Spontaneous dissection of the cervical internal carotid artery: case report

Abstract

Objective: We report a case which conservative treatment was performed for spontaneous dissection of the cervical internal carotid artery (CICA) and the prognosis was good.

Case: A-37-year old male developed sensory disturbance of the left side and the weakness of left lower limb and came to us 3 day later. Brain magnetic resonance imaging on diffusion-weighted image showed acute ischemic lesions in the right frontal lobe, and magnetic resonance angiography (MRA) of the cervical lesion demonstrated the stenosis and intramural hematoma in the lower portion of right CICA. After hospitalization, we started conservative therapy, including received antiplatelet drug and blood pressure control. Six days later, cerebral angiography revealed irregularities and stenosis of the carotid wall, stasis of the contrast agent in the lower portion of right CICA. After that, the neurological deficit of the patient improved gradually, and the patient was discharged on Day 20. Three weeks later after discharge, MRA showed an almost normalized condition. Based on these observations, we had a diagnosis of spontaneous CICA dissection, and MRA demonstrated complete recovery of the carotid artery dissection on 180 day.

Conclusion: Compared with western countries, in Japan, spontaneous CICA dissection is rare. Spontaneous CICA dissection should be considered as a differential diagnosis of young stroke patients.