Abstract
Objective: We report a case of acute cerebral ischemia caused by spontaneous cervical internal carotid artery dissection (SCICAD) in a patient who underwent emergent stenting and whose outcome was good.
Case presentation: A 48-year-old man was admitted 105 minutes after the acute onset of right hemiplegia, aphasia, and right unilateral spatial neglect (USN) [all assessed as having a National Institute Health Stroke Scale (NIHSS) score of 21]. A CT scan showed a broad early ischemic change in the left middle cerebral artery (MCA) territory. Diffusion-weighted magnetic resonance (MR) imaging demonstrated small infarctions mainly in the superior trunk and lenticulostriate arteries of the left MCA. Perfusion-weighted MR imaging showed hypoperfusion in almost all the left MCA territory, indicating a large area of diffusion-perfusion mismatch. An angiogram showed long tapered severe stenosis in the left cervical internal carotid artery (ICA) with intimal flap and mild left MCA thromboembolic stenosis, resulting in profound flow restriction. Emergent stenting was successfully performed using two Carotid Wallstents within 5 hours after the onset. Flow in the distal ICA resumed and the left intracranial perfusion improved, paralleling a rapid clinical improvement. Mild motor aphasia remained, but the right hemiplegia and USN disappeared completely (NIHSS score 2).
Conclusion: SCICAD is not common in Japan, but it may be an important etiology of developing severe cerebral infarction. Emergent stent placement should be considered as a good option in the setting of acute stroke intervention for SCICAD. Cone-beam CT was useful for visualizing the true lumen.
