Eagle Syndrome

Introduction : Eagle Syndrome (ES) also known as styloid–carotid artery syndrome is a caused by elongation of the styloid process or calcification of the stylohyoid ligament. Usually, normal stylohyoid process is 2.5 cm in length. However, it is classified as an elongated styloid process if its length is more than 2.5 cm. Carotid Artery dissection which is a significant cause of ischemic stroke in all age groups is a known rare complication of ES. Goal of our study is to assess for correlation between degree of styloid process lengthening and grades of Carotid and Vertebral Dissections in adult population. Methods : Retrospective database review of adult patients with known cervical dissections (traumatic and non‐traumatic) were analyzed from Level I Comprehensive Stroke Center. Patients in pediatric age group (less than age 18 years) were excluded. Deidentified patient information including patient’s age, demographics, past medical history, mechanism of injury (if applicable) prior to initial clinical presentation, initial clinical presentation, methodology for diagnosis of cervical dissection (Internal Carotid vs External Carotid vs Vertebral Arteries) along with measurements of stylohyoid ligaments and degrees of dissections bilaterally were retrieved and analyzed. Data analysis was performed by using IBM SPSS Statistics Software 28.0. Results : Total number of patients were 111 (N). Mean age of patients was 52.97 (±16 years). Demographic distribution: African Americans (47/111), Caucasians (62/111) and Others (2/111). Gender distribution: Males (55/111) and Females (56/111). Mechanisms of injury based on available data were as follows: Mechanical Fall (21); MVC (21) and other mechanisms (12). 43/111 patients did have a headache as compared to 68/111 who did not during initial clinical presentation. Imaging confirmation for arterial dissection was performed via MRA (6/111); CTA (98/111) and DSA (7/111). Average styloid length for patients with Eagle syndrome was 3.1 cm vs non‐Eagle group which was 2.38 cm. In Non‐Eagle Syndrome group (Styloid length <2.5 cm), average grades of arterial dissections were as follows: Left Vertebral Artery dissection‐2.1; Left Internal Carotid Artery‐2.1; Right Internal Carotid Artery‐0.40 and Right Vertebral Artery‐2.5. For Eagle Syndrome patients (Styloid length >2.5 cm), average grade of arterial dissections were as follows: Left Vertebral Artery‐2.6; Left Internal Carotid Artery‐3.38; Right Internal Carotid Artery dissection‐2.3 and Right vertebral artery dissection‐1. Based on statistical analysis (paired samples T‐test), styloid length of more than 2.5 cm was significantly correlated with left internal carotid artery dissection (p value 0.012; p<0.05***). For dissections in other arteries including Right Internal Carotid (p value 0.91), Right Vertebral (p value 0.12) and Left vertebral (p value 0.488) no statistical significance was found when both groups were compared. Conclusions : From our study we can conclude that in patients with EAGLE syndrome styloid length more than 2.5 cm is significantly correlated with higher risk of Left Internal Carotid Artery dissection.

Immediate surgery for acute internal carotid artery dissection and thrombosis during filter deployment prior to stenting: a case report

Vascular ◽  
2013 ◽  
Vol 21 (4) ◽  
pp. 247-250 ◽  
Author(s):  
V Tolva ◽  
G B Bertoni ◽  
P G Bianchi ◽  
G C Keller ◽  
R Casana
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Procedures ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Left Internal Carotid Artery ◽  
Extracranial Carotid Artery ◽  
Acute Dissection ◽  
Immediate Surgery

Carotid artery stenting (CAS) is a validated option in the treatment of selected extracranial carotid artery stenosis. Carotid artery dissection during CAS is a rare but potentially devastating complication. We report a case of acute dissection and thrombosis of the left internal carotid artery during filter tip wire engaging maneuvers, complicated by intraoperative complete blindness of the left eye. Immediate conversion to carotid endarterectomy was performed under general anesthesia with electroencephalographic monitoring. The patient was discharged home symptomless and remains asymptomatic eight months after the operation, with normal left internal carotid patency and fully recovered eyesight. In conclusion, the management of acute carotid occlusion during CAS requires emergent evaluation and definitive endovascular or open surgical repair to minimize neurologic morbidity. We advocate that all endovascular procedures are carried out in a well-established surgical environment.

scholarly journals Oropharyngeal swab for SARS-CoV-2 test causing atypical internal carotid artery dissection and stroke in a patient after mild COVID-19

2021 ◽  
Vol 14 ◽  
pp. 175628642110335
Author(s):  
Livia Asan ◽  
Cornelius Deuschl ◽  
Michael Forsting ◽  
Christoph Kleinschnitz ◽  
Martin Köhrmann
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Tissue Injury ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Left Internal Carotid Artery ◽  
Systemic Thrombolysis ◽  
Acute Cerebral Ischemia ◽  
Oropharyngeal Swab

We report a patient who had recovered from pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presenting with acute cerebral ischemia due to atypical dissection of the left internal carotid artery immediately after an oropharyngeal swab (OPS) for SARS-CoV-2 RT-PCR testing. The symptoms consisting of right-side hemiparesis and aphasia improved after systemic thrombolysis and the patient recovered completely in the further course. We demonstrate findings from imaging (computed tomography, magnetic resonance imaging, neurovascular ultrasound) among other investigations and discuss coronavirus disease 2019 (COVID-19)-related vessel wall vulnerability as well as tissue injury posed by the swab procedure as underlying causes of the dissection. Individuals performing OPSs during the corona pandemic should be aware of this so far undescribed complication.

Carotid artery dissection: a case of recurrence

2021 ◽  
Vol 14 (5) ◽  
pp. e241718
Author(s):  
Pratiksha Srinivas ◽  
Joel Nwosu ◽  
Aloaye Foy-Yamah ◽  
Clement Okiemute Ejohwomu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Brain Mri ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Left Internal Carotid Artery ◽  
Internal Carotid Artery Dissection ◽  
Ct Angiogram ◽  
History Of

A 53-year-old healthy man with history of left internal carotid artery dissection in 2006 presented with right-sided facial pain with paraesthesia associated with taste and speech disturbances. A CT angiogram was done without further delay considering the patient’s history of dissection, and revealed a non-occlusive right-sided internal carotid artery dissection at the skull base level. The neurologist, neurosurgeons and stroke team were involved in the care, and the patient was immediately moved to a tertiary hospital for further intervention. Brain MRI and magnetic resonance angiography did not reveal further progression of the dissection and the patient was therefore medically managed.

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