Dados do Trabalho

Título

Spontaneous bilateral carotid dissection: a rare presentation of acute ischemic stroke.

RESUMO

Case report: A 57-year-old male patient was referred from an Emergency Care Unit to our hospital due to a sudden loss of consciousness associated with headache and high blood pressure at 10:55 on 15/04/2022. There was no history of neck pain, trauma, fall or substance use or abuse. The patient was admitted intubated due to Glasgow Coma Scale < 9. Computed tomography was performed, which showed slight left basal nuclei and bilateral frontoparietal subcortical hypodensity, with no bleeding. A new computed tomography was performed the next day, which showed progress of the initial lesion and a small right frontal cortical hypodensity. The patient underwent magnetic resonance imaging that showed DWI increased signal and reduced ADC values involving the frontal cortex, frontoparietal white matter, basal nuclei and internal capsule of both hemispheres with hyperintense signal on T2/FLAIR, suggesting ischemia. Furthermore it showed T2 and DWI high signal crescent sign indicating intramural hematoma of both internal carotid arteries and angiography was performed the next day which also suggested bilateral carotid dissection and ruled out other causes.
Discussion: Dissection of vertebral and carotid arteries are known causes of ischemic stroke and transient ischemic attack. Dissection can occur due to an external factor, such as trauma, neck manipulation, fall, or due to an intrinsic vessel disease, such as fibromuscular dysplasia, or spontaneously. Bilateral carotid dissection is a rare presentation of the phenomenon. In the literature, these cases were associated with blunt trauma, Eagle syndrome, medication use, Ehlers-Danlos syndrome, and others. Spontaneous bilateral carotid dissection is an even rarer presentation of neck artery dissection, especially in a patient without previous history of vessel disease.
Final considerations: Spontaneous bilateral carotid dissection is a rare presentation of acute ischemic stroke and can cause sudden loss of consciousness due to bilateral infarcts in the brain. This case illustrates this rare presentation and the importance of performing a vessel study in a patient with a history suggestive of stroke for the evaluation of cervical and intracranial vessels.

Palavras Chave

Stroke, carotid artery, dissection, arterial dissection, emergency, ischemic stroke, neuroimaging