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Traumatic bilateral carotid dissection with concomitant cerebral infarction
S J Pittock1, J T Moroney, M Alexander
1Department of Neurology, Beaumont Hospital, Dublin, Ireland.
Insights
A major stroke occurred in a 40-year-old man due to bilateral carotid artery dissection, a rare complication of fibromuscular dysplasia. This case highlights the management challenges and lack of clear guidelines for such complex cerebrovascular events.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Cerebral infarction and arterial dissection pose significant management challenges.
- Fibromuscular dysplasia is an underlying condition associated with arterial dissections.
Observation:
- A 40-year-old male sustained a large right hemisphere infarction after a road traffic accident.
- Imaging revealed bilateral internal carotid artery dissection and fibromuscular dysplasia.
Findings:
- Anticoagulation with heparin was initiated to prevent further ischemic injury to the contralateral hemisphere.
- The case presents a dilemma due to the coexistence of extensive cerebral infarction and multiple arterial dissections.
Implications:
- This case underscores the need for clear management guidelines for patients with multiple cerebral arterial dissections and infarction.
- Further research is required to establish optimal treatment strategies for these complex cerebrovascular conditions.
Abstract:
A 40-year-old man presented with a major nondominant hemisphere stroke syndrome after a road traffic accident. Cranial computed tomography scan revealed an extensive right hemisphere infarction involving the entire anterior and middle cerebral artery territories. Duplex Doppler ultrasound and cerebral angiography revealed bilateral internal carotid artery dissection with evidence of underlying fibromuscular dysplasia. Anticoagulation with heparin was commenced despite the coexisting large cerebral infarction, with the objective of protecting the uninjured but at-risk left cerebral hemisphere from ischemic injury. Patients with multiple cerebral arterial dissections complicated by cerebral infarction present a significant management dilemma. Our literature review revealed a lack of clear management guidelines for such cases.