Carotid Web with Ischaemic Stroke

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Carotid Web
MRA brain showing total occlusion of M1 segment of left MCA (red arrow) and normal circle of Willis.

Case of carotid web in 20-year-old.

This article describes the case of a 20-year-old Caucasian female diagnosed with carotid web ischaemic stroke. The patient presented with left MCA stroke, 8 hours after aphasia. Doctors initially advised a magnetic resonance imaging of the brain (MRI) without contrast in an outside facility consistent with acute ischemic infarct. The infarct involved the distribution of the left MCA, measuring 9 cm in the area of the left temporal lobe. In addition, an angiogram was also performed which showed total occlusion of M1 segment of left MCA.

Her medical history revealed that she was a non-smoker and was only taking oral contraceptives. On examination, the patient’s vital signs were stable. Other findings included expressive aphasia and right-sided facial droop. All other examinations, including gross motor and sensory functions, deep reflexes and Babinski reflexes were normal. However, he was unable to perform blind eyes and squeeze hands tasks with NIH Stroke Scale/Score (NIHSS) 6.

He was referred to neurology and given shortly after aspirin and atorvastatin through a nasogastric tube.

Although since the patient was outside the therapeutic window, no tissue plasminogen activator was given. CT scan of the neck showed partially recanalized vessel in a short segment between M1 and M2 segments of left MCA. Similarly, CTA of the neck showed a short segment of linear filling defect. Based on the findings, doctors diagnosed the patient with carotid web.

A neurointerventionist and vascular surgeon were also consulted, deferring any invasive procedure because of acute cerebrovascular accident (CVA) and a large area of infarct. In addition to a previously thrombosed vessel as evidence in CTA. The patient was given clopidogrel and conservatively treated with permissive hypertension. A two-lead resting electrocardiogram showed normal sinus rhythm.

Doctors advised testing the patient for hyper-coagulability and vasculitis. Blood tests showed normal levels of C and S and antithrombin III levels. She was negative for lupus anticoagulant, pregnancy test, antinuclear antibody, C-reactive protein and Factor V Leiden. There was no evidence of right to left shunt agitated by saline challenge on transthoracic echocardiogram. In addition, she required a feeding gastrotomy tube because of severe dysphagia. There were no new recurrent events noted during her stay at the hospital. The patient was discharged on conservative medical therapy with aspirin, clopidogrel and atrovastatin.

References

A Rare Case of Carotid Web Presenting with Ischemic Stroke in a Young Woman and a Brief Review of the Literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836297/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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