Transitory ischemic attack associated with a rare fenestration of the cervical segment of the internal carotid artery: a case report

Background Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis range from dissections leading to the fenestration to the more common interpretation as a developmental vascular variant. However, most reported cases were symptomatic and presented with dissections, where even endovascular treatment of the fenestration of the cervical segment of the internal carotid artery became necessary. Here we report a case of a fenestration of the cervical segment of the internal carotid artery suffering a transitory ischemic attack and local pain in absence of any sign of dissection. Case presentation A 62-year-old Caucasian male patient was admitted to our institution because of an episode of amaurosis fugax, initially accompanied with headache. Magnetic resonance imaging revealed an intact fenestration of the cervical segment of the internal carotid artery on the symptomatic side. With antiplatelet therapy, all symptoms vanished within 2 months of the initial event. Conclusions Our findings support the interpretation of a fenestration of the cervical segment of the internal carotid artery as a developmental vascular variant, but also suggest a substantial risk for dissection and ischemic stroke. Even in case of an accidental finding, clinicians should be aware of this. At least in this case, antiplatelet therapy seemed beneficial.

Rate of strokes 1 year after retinal artery occlusion with analysis of risk groups

Background: The risk of developing stroke after retinal artery occlusion was reported to be increased. The aim of our study was to assess the rate of strokes/transitory ischemic attacks after retinal artery occlusion in a European population and to identify the risk groups. Methods: All patients, diagnosed with branch or central retinal artery occlusion at our outpatient department since 2014, were asked to participate in this prospective case–control study. At the initial examination, the medical history was documented and 1 year after retinal artery occlusion, patients were called by telephone interview for assessment of the rate of strokes/transitory ischemic attack in the follow-up period. Results: In all, 30 eyes of 30 patients could be included. Among these, six patients had a stroke, one a transitory ischemic attack, and one an amaurosis fugax in the medical history before retinal artery occlusion. In the period 1 year after retinal artery occlusion, one patient had a re-stroke and one patient had a transitory ischemic attack, with amaurosis fugax in the medical history. Rates of strokes/transitory ischemic attack before and after retinal artery occlusion did not show significant differences between branch and central artery occlusion. Conclusion: The number of strokes/transitory ischemic attacks within the first year is relatively low after retinal artery occlusion and patients that already had a previous stroke, transitory ischemic attack, and/or amaurosis fugax before retinal artery occlusion seem to have a higher risk for a cerebrovascular event after retinal artery occlusion.