COVID-19-associated ischaemic stroke due to underlying carotid artery thrombosis in a healthy young woman

SARS-CoV-2 has proven its versatility in host presentations; one such presentation is a hypercoagulable state causing large-vessel thrombosis. We report a case on a previously asymptomatic COVID-19-positive patient presenting with an acute ischaemic stroke and an incidental left internal carotid artery thrombus. The patient’s medical, social and family history and hypercoagulability screening excluded any other explanation for the left carotid thrombus or stroke, except for testing positive for the COVID-19. This case explores the known hypercoagulable state associated with COVID-19 and the effect of the virus on the host’s immune response. It also questions whether administration of recombinant tissue plasminogen activator (t-PA), according to the American Heart Association guidelines, following a negative head CT for haemorrhagic stroke is safe without prior extended imaging in this patient population. We recommend, in addition to obtaining a non-contrast CT scan of the brain, a CT angiogram or carotid duplex of the neck be obtained routinely in patients with COVID-19 exhibiting stroke symptoms before t-PA administration as the effects may be detrimental. This recommendation will likely prevent fragmentation and embolisation of an undetected carotid thrombus.

Download Full-text

Ischaemic stroke caused by spontaneous unilateral carotid artery dissection in patient with connective tissue disorder

Aktualności Neurologiczne ◽

10.15557/an.2021.0006 ◽

2021 ◽

Vol 21 (1) ◽

pp. 41-46

Author(s):

Weronika Pużyńska ◽

◽

Anna Mirończuk ◽

Katarzyna Kapica-Topczewska ◽

Adam Łukasiewicz ◽

...

Keyword(s):

Carotid Artery ◽

Connective Tissue ◽

Ischaemic Stroke ◽

Young Patients ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Left Internal Carotid Artery ◽

Cervical Artery Dissection ◽

Connective Tissue Disorders ◽

Ehlers Danlos Syndrome

Background: Spontaneous cervical artery dissection is a major cause of ischaemic stroke in young patients. It is supposed that genetic variants associated with connective tissue disorders often lead to neurovascular complications, the management of which remains a challenge. Case presentation: A 30-year-old female was admitted to the Department of Neurology with an episode of visual disturbances, speech problems, and concomitant headache. Computed tomography angiography revealed left internal carotid artery dissection. Magnetic resonance of the brain showed cortical and subcortical acute ischaemic lesions in the left cerebral hemisphere. The patient was diagnosed with vascular Ehlers–Danlos syndrome based on the clinical course of the disease. Conservative treatment was administered with full neurological recovery. Conclusion: It is very important for clinicians to consider the coexistence of genetically determined connective tissue disorders in young patients who develop arterial dissections.

Download Full-text

Moyamoya Syndrome after Radiation Therapy: a Clinical Report

European Journal of Case Reports in Internal Medicine ◽

10.12890/2019_001337 ◽

2019 ◽

Author(s):

Paulo Almeida ◽

Ana Rocha ◽

Gonçalo Alves ◽

Tiago Parreira ◽

Maria Silva ◽

...

Keyword(s):

Radiation Therapy ◽

Ischaemic Stroke ◽

Late Complication ◽

Neurological Deficits ◽

Motor Deficits ◽

Left Internal Carotid Artery ◽

Clinical Report ◽

Moyamoya Syndrome ◽

Functional Rehabilitation ◽

Ct Angiogram

Moyamoya syndrome (MMS) is a rare, chronic and progressive vasculopathy with a characteristic angiographic pattern and well-recognized predisposing conditions, such as cranial therapeutic radiation. We report the case of a 36-year-old Caucasian female with a history of craniopharyngioma treated with whole-brain radiotherapy 20 years previously. She was admitted to the emergency department with disorientation and imperceptible speech lasting for 1 hour. Upon examination, she had slight motor aphasia, without sensory or motor deficits. However, the neurological deficits worsened on standing position. The computed tomography (CT) angiogram and transcranial Doppler ultrasonography revealed occlusion of the distal portion of the left internal carotid artery (ICA). Mechanical thrombectomy was attempted without success. Head CT was repeated, revealing left periventricular acute ischaemic stroke. The cerebral angiography showed total occlusion of the left ICA with an exuberant network of transdural collateral vessels, confirming MMS. The patient completed a functional rehabilitation program with progressive improvement of deficits and maintained a multidisciplinary follow-up. MMS is a serious late complication from cranial radiation therapy and a well-described risk factor for ischaemic stroke in younger patients. Therefore, early detection and prompt treatment are mandatory, as the consequences can be disastrous, such as cognitive and neurologic decline due to repeated strokes.

Download Full-text

Carotid artery dissection: a case of recurrence

BMJ Case Reports ◽

10.1136/bcr-2021-241718 ◽

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.

Download Full-text

Carotid Endarterectomy in a Patient with Severe Internal Carotid Artery Stenosis with Persistent Trigeminal Artery and Ischemia of the Anterior and Posterior Circulation

Case Reports in Neurological Medicine ◽

10.1155/2017/7193734 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Melanie R. F. Greenway ◽

Hussam A. Yacoub ◽

Shweta Varade ◽

Yevgeniy Isayev

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Endarterectomy ◽

Internal Carotid ◽

Posterior Circulation ◽

Left Internal Carotid Artery ◽

Persistent Trigeminal Artery ◽

Trigeminal Artery ◽

Ct Angiogram

Occurrence of cerebral ischemia in the posterior circulation as a result of severe internal carotid artery disease and persistent trigeminal artery is rare. An 81-year-old man with medical history of hypertension and ischemic stroke presented with dizziness, nausea, and mild dysarthria. Magnetic resonance imaging of the brain revealed acute infarcts in the left internal carotid artery territory. CT angiogram revealed a persistent trigeminal artery (PTA) and severe atherosclerosis. The patient developed new neurological symptoms and repeat imaging revealed new acute infarcts in the PTA distribution. After undergoing a left carotid endarterectomy with no complications, the patient was discharged to a skilled nursing facility with no recurrence of ischemic stroke. This case adds a rare complication of an infrequent vascular anomaly to the limited body of the literature.

Download Full-text

Acute Left Internal Carotid Artery and Right Popliteal Artery Occlusion Related to Cisplatin-Gemcitabine Based Chemotherapy

Case Reports in Neurological Medicine ◽

10.1155/2018/9281918 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Saman Zafar ◽

Rashmika Potdar ◽

Andrew Tiu ◽

Gabor Varadi ◽

John Leighton

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Popliteal Artery ◽

Vision Loss ◽

Internal Carotid ◽

Artery Occlusion ◽

Left Internal Carotid Artery ◽

Ct Angiogram ◽

Increased Risk ◽

The Right

Objectives. The increased risk of thromboembolic complications with active cancer is well known. We present this case to highlight that chemotherapy may increase the risk of thromboembolic events even further in cancer patients. Methods. We report a case of a 64-year-old male with Diffuse Large B-Cell Non-Hodgkin’s Lymphoma who presented with left-sided headache and right calf pain two weeks after starting Rituximab/Gemcitabine/Cisplatin/Dexamethasone chemotherapy. Neurological examination was normal, but there was an absent right dorsalis pedis pulse. He subsequently developed left vision loss. CT angiogram of the head and neck revealed occlusion of his left internal carotid artery and poor opacification of the left ophthalmic artery. An angiogram of the right leg further revealed acute occlusion of the popliteal artery. Results. The patient underwent intra-arterial Tissue Plasminogen Activator injection to his lower limb and was started on Low Molecular Weight Heparin. His vision gradually recovered with time. His chemotherapy regimen was changed to RICE (Rituximab, Ifosfamide, Carboplatin, Etoposide). Conclusion. Based on literature review, there are numerous similar presentations of arterial thromboembolism in patients on Cisplatin-based chemotherapy. A high index of suspicion for such events should be maintained for patients on chemotherapy presenting with unusual symptoms.

Download Full-text

Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽

10.1024/0301-1526/a000153 ◽

2011 ◽

Vol 40 (6) ◽

pp. 491-494 ◽

Cited By ~ 4

Author(s):

Vávrová ◽

Slezácek ◽

Vávra ◽

Karlová ◽

Procházka

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Rare Complication ◽

Left Internal Carotid Artery ◽

Acute Tonsillitis ◽

Artery Pseudoaneurysm ◽

Complete Occlusion ◽

Endovascular Approach ◽

Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

Download Full-text