ABSTRACT
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.
Resumo A dissecção isolada da artéria carótida interna em pacientes jovens é rara, e a displasia fibromuscular deve ser altamente suspeitada principalmente quando estiver associada a alongamento e tortuosidade da artéria. A história natural da displasia fibromuscular cerebrovascular é desconhecida, e o manejo de pacientes sintomáticos pode ser desafiador. Apresentamos o caso de uma paciente de 44 anos com histórico de ataque isquêmico transitório sem fatores de risco cardiovasculares, associado a dissecção e acotovelamento isolados da artéria carótida interna esquerda. O ultrassom duplo das carótidas confirmou o diagnóstico de dissecção e demonstrou estenose grave na artéria carótida interna esquerda. A paciente foi submetida a reparo cirúrgico, e a avaliação histopatológica confirmou o diagnóstico de displasia fibromuscular com dissecção. Foi realizada cirurgia de ressecção do segmento e reconstrução com veia safena magna autógena, e a paciente se recuperou sem complicações. A dissecção da artéria carótida cervical pode estar relacionada a doenças arteriais subjacentes, como a displasia fibromuscular, e a presença da tortuosidade da artéria carótida interna destaca algumas particularidades no manejo ideal, o qual pode ser cirúrgico.
Subject(s)
Humans , Female , Adult , Carotid Artery, Internal/pathology , Carotid Artery, Internal, Dissection/complications , Fibromuscular Dysplasia/complications , Constriction, Pathologic , Carotid Artery, Internal, Dissection/surgery , Carotid Artery, Internal, Dissection/diagnostic imagingABSTRACT
Summary Carotid dissection is a rare occurrence but it is the main cause of stroke in individuals aged less than 45 years, and can be the etiology in up to 25% of strokes in young adults. We report a case with classic image of ying yang on vascular ultrasound, which was treated according to the best available medical evidence, yielding a favorable outcome.
Resumo A dissecção de carótida é entidade rara, mas é a principal causa de acidentes vasculares cerebrais isquêmicos em menores de 45 anos e pode ser a etiologia de até 25% dos acidentes vasculares cerebrais em adultos jovens. Apresenta-se um caso com imagem clássica de ying yang à ultrassonografia vascular, que foi tratado de acordo com as melhores evidências médicas disponíveis e apresentou boa evolução.
Subject(s)
Humans , Female , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal, Dissection/diagnostic imaging , Magnetic Resonance Imaging , Platelet Aggregation Inhibitors/therapeutic use , Angiography/methods , Fluoroscopy/methods , Treatment Outcome , Ultrasonography, Doppler, Color , Carotid Artery, Internal, Dissection/complications , Carotid Artery, Internal, Dissection/drug therapy , Stroke/etiology , Middle AgedSubject(s)
Humans , Carotid Artery, Internal, Dissection/diagnosis , Carotid Artery, Internal, Dissection/therapy , Vertebral Artery Dissection/diagnosis , Vertebral Artery Dissection/therapy , Carotid Artery, Internal, Dissection/complications , Risk Factors , Stroke/etiology , Trigger Points , Vertebral Artery Dissection/complicationsSubject(s)
Humans , Male , Middle Aged , Carotid Artery, Internal, Dissection/complications , Hypoglossal Nerve Diseases/etiology , Paralysis/etiology , Carotid Artery, Internal, Dissection/diagnosis , Hypoglossal Nerve Diseases/diagnosis , Magnetic Resonance Imaging , Paralysis/diagnosis , Tomography, X-Ray ComputedSubject(s)
Humans , Carotid Artery, Internal, Dissection/complications , Cranial Nerve Diseases/etiology , Paralysis/etiology , Aspirin/therapeutic use , Carotid Artery, Internal, Dissection/drug therapy , Prognosis , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic useABSTRACT
Carotid dissection is an uncommon complication of trauma. They can present with immediate or delayed complications. We describe the case of a young patient with bilateral carotid dissections and acute infarcts. Brief review of literature and treatment options are discussed.
Subject(s)
Adult , Athletic Injuries , Carotid Artery, Internal, Dissection/complications , Functional Laterality , Humans , Magnetic Resonance Imaging , MaleABSTRACT
In young and middle age subjects, spontaneous carotid dissection is an increasingly recognized cause of ischemic stroke. Their usual presentation is facial pain with a Horner syndrome and a contra lateral paresis. Blindness has been reported as a presenting symptom in only a few cases. We report a 50 years old man who presented with amblyopia in the left eye, without periocular pain. Fundoscopy showed papilledema and a peripapillar hemorrhage, compatible with an ischemic optic neuropathy. A magnetic resonance angiography confirmed a left carotid dissection.