Ischemic stroke due to spontaneous reversible extracranial internal carotid artery vasospasm: A case report

[摘要] Reversible idiopathic extracranial internal carotid artery (ICA) vasospasm is a rare cause of ischemicstroke especially seen among young patients and the pathophysiology is not fully understood. Wereport here a 23-year-old female who presented with left hemiparesis and hemihypoesthesia. She hadseveral similar reversible attacks which last about 30 minutes in the past years. She had migrainetype headaches five times a month and history of bipolar disease. MRI showed multiple infarctionareas on the right middle cerebral artery (MCA) territory with no large vessel abnormality. We couldnot find any cardioembolic or other etiology except for a PAI-1 heterozygote 4G/5G mutation. Shewas given warfarin and had several ischemic attacks in different vascular areas in the followingyears with various treatment strategies. MR angiography showed reversible stenosis of both internalcarotid arteries (ICA) in every attack with different severities. We diagnosed the patient as reversiblevasoconstriction syndrome of the ICA and started prednisolone, nimodipine, and ASA treatment. Inconclusion, spontaneous reversible extracranial internal carotid artery vasospasm is a rare conditionwith uncertain pathology. There is also no effective treatment.

[学科分类] 精神健康和精神病学

[关键词] Reversible carotid spasm;recurrent stroke;internal carotid artery